Sterilization or Hysterectomy Consents – Incomplete Forms Cause Anesthesia Denials

Published on July 3, 2018

Many Medicaid programs require a completed and signed consent form prior to sterilization or hysterectomy being performed.  It makes sense that the surgeon’s services would be denied without these, but did you know that anesthesia providers will also not be paid?

Consent forms must be filled out in full including the following information: patient’s signature and date, surgeon’s signature, date and NPI and the information of the person completing the form, if applicable.  These are the fields most often left blank.  Additionally, only the current consent form can be submitted.  Old or outdated forms are rejected as invalid.  Some state Medicaid agencies also have a specified time period prior to the proposed surgery which must be observed.  Check with local carriers for specific details.

This can potentially create a real problem for billing offices.  Because of the nature of anesthesia practice, anesthesia billing offices do not know who their patients are until after services have been furnished.  In the case of a consent form, the documentation must be completed prior to the surgery.  This is the surgeon’s responsibility, however they are not always completed properly beforehand.  By the time the anesthesia billing office receives an incomplete sterilization consent, it’s already too late to correct the documentation.  The only hope left at this point, is that there is a completed original on file with the facility or the surgeon’s office.

Reaching out to the surgeon’s office may help to resolve the issue.  Sometimes, simply educating the office staff of the necessity of properly completed forms, can improve documentation a great deal.  Creating a good rapport with the office manager or surgical coordinator is a good idea, particularly if the surgeon performs a large volume of these procedures.  These key personnel can often be of assistance.

If the above approach does not improve documentation, reaching out to the surgeon through the anesthesia providers may be a better option.  Most providers are willing to help if they understand that the lack of documentation is causing a loss of reimbursement, and compliance issues.

 

By: Heather E. Golfos, CPC, CANPC

Coding Department Manager