decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 7 (July)
Aetna pays for E/Ms with injections, other procedures
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Article Overview
This article explains an Aetna reimbursement policy update relevant to physicians, coders, and billing staff. It focuses on which categories of minor procedures and related services may be reprocessed when billed with evaluation and management services, the retroactive time frame, temporary claims-processing issues, and the role of modifier use during the transition period. The discussion is especially relevant to practices that bill office-based procedures and preventive services.
Why This Topic Matters
It helps readers understand a payer-specific payment policy change that can affect claim denial patterns, retroactive reimbursement, and workflow for offices that bill both evaluation and management services and minor procedures.
Article Sections
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Retroactive policy update and claim reprocessing
Overview of the payer announcement, the retroactive date range, and the general approach to revisiting previously denied claims.
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Temporary claims-processing guidance
Discussion of the interim handling of claims while system updates are underway and how providers are instructed to respond to automated notices.
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Billing combinations and modifier use
General guidance on the types of code combinations addressed by the policy and the transition guidance related to modifier use.
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Exceptions and related payment considerations
Broader discussion of additional policies that may still affect payment, including considerations tied to lab-related services and related workflow cautions.
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Urology-related codes Aetna will reprocess if billed since July 2004 with an E/M and modifier -25
A payer-specific list of procedure and service categories referenced for retroactive claim review within the specialty context discussed in the article.
What You Will Learn
- What the article says about an Aetna policy change affecting payment for certain procedures billed with evaluation and management services
- How retroactive claim reprocessing is described in the article
- What general transition issues are mentioned for claims system updates
- Which broad categories of services are discussed in relation to the policy update
- What specialty context the article uses to illustrate the payer change
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Physician offices
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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