1. T

    Aetna Medicare: Zilretta Policy

    Hi all, I'm inquiring about the Aetna Medicare Zilretta Injection Policy. Does a patient have to wait 3 or 6 months between Zilretta (J3304) Injections? I cannot find that information anywhere! Thanks!
  2. S

    Coding Query Escalation P&P

    Would anyone happen to have a sample policy & procedure they could share related to Coding Query Escalation and/or Clinical Documentation Improvement Escalation? Thanks! Scott
  3. C

    Wiki Highmark BS and CPT 69210 denials

    Hello, We are being denied by Highmark BS for the procedure code 69210. The denials have been for claims with and without an office visit. The claims submitted with an office visit have been submitted with the appropriate modifier (25). We have not seen any rejections for cerumen removal...
  4. C

    Provider REFUSING to sign documents prior to billing

    I work for a small specialized practice. I have a doctor that refuses to sign her op notes prior to billing, if at all. I have provided references to e-signature requirements and am looking into HCA guidelines for Utah. I have asked for a signed letter stating that she accepts liability of...
  5. A

    Cpt 20610 - Is anyone having issues

    Is anyone having issues with getting paid for 20610 from United, Humana or Aetna?? Looks like they only have knee Dx codes listed on their policy, but not taking into consideration of the other major joints.
  6. D

    Cardiac Resynchronization Therapy for treatment of Heart Failure

    I am needing some help with Cardiology practice billing CPT 33249 and 33225 for POS 22 to Medicare Part B J5. The claims are being denied as not medically necessary, decision based on NCD policy online. The policy I found is 20.4 NCD for Implantable Automatic Defibrillators. This policy does not...
  7. M

    Wiki Corporate Membership

    I have a question for anyone using an AAPC Corporate Membership - As a certified coder I work in a billing office for a large multi-specialty practice - my job entails working with providers on their coding and billing (yes, our providers select and enter their own codes electronically) and also...
  8. C

    Ob Post-op/global Days

    Question on OB patient post-op visits. How many visits do you give to an OB patient after they have had the baby? There is no global days on deliveries. My ACOG book states that the normal is 1 free visit for a vaginal delivery and 2 free visits for a cesarean section. We have adopted a policy...