WISER denials

[jsaul]

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Thanks....my authorizations person was putting something in the claims that was getting it rejected. Biller figured it out. Whew......

Easy fix.

What were they putting in the claims that was getting it rejected

 

[mille125]

Glad that worked out. The checks haven’t cleared but my biller says they are listed in the portal as paid

It takes you that long to get paid?

Medicare is paying us for 7/13-7/14 claims as of Friday

 

[paindoc007]

I’ve had a boatload of denial recently as the patient is not currently in therapy, despite documenting active participation in home exercise. Is there a template/blurb I can write that bypasses the AI engine that you guys have found yet??

 

[Agast]

Patient has done physical therapy type exercises at home under physician direction

 

[mille125]

Patient has done physical therapy type exercises at home under physician direction

That is what I say too

 

[giddyup]

Must be nice! I keep getting denials and don’t have gold status. They’re denying me for semantics.

Can you guys share your wiser dot phrases (those in gold status)- or tips. Please PM if you feel uncomfortable for forum

The patient was examined and evaluated and has symptoms consistent with the diagnosis of radiculopathy. To address the changes on the imaging studies that correlate with the history and examination, I have recommended an epidural steroid injection. Questions were answered and I reviewed some of the possible complications such as infection, bleeding, nerve damage, paralysis, inflammation, medication allergy, cerebrospinal fluid leak and spinal fluid headache. Alternative treatment options were briefly reviewed. The patient voiced an understanding and wished to proceed. For precise localization, fluoroscopic guidance will be used for this procedure.

The pain is radicular in nature

Other causes like intraspinal tumor or other space-occupying lesion have been ruled out as the cause of pain

Imaging of affected area has been performed.

Nerve root impingement/compression has been confirmed by imaging and/or testing.

The patient has failed to improve with conservative treatment after 4 weeks of conservative therapy.

Non invasive measures such as physical therapy and non narcotic analgesics and activity modification have failed or are contraindicated.

Pain has ranged from 3-7 on the VAS scale and interferes with ADLs and is severe enough to greatly impact quality of life and function

The injection is being provided as a part of a comprehensive pain management program

The patient has a home exercise program and stretches and continues to attempt do so on a regular basis within the last 6 weeks

The patient is experiencing pain in a dermatomal distribution

The pain is severe enough to greatly impact quality of life or function

The anticipated number of ESI sessions will be four or less per year per spinal region in a rolling 12 month period

Fluoroscopy will be used for needle guidance

The ESI will be performed in conjunction with the following conservative treatments,
including but not limited to a combination of:
a) Medication
b) Physical Therapy
c) Spinal manipulation therapy
d) Cognitive behavioral therapy
e) Home exercise program

The patient is part of an active rehabilitation program, home exercise
program, or functional restoration program