Musculoskeletal procedure authorizations: Reminders for facilities

This article provides a review of how to change the place of service from outpatient to inpatient for musculoskeletal surgical and related procedures that require authorization from TurningPoint Healthcare Solutions LLC.**

• Prior to inpatient admission: If TurningPoint approved an authorization with an outpatient place of service and you need to change it to inpatient prior to surgery, the ordering provider should contact TurningPoint to make the change. Call TurningPoint toll-free at 1-833-217-9670 or locally at 313-908-6040.
• After inpatient admission when the setting must be inpatient based on Centers for Medicare & Medicaid Services requirements: If TurningPoint approved an outpatient setting for a procedure that’s on the CMS list of inpatient-only procedures, call TurningPoint toll-free at 1-833-217-9670 or locally at 313-908-6040. TurningPoint will update the setting on the authorization.
• Due to a change in a member’s condition during outpatient stay: If a change in a member’s condition during their outpatient stay requires an extended stay, the facility should submit an inpatient request to Blue Cross Blue Shield of Michigan or Blue Care Network. To do this, submit procedure code *99222 as outlined in the e-referral User Guide; see the “Submitting an emergency or urgent admission (includes Blue Cross member submissions)” subsection within the “Submit an inpatient authorization” section for more information. The request must meet InterQual^® criteria.

Additional reminders

• When TurningPoint approves an authorization request from an ordering physician, the authorization covers both the procedure and the site of service. Facilities don’t need to submit a separate authorization request for an inpatient request if TurningPoint already approved an inpatient place of service.
• Musculoskeletal surgeries don’t require prior authorization from TurningPoint when they’re performed emergently during an inpatient admission that originated in the emergency department. For more information, see the “Do musculoskeletal procedures that are performed during an inpatient admission that originated in the emergency department require prior authorization from TurningPoint?” section in the document titled Musculoskeletal procedure authorizations: Frequently asked questions for providers.
• To update the date of service on a prior authorization, call TurningPoint.
• To update the procedure codes on an authorization after a musculoskeletal surgery has taken place, see the Postservice change request form.
• You can request additional days for an inpatient stay through the e-referral system. In the e-referral system, you’ll need to search for the member, not for the TurningPoint authorization number.

Additional information

TurningPoint Healthcare Solutions LLC is an independent company that manages authorizations for musculoskeletal surgical and related procedures for Blue Cross Blue Shield of Michigan and Blue Care Network. For more information, see the Musculoskeletal Services pages on our ereferrals.bcbsm.com website.

**See the document titled Musculoskeletal procedure codes that require authorization by TurningPoint to determine which codes require authorization. Only the codes on this list require prior authorization. Incidental codes don’t require prior authorization.