Question Antibiotic Beads!!! 11981 Help!!

along06

Contributor
Messages
12
Best answers
0
Does anybody have any ideas on how to get these paid? I have an Aetna claim being denied. thanks
 

thomas7331

True Blue
Messages
2,255
Best answers
5
Denials can be for many different reasons - reimbursement policy, patient benefits, payer processor error, etc. - if you could share the reason that Aetna denied the claim, we'd be more likely to be able to help.
 

along06

Contributor
Messages
12
Best answers
0
Aetna denial states that 11981 is denying due to benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. We charged 27030 (I&D) and Aetna is saying 11981 is included in that procedure.
 

thomas7331

True Blue
Messages
2,255
Best answers
5
11981 does not bundle to 27030 per NCCI, but Aetna may have its own bundling policies (or it could just be a processing error). If you have documentation to support that the services billed with 11981 were unrelated to the I&D and that would support using a modifier to unbundle this, you can submit a correct claim, or else send an appeal or otherwise challenge this denial if you think it is in error.
 
Top