Wiki Antibiotic Beads!!! 11981 Help!!

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.
 
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.
 
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.
 
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