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Denials

  1. Default Denials
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    Hello everyone,
    I have a question for all of you, How can I get a list from each insurance company to see what they consider included in fracture care, global (surgery) and what injections? I have googled my heart out and I cant find anything. Some insurance companies are saying that the office visits are included in a injection, that office visits are included with the xray. Aenta will not cover the xray at our office for some patients and others they do. Thats just one example.
    Thank you

    Krystal Prass
    Krystal Prass, CPC-A

  2. #2
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    Quote Originally Posted by krystalcamren@yahoo.com View Post
    Hello everyone,
    I have a question for all of you, How can I get a list from each insurance company to see what they consider included in fracture care, global (surgery) and what injections? I have googled my heart out and I cant find anything. Some insurance companies are saying that the office visits are included in a injection, that office visits are included with the xray. Aenta will not cover the xray at our office for some patients and others they do. Thats just one example.
    Thank you

    Krystal Prass
    Many insurance companies, Aetna is one of them, now have on their websites an area where you can go in and input the codes you are planning to bill. It will show you what will be allowed on those codes. You would be hard pressed to get a list from each insurance on their edits for every type of procedure. You can always check the CCI edits as that is one tool many insurances use to establish their edits. As you discover specific edits within an insurance company, you can begin to make up your own list.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Quote Originally Posted by krystalcamren@yahoo.com View Post
    Hello everyone,
    I have a question for all of you, How can I get a list from each insurance company to see what they consider included in fracture care, global (surgery) and what injections? I have googled my heart out and I cant find anything. Some insurance companies are saying that the office visits are included in a injection, that office visits are included with the xray. Aenta will not cover the xray at our office for some patients and others they do. Thats just one example.
    Thank you

    Krystal Prass

    Hi Krystal,

    Are you putting a 25 modifier on the office visits for the injections? Almost all injections will have to have a 25 on the office visit.

    Thanks,
    Sincerely,

    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

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