Wiki Aetna Ablation Experimental

[cortneyfigurell]

Has anyone had any issues billing ablations to Aetna and getting the denial for experimental?

We seem to continue to get denials and we follow their very strict guidelines for everything that has to be done prior to doing an ablation but still having tons of issues. Any tips on how to resolve this?


Thanks!

 

[csperoni]

I'll assume you mean endometrial ablations since the post was in the ob/gyn forum. We don't see a lot of Aetna in our office, and don't do a lot of ablations, but don't recall seeing any denials.

Aetna has a clinical policy specifically addressing this issue. They require a fairly long list before believing the ablation is medically necessary. Here's a link to their policy: http://www.aetna.com/cpb/medical/data/1_99/0091.html.

Hope this helps.

 

[meghanhannus]

Has anyone had any issues billing ablations to Aetna and getting the denial for experimental?

We seem to continue to get denials and we follow their very strict guidelines for everything that has to be done prior to doing an ablation but still having tons of issues. Any tips on how to resolve this?


Thanks!

Hello,

Back when I was working for an OBGYN Centralized Billing office I remember Aetna would deny endometrial ablations if an endometrial biopsy was not performed within a certain time frame. I see that this is still one of their requirements before the ablation.

M.Hannus, CPC, CPMA, CRC