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Aetna 77003

nyyankees

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Has anyone had difficulty getting 77003 and of course 77002 paid with their injections? They keep bundling the fluoro and there is no policy on their website.
 

dwaldman

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Aetna has a way of coming up with some unique denials. I would have a standard way to appeal them Like a letter that addresses why the fluoro is not bundled. In the current issue of Coding Edge, in the article for transforaminal injections, the writer of the article, mentions the link/article from ASA the fact that fluoro is not bundled into certain injections.

http://www.asahq.org/news/031907Fluoroupdate.pdf

I think this is the link he mentions.

Another thing to look at is that you mentioned 77002. Nowadays, 77002 is bundled in a lot of codes such as many from this range 64400-64450, 64520, 64510. That might be something to look at.

For 77003, it should be separately reportable with 62273,62310,62311,64479-64484,64622,64623,64626,64627. And 27096 these are the codes that come to mind, where an appeal would be necessary if they want go the route they are when processing.
 
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