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Wiki E/M codes bundled to procedures

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mzavorski15

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14
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Crystal Lake, IL
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We are having issues with Aetna and UHC bundling e/m codes to procedures. Specifically they seem to bundle with 17000. We are using modifier 25 on E/M code and there are different diagnosis codes associated with both. I have reviewed Aetna policy and it does not show this as bundled. I am still searching for UHC policy. Is anyone else having this issue? We are appealing and supplying records but they are still being denied. Any ideas/help would be greatly appreciated.
 
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17000, 17003 or 17004 always go out with L57.0. The examples I am looking at have 99213 25 with D22.0 and L82.1, 99213 25 with D22.9 and L82.1 and 99212 25 with L81.4.
 
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dcollazo1 said:
What diagnosis are you billing with and in what order?
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17000 and 17003 or 17004 always go out with L57.0. The examples I am looking at have 99213 25 with D22.0 and L82.1, 99213 25 with D22.9 and L82.1 and 99212 25 with L81.4. They are all billed with E and M code first followed by procedures. Aetna has told me they are bundling the office visit with the procedure but cannot point me to policy. This is fairly new, as they were previously paying.
 
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