Denials from Aetna for L2795

Biller2023

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When I code both L1810 or L1812 + L2795 and bill to Aetna they pay for L1810/L1812 and deny L2795 stating
The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.​
Denial also has the adjustment reason code MA66 which means Missing/incomplete/invalid principal procedure code
What should we do in this case. Is there a code that we should use as a replacement or add another code to get paid for L2795 also? Thanks!
 
When I code both L1810 or L1812 + L2795 and bill to Aetna they pay for L1810/L1812 and deny L2795 stating
The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.​
Denial also has the adjustment reason code MA66 which means Missing/incomplete/invalid principal procedure code
What should we do in this case. Is there a code that we should use as a replacement or add another code to get paid for L2795 also? Thanks!
Can someone please respond to this?
 
When I code both L1810 or L1812 + L2795 and bill to Aetna they pay for L1810/L1812 and deny L2795 stating
The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.​
Denial also has the adjustment reason code MA66 which means Missing/incomplete/invalid principal procedure code
What should we do in this case. Is there a code that we should use as a replacement or add another code to get paid for L2795 also? Thanks!


Aetna has a Clinical Policy Bulletin for Orthopedic Casts, Braces and Splints, which includes a chart showing which base codes are eligible for add on reimbursement.

According to this Aetna document, L2795 could potentially be reimbursed with L1832, L1833, L1845, and L1852.

L1810 and L1812 have no additional codes that could give additional reimbursement.

The full Aetna bulletin for Orthopedic Casts, Braces and Splints can be found at this link:

 
I should add that I'm not an orthopedic coder, so I can't offer advice on choosing the correct code(s).

I'm just sharing the link to the applicable Aetna Clinical Policy Bulletin, so you can use it for reference.
 
THE PLACE -OF -SERVICE CODES IS (81, INDEPENDENT LABORATORY), CAN BILL THE CPT CODE P9603 TO MEDICARE?
 
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