Wiki Urgent !!!!!!!!!!!!!!!!!Please help!!!!!AETNA reimbursement policy for Pulse oximetry

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NishaJ

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Hi ......

Anyone know the reimbursement policy for Aetna on Pulse oximetry...
Aetna denied Px 94760 as bundling with E&m. Anybody received the payment for this Pulse oiximetry. Do we have supportive documentation in Aetna website....

If anyone came across this type of denial, please share with me.
Thanks in advance....
 
The code is RBRVS status T which means it bundles for professional when performed on the same DOS with another service. Its only reimbursable in the professional setting if its the sole service provided. Pulse ox treated the same as height, weight, BP and Temp, its bundled into the E&M and not separately reimbursable. There isn't much effort that goes into this (less than taking a BP) which is why its bundled. Pretty much any carrier that reimburses under Medicare & RBRVS follow this.
 
Aetna Reimbursement Policies

NishaJ,

Not sure if you received your answer. I just wanted to share there is a "Coding Edit Tool" for Aetna through Navinet. You can plug in all codes, modifiers and Dx Codes billed for that day to see Aetna's coding edit policies with rationale on why it is not covered. You would: log on to Navinet> Aetna > Claims tab > Code Editing > McKesson Clear Claim Connection > plug in your info and go from there.

Hope this was informative.
 
JHenson1 said:
NishaJ,

Not sure if you received your answer. I just wanted to share there is a "Coding Edit Tool" for Aetna through Navinet. You can plug in all codes, modifiers and Dx Codes billed for that day to see Aetna's coding edit policies with rationale on why it is not covered. You would: log on to Navinet> Aetna > Claims tab > Code Editing > McKesson Clear Claim Connection > plug in your info and go from there.

Hope this was informative.
Click to expand...


JHenson 1 , thanks for your valuable input. Surely I will check in Navinet...
I have found this below lines in Navinet log in..I could not find any other info ...

Decision: Allow pulse oximetry codes when billed with any lab or radiology procedure

Generic ClaimCheck denies pulse oximetry codes when billed with lab or radiology

procedures

https://www.aetna.com/pws/searchResult.do?searchResultBox=yes

Please can you help me to get the exact documentation...
 
Last edited:
CodingKing said:
The code is RBRVS status T which means it bundles for professional when performed on the same DOS with another service. Its only reimbursable in the professional setting if its the sole service provided. Pulse ox treated the same as height, weight, BP and Temp, its bundled into the E&M and not separately reimbursable. There isn't much effort that goes into this (less than taking a BP) which is why its bundled. Pretty much any carrier that reimburses under Medicare & RBRVS follow this.
Click to expand...



Thank you @ coding king, in most cases, we have received denial, as you said like ..
 
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