Here are the top conversations from last quarter in the List Serv.  You can read the full threads by visiting:

Member’s Home Page → My Profile → My Features → E-Lists → NERVES Listserv.

1. Aetna Downcoding Inpatient Admissions.
A great discussion unfolded around the growing trend of Aetna downcoding inpatient admissions to observation status. Several practices reported similar experiences, reinforcing the need for careful monitoring of claim outcomes and strong documentation of inpatient necessity.

2. Request for De-Identified MIPS Cost Measure Data
Rebecca Ruegg-Cowan, the AANS/CNS Washington Committee NERVES Liaison, requested participation from practices willing to share de-identified MIPS Cost Measure reports.
This information will support AANS and CNS—working in collaboration with the AMA—in investigating a potential issue that may be resulting in unfair penalties for some physicians.
They are seeking submissions from a diverse range of practice types to strengthen advocacy efforts on behalf of neurosurgery and ensure that MIPS scoring remains fair and accurate.

3. Do your Surgeons Choose CPT Codes for Pre-Auths?
This popular thread examined whether surgeons should select their own CPT codes for prior authorizations.  A variety of topics were mentioned, including:

• Surgeons choosing their own codes.  They are sent to the AANS/KZA coding seminars, sometimes with their coders.  Some  have built “quickTexts” or “dotphrases” that when the provider selects, will populate the codes for that surgery. 
• Using AI tools, including ChatGPT which was reported as highly accurate but some stated the results differed from a   coder’s interpretation.    Doximity’s AI tool was also mentioned as another reliable option.  
• For EPIC users: leveraging the Electronic Prior Authorization (ePA) feature, which helps surgeons save time filling in electronic prior authorizations by using Epic’s recommended answers to prior auth questions based on data in the chart. 

With Medicare’s prior authorization requirement for cervical fusion procedures, some practices reported increases in denials citing lack of medical necessity or lack of authorizations—especially in instances where facility did not complete the authorization.  This thread emphasized the need for clear communication between practices and facilities, validation of authorization status prior to surgery, and consistent documentation to support medical necessity.