Recent content by coop22

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    Question 99221-99223 denials

    Our office is also getting these. We are a cardiac surgeons office and a lot of our patients are TAVR's and are required to have a cardiologist and a cardiac surgeon sometimes this happens on the same day. Whomever gets the claim out first they pay. This just started happening
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    Question MODIFIER HELP!! 24 AND 25

    We do this with LVAD interrogation codes and e&m. Medicare pays we never have an issue.
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    Question Horizon denying E&M for valid Dx codes

    We have gotten some on surgeries. AVR 33405 with Aortic stenosis I35.0. Incorrect DX code. NO payment. Will bill hundreds of cases a year with that and to them. This was a first!
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    Aetna E&M Policy

    No we are a small office. Only 8 physicians on 1 tax ID. They are denying off physicians our office has nothing to do with. We are cardiac surgeons. The denials keep coming! It just started about 3 months ago.
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    Aetna E&M Policy

    There is a long article in Provider Communications 2018 No Policy # But in Claim Payment and Coding Policies it's listed unter Evaluation and Management E&M Services Payment Policy
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    Aetna E&M Policy

    Yes we have and they state it is their policy no matter whom bills the code that they will only pay ONE per day! How are we supposed to know that and if our billing is behind theirs we lose the money! Its been happening for a couple months now. On ALL Aetna plans
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    Aetna E&M Policy

    Message 005 "We were previously billed by and paid another provider for this service" D40
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    Aetna E&M Policy

    No we are a cardiac surgeons office. We are being denied off other offices under diff NPI's and Diff specialties. To us these are NEW patients. Their new policy states FOR ALL PLANS "We allow 1 of this group of codes per patient per day across all providers based on CMS guidelines." CPT codes...
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    Aetna E&M Policy

    Our office started to get denials for E&M stating this was partially or fully furnished by another provider. This is for a NEW PATIENT! 99204 Their new policy states FOR ALL PLANS "We allow 1 of this group of codes per patient per day across all providers based on CMS guidelines." CPT codes...
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    Medicare Denial: MA130-CLM IS UNPROCSSBLE, SBMT NEW CLM/

    I would look into Modifier XS or 59. And don't forget 51 for multiple procedures.
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    Little Frustrated

    I would just like to voice opinion if anyone at AAPC is listening. Member ship fees bit pricey. And last year when renewing my membership I was offered 12 months of webinars for $150 this year it went up to $215. And the CEU's went from 2 per webinar down to 1. Just wanted to put that out there.
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    TAVR denials

    No they do not. We use I35.0 and Z95.2
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    CAD with other angina

    I25.118 CAD with Exertional Angina 125.119 CAD with Stable Angina I25.110 CAD with Unstable Angina I25.10 CAD without Angina I tend to agree with the coder. Our Physicians are not always that specific but it helps us get to a better DX for the patient when they are.
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