May 31st, 2018
Aetna, bruised by a PHI breach where letters detailing a lawsuit settlement were sent to HIV-positive members revealing their status, is now suing the plaintiffs in the original 2014 class action lawsuit  for $20 million, blaming a consumer advocacy group and law firm for their woes. Aetna demands $20 million and indemnification from any actions related to the breach. ...
In Billing
Feb 14th, 2018
The HCPCS Level II code G0475 HIV antigen/antibody, combination assay, screening is effective for dates of service on or after April 13, 2015, and is subject to Clinical Laboratory Improvement Amendments (CLIA) edits, despite its omission in previous transmittals from the Centers for Medicare & Medicaid Services (CMS). For Medicare reimbursement, G0475 requires a facility to have either a ...
Feb 13th, 2018
Here’s a stark reminder of the responsibilities  – and risks – of being a business associate: Aetna is suing the company that mailed 12,000 envelopes last summer revealing the recipients had HIV for $20 million and more. Aetna hired claims administrator Kurtzman Carson Consultants (KCC) to send letters notifying Aetna members of a settlement the ...
In Coding
Oct 18th, 2017
Obstetric panel code 80081 is identical to 80055, with one exception: 80081 includes HIV testing. Required components for both codes include: Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen ...
In Coding
Jun 19th, 2017
In the outpatient setting, do not code a diagnosis unless it is certain. Examples of language seen in the medical record that identify uncertain diagnoses include: Probable Suspected Questionable Rule out Differential Working When a definitive diagnosis has not been determined, code the signs, symptoms, and abnormal test result(s) or other reasons for the visit. ...