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Wiki Aetna- facet inj

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mattrobin

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Has anyone else had issues with Aetna denying cervical and/or lumbar facet joint injections as "experimental/ not medically necessary"? I have reviewed their medical policy, and we are within the parameters. However, EVERYONE we bill lately is denied as "experimental"... any ideas/ thoughts/ suggestions?? thanks.
 
mattrobin said:
Has anyone else had issues with Aetna denying cervical and/or lumbar facet joint injections as "experimental/ not medically necessary"? I have reviewed their medical policy, and we are within the parameters. However, EVERYONE we bill lately is denied as "experimental"... any ideas/ thoughts/ suggestions?? thanks.
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You read this policy, right? http://www.aetna.com/cpb/medical/data/1_99/0016.html

Make sure you're billing out the correct primary diagnosis code, and if you are, appeal with documentation showing how you met their requirements. You'll have to go back 3 months to show the failed conservative Tx, which may mean getting records from a referring physician, if necessary.
 
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