Reimbursement and Coding

Coding Guides and Resources

LAAC and PFO Prior Authorization and Appeal Toolkit

Abbott offers this Prior Authorization and appeal Tool Kit for use by physicians and their offices when seeking prior authorization or appealing denials of coverage. This comprehensive tool kit includes information to assist your office in submitting coverage requests for patients who may benefit from a LAA or PFO closure procedure. Download the guides and the accompanying templates using the links below.

  • Download this guide for submitting prior authorization requests for your patients. It includes instructions on how to use this tool kit and the associated forms.

  • Download a sample letter template that provides suggestions to assist in writing a Letter of Appeal of a denial of coverage for LAAC device implant procedures. Physicians should customize the letter based on the patient's actual medical history and diagnosis, and to be consistent with any specific appeal requirements.

  • Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for LAAC device implant. Physicians should customize the letter based on the patient's actual medical history and diagnosis and to be consistent with any specific prior authorization requirements.

  • Checklist provided as a summary of the information used to process Prior Authorization Requests for Left Atrial Appendage Closure (LAAC) Intervention procedures.

  • Download this checklist for submitting prior authorization requests for your patient. The checklist includes a list of assessments recommended in the latest professional society guidelines for diagnosing a cryptogenic ischemic stroke.

  • Download a sample letter template that provides suggestions to assist in writing a Letter of Medical Necessity or prior authorization request for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific prior authorization requirements.

  • Download a sample letter template that provides suggestions to assist in writing a Letter of Appeal of a denial of coverage for PFO closure procedures. Physicians should customize the letter based on the patient’s actual medical history and diagnosis, and to be consistent with any specific appeal requirements.

*This Tool kit provides suggested instruction and summary of guidelines for facilitating prior authorization or appeal requirements. It is not an endorsed resource of any benefit provider as providers are highly encouraged to review each benefit provider's policy and requirements for prior authorization and medical guidelines.

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HE&R Disclaimer

This material and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal, reimbursement, business, clinical, or other advice. Furthermore, it is not intended to and does not constitute a representation or guarantee of reimbursement, payment, or charge, or that reimbursement or other payment will be received. It is not intended to increase or maximize payment by any payer. Abbott makes no express or implied warranty or guarantee that the list of codes and narratives in this document is complete or error-free. Similarly, nothing in this document should be viewed as instructions for selecting any particular code, and Abbott does not advocate or warrant the appropriateness of the use of any particular code. The ultimate responsibility for coding and obtaining payment/reimbursement remains with the customer. This includes the responsibility for accuracy and veracity of all coding and claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently and is subject to change without notice. The customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial, coding, or reimbursement specialist for any questions related to coding, billing, reimbursement, or any related issues. This material reproduces information for reference purposes only. It is not provided or authorized for marketing use.

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