How to handle a denial by an Insurance carrier for Intraoperative Neuromonitoring services?
Once a denial is received, the first step should be to review the policy or LCD(Local Coverage Determination) by the carrier regarding the services in question to determine if the claim has
been denied correctly or not. Once that is determined, the next step is to write an effective appeal letter clearly stating the medical necessity for that procedure. Include a copy of the Op Report, Copy of IONM interpretation report and a copy of the LCD/Policy from the insurance carrier highlighting the areas that justify and support your appeal.
If after reviewing the LCD, it is determined that the claim has been denied correctly for not medically necessary reasons, make sure that the ICD-9 codes listed on the claim are definitive and not general. It is also very important to use the appropriate modifiers to capture the complete payment on the code.