Wiki aetna denials on wax removal

I know that some insurances do NOT want laterality modifiers on the 69210.

was the office visit separate for the cerumen removal?

what was the denial reason?
 
Hi
anyone having an issue with Aetna denying 69210 with an office visit? for the last few months they have been denying every claim
My office is having the same issue, have you been able to resolve this or find out what is going on? We have reviewed our notes and 69210 is definitely separately identifiable from the E/M. It is also weird because, most insurances will deny the E/M and not 69210.
 
Same with our practice for Aetna commercial as well as Aetna Medicare. Our physicians want each denial appealed, no payer response yet. Is this occurring with Florida practices only? Any practices in other states, please comment on your Aetna denials experience. Thank you.
 
this is crazy, we are ENT docs and this is causing our office so much extra work, and they are still denying most of them, even if pt came in for an unrelated issue
 
Same for the practice I work for in GA. Sometimes it gets denied but then will go through after appending the 59-mod to it. If the corrected claim gets denied, then I submit an appeal with medical records; but lately even with the appeal it's been getting denied. It's a hit or miss. If all else fails, I call Aetna directly and have them send it back to be reviewed.
 
It's happening in New Jersey and I am finding the issue is related to HMOs. I am still getting paid for 69210 with an E&M for unrelated issues, when the plan is a PPO. If it's bundled, then I will bill by time spent and charge a 99214 for the E&M visit. That seems like a solution, but it's very maddening that they sell Medicare replacements, Joe Namath insists that the plans cover what Medicare covers and we all know that's not true.
 
So this thread is a little old, but I won't code a 69210 anymore UNLESS documentation states something along the lines of "cerumen cleared" "no longer impacted" etc. etc. Seems to do the trick. Simply having the details of the removal on the chart won't get it done anymore. Just have your providers include that last little bit, it should push your claim through. For now anyway
 
So this thread is a little old, but I won't code a 69210 anymore UNLESS documentation states something along the lines of "cerumen cleared" "no longer impacted" etc. etc. Seems to do the trick. Simply having the details of the removal on the chart won't get it done anymore. Just have your providers include that last little bit, it should push your claim through. For now anyway
THAT IS REALLY WORKING?
 
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