Wiki INCIDENTAL DENIALS

[kcowan]

THIS MAY BE A DUMB QUESTION BUT HERE IT GOES I HAVE BEEN GETTING DENIALS LATELY THAT ARE (N19) PROCEDURE CODE INCIDENTAL TO PRIMARY PROCEDURE. AETNA MEDICARE INSURANCE, THIS CLAIM IN PARTICULAR IS A E/M WITH MODIFIER 25, WITH 69210 OVER HAS BEEN PAID BUT NOT THE 69210, FOR ME TO APPEAL THIS WOULD BE DIFFERENT KIND OF APPEAL THEN A BUNDLED DENIAL? I HOPE SOMEBODY UNDERSTANDS WHAT I AM TRYING TO SAY. LOL

 

[lgardner]

Was the E/M "significant and separately identifiable" from the cerumen removal?

I think what the denial is saying, is that an E/M would be included in the cerumen removal, unless there was sufficient documentation to support an E/M on top of the procedure.

 

[kcowan]

THIS MAY BE A DUMB QUESTION BUT HERE IT GOES I HAVE BEEN GETTING DENIALS LATELY THAT ARE (N19) PROCEDURE CODE INCIDENTAL TO PRIMARY PROCEDURE. AETNA MEDICARE INSURANCE, THIS CLAIM IN PARTICULAR IS A E/M WITH MODIFIER 25, WITH 69210 OVER HAS BEEN PAID BUT NOT THE 69210, FOR ME TO APPEAL THIS WOULD BE DIFFERENT KIND OF APPEAL THEN A BUNDLED DENIAL? I HOPE SOMEBODY UNDERSTANDS WHAT I AM TRYING TO SAY. LOL

HAVE YOU HAD ANY LUCK IN THESE DENIALS, I AM GETTING THEM ALSO......

 

[CBLENNIE]

If you search the forums for Aetna and 69210 you'll find multiple threads reporting issues with Aetna denying 69210 with an E&M billed with modifer 25. This seems to be some type of policy Aetna has instituted in the last year or so. I don't think that anything has changed and Aetna is still denying the 69210 billed with an E&M with modifier 25. This thread is specifically about Aetna, Aetna denials on wax removal and thread 69210 all of sudden being denied as global mentions Aetna in addition to Cigna denying these services.

You might want to follow up with those who posted to these threads to see if the denials from Aetna are ongoing or if they are receiving reimbursement and if so, what changed so that they are now receiving reimbursement.