Wiki Denial for bundling 76942

[btauzin]

I'm billing for trigger point injections with a nerve block all by ultrasound guidance; ins is Aetna; they denied 76942 as experimental and bundled all of the other codes with it which resulted in denial. My billing looks like this:

99214 - 25
64550
20553 - 59
20552 - 59
20551 - 59
76942

Any recommendations?????????

 

[thomas7331]

Yes, contact Aetna and ask them to explain themselves. They've obviously made an error. My guess it the denial codes are switched and that the rest of the claim has been denied as experimental. You may be able to shed some light on this by reviewing their policies on line.

 

[littlelora]

I usually have to add -59 on the ultrasound code when billing also, but, if it is being denied as "experimental" that may just be the payers policy, or could be specific to the patients plan. Have you checked with them to see about this first?

 

[CodingKing]

if its for back pain, Aetna considers the whole procedure experimental and investigational if it was done with ultrasonic guidance.

http://www.aetna.com/cpb/medical/data/1_99/0016.html