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Aetna denying the New E/M 2023 changes CPT and POS

M

midnight1995

Networker
Messages
78
Location
Chapachet, RI
Hi everyone

I am trying to find out if anyone else is having the same issue regarding Aetna (all Plans) denying the New E/M changes:
 
From my understanding only the admitting MD for observation can bill the inital observation & subsequent codes. All other providers have to use the NEW/EST codes.

This is from Chapter 12 30.6.8 of CMS manual - Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes.

For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial and subsequent observation care codes. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.
 
For Assisted Living Patients for Professional Providers are to bill the Home Visit Codes. They removed LOS 3. You are to utilize the correct POS. I bill for Assisted Living so I bill for example: 99344 as POS 13. I have appealed with Humana, UHC, Aetna... they are all paying now.
 
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