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I am in a weird situation right now, scheduled for pre-op clearance with my cardiologist next week Aug 6. I need to do it way in advance ( but in range of less then 30 days before surgery) because I will be out of Country On European vacation with y wife celebrating our 30th wedding anniversary.
My surgery is scheduled for September 5.
Doctors office needs clearance for surgery at least 2 weeks prior to scheduled date. At that time, I will still be out of Country.
Yesterday, I called insurance verification department at my doctors office and was told: They won’t know if it is approved or not until about 2 weeks prior to surgery.
We are coming back from vacation on August 27th which is only 8 days before surgery ( if it is approved).
I told verification people about me being on vacation. Also told Hospital admission office.
Rescheduling is always an option but I prefer to stay on current date.
Weird, isn’t it.
MK

MK1965 wrote:I am in a weird situation right now, scheduled for pre-op clearance with my cardiologist next week Aug 6. I need to do it way in advance ( but in range of less then 30 days before surgery) because I will be out of Country On European vacation with y wife celebrating our 30th wedding anniversary.
My surgery is scheduled for September 5.
Doctors office needs clearance for surgery at least 2 weeks prior to scheduled date. At that time, I will still be out of Country.
Yesterday, I called insurance verification department at my doctors office and was told: They won’t know if it is approved or not until about 2 weeks prior to surgery.
We are coming back from vacation on August 27th which is only 8 days before surgery ( if it is approved).
I told verification people about me being on vacation. Also told Hospital admission office.
Rescheduling is always an option but I prefer to stay on current date.
Weird, isn’t it.
MK

I would move ahead just like you would if you already had insurance clearance IF others with the same insurance company have been approved. Good luck.

Larry

I asked my insurance company if they covered the medical code for my surgery “CPT 54405” and was told if the doctor requests and checks all the conditions it would be approved. My Surgeon provided all the information up front but I didn’t get final confirmation it was approved until the Friday prior to my Monday Surgery.

It is my understanding if the procedure is covered under your insurance it is up to your doctor to make the case that this is the next step and it will be approved. In my case that required a history of pills, VED/rings, injections, and finally an ultrasound that showed the VL. My doctor said he has had some insurance companies come back and recommend injections if they were not tried as part of the progression of treatment

Good Luck.

Had my pre-op 7 days prior to surgery at my family dr office. Told the girls in the office to get the results to the URO fast. Implant surgeon got the results the next morning.

David,
Doctors office gave me same CPT code you mentioned 54405 and an ICD10 code N52.31 which means - Erectile Dysfunction After Radical Prostatectomy.
So, who knows? Everything depends on insurance people.

MK

All...great discussion to have in advance of procedure day. I had been very concerned about a similar insurance coverage issue: whether or not Medicare covered the anesthesia/ anesthesiologist portion of the surgery. I just spoke to the patient accounting office at the surgical center where my urologist will perform my implant on 11/1. CPT 54405 covers the procedure and CPT 0054405 covers the anesthesia. Their facility does NOT outsource the anesthesia portion of the procedure as might other medical facilities. The anesthesiologist is part of Virginia Urology so the cost is covered under the procedure code. The surgical center must still confirm a pre-approval from Medicare for the procedure prior to 11/1 and, when I asked specifically, will contact me with any changes in policy that Medicare or Tricare for Life has made prior to my procedure. "So many insurance and medical plans...so little detail unless we look closely."
Edd