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Wiki Aetna and G0378

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tradon

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We are getting denials in for G0378 when coded with 96361 stating they are inclusive. Has anyone had luck appealing this?
 
I have run into this issue. From what we have gathered it usually has a problem with Aetna plans that follow more of a medicare pricing guidelines since some of Aetna plans (usually ones that go through GCS) have no problem process that line. We have also run into where they are not only denying those two lines but all the lines starting 963XX. I do believe we are attempting to try the primary code 96360 but I don't believe we have had any luck at this time getting it reprocessed. Usually, the line has to be removed in order to get the line processed for those certain claims.
 
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