|by Cheryl Nash|
|It has come to our attention that Anthem is initiating pre-payment reviews for frequently billed Varicose Vein CPT codes including 36470 and 36471 along with ablative codes 36465-36479. A conversation with a reviewer revealed this is in their nationwide markets and many providers may be affected.
It was advised that the review can last from three to twelve months, with the full year being common.
Some suggestions for addressing this operationally would be to inform your biller that for each claim encompassing one of the targeted codes a copy should be printed in a paper HCFA format and mailed in with the necessary documentation. We do recommend continuing to send the claim electronically as well to retain proof of timely filing.
A copy of the needed records should be attached to the paper claim and mailed to Anthem. Best practice would be to send records at least weekly if not more often dependent upon volume. Be sure to include all records that support both the medical necessity of services and in support of CPT code choices. Any errors should be formally corrected prior to submission.
Anthem has made it clear that they are performing this review to mitigate the instances of inappropriate billing and care of their members. Unfortunately it only takes a couple bad apples to spoil a bunch and payers are unable to tell the difference without increased scrutiny.