April 25, 2019
We are receiving denials for 31237, performed right after endoscopic sinus surgery, stating we did not get prior approval and there was no documentation stating the need for the debridement in my office notes. Have you heard of this?
Yes. Some payors require precertification for this surgical procedure even when performed in the office. We have always recommended checking to see if this procedure requires precertification and obtaining it at the time you obtain precertification for the surgery.
*This response is based on the best information available as of 4/25/19.