Wiki Dx code M23.232

[sandraclark5123@gmail.com]

We billed CPT 29881 and used dx code M23.232. Patient has commercial Aetna and they have denied our claim as the diagnosis is experimental. In my research this dx code is reimbursable. Is there another dx that should be used or anyone have any luck getting their claim to pay?

 

[Orthocoderpgu]

You are correct...M23.232 supports 29881. The issue is that you are dealing with AETNA. You will find that when you bill this and similar codes to other insurance companies there won't be an issue getting paid. The issue is not your coding.

 

[sls314]

We billed CPT 29881 and used dx code M23.232. Patient has commercial Aetna and they have denied our claim as the diagnosis is experimental. In my research this dx code is reimbursable. Is there another dx that should be used or anyone have any luck getting their claim to pay?

Here's a link to the applicable Aetna Clinical Policy Bulletin: https://www.aetna.com/cpb/medical/data/600_699/0673.html

For 29881, the policy does specifically exclude M23.200 - M23.269 Derangement of meniscus due to old tear or injury.

The only covered diagnosis codes listed for 29881 are S83.200A - S83.289S Tear of meniscus, current injury.

Aetna does maintain a fairly comprehensive list of their clinical policies on the website. It can be a helpful resource when trying to resolve issues with Aetna. (Not saying that I agree with all of the policies, of course, but at least it is out there as a reference to know what you're up against!)

Hope this helps.

 

[sandraclark5123@gmail.com]

Here's a link to the applicable Aetna Clinical Policy Bulletin: https://www.aetna.com/cpb/medical/data/600_699/0673.html

For 29881, the policy does specifically exclude M23.200 - M23.269 Derangement of meniscus due to old tear or injury.

The only covered diagnosis codes listed for 29881 are S83.200A - S83.289S Tear of meniscus, current injury.

Aetna does maintain a fairly comprehensive list of their clinical policies on the website. It can be a helpful resource when trying to resolve issues with Aetna. (Not saying that I agree with all of the policies, of course, but at least it is out there as a reference to know what you're up against!)

Hope this helps.

Thanks. This helps tremendously.