Holy Rosita
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Aetna breast cancer patient had delayed reconstruction so the doctor inserted bilateral implants. I coded 19342 with modifier 50 and aetna only paid for one side, do i need to bill with rt and lt modifiers to receive proper reimbursement? We billed 99215 and G2212 (Prolonged out patient office visit) to Aetna (since provider spent more than 55 minutes) but they paid for 99215 and denied G2212 stating «This claim is being denied for one of two reasons: – We did not receive a claim for the primary service performed. Add-on codes… Now, I couldn’t find Aetna’s E/M policy, but I would be very surprised if they decided to deviate too much on that sense. Possible reasons for the denial: -The patient was seen by the same provider at a previous practice, within 3 years -The patient was seen by a similar credentialed provider from the same practice (fairly common denial reason) Hello! Aetna has been denying our telehealth visits billed with modifier 93 when the video connection fails and the visit is completed as audio-only. (99214-93) I called and spoke with a representative who confirmed that Aetna is no longer accepting modifier 93. He advised us to use modifier 95… The Current Procedural Terminology (CPT ®) code 29881 as maintained by American Medical Association, is a medical procedural code under the range – Endoscopy/Arthroscopy Procedures on the Musculoskeletal System. The Current Procedural Terminology (CPT ®) code 97164 as maintained by American Medical Association, is a medical procedural code under the range – Physical Therapy Evaluations. The Current Procedural Terminology (CPT ®) code 76820 as maintained by American Medical Association, is a medical procedural code under the range – Diagnostic Ultrasound Procedures of the Pelvis Obstetrical. I was also researching as the big commercial insurances have and or are in the process of adding policies specific to G2211 – Here is what I located from Aetna- Hope this helps HCPCS Code for Slings A4565 HCPCS code A4565 for Slings as maintained by CMS falls under Various Medical Supplies Including Tapes and Surgical Dressings . The Current Procedural Terminology (CPT ®) code 43246 as maintained by American Medical Association, is a medical procedural code under the range – Esophagogastroduodenoscopy Procedures.
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