Wiki Aetna denial of 95024

[absimpson721230]

Recently our practice is receiving Aetna denial for 95024 stating this is bundled with the NP visit 99204 and Aetna is following the CMS NCCI edits. According the NCCI edits, 95024 can be billed with a NP E/M service. Is anyone else receiving these types of denials and how are you resolving the issue. CSR has stated the NCCI edits are in place and are not sending the claims back for reprocessing.

 

[sls314]

Recently our practice is receiving Aetna denial for 95024 stating this is bundled with the NP visit 99204 and Aetna is following the CMS NCCI edits. According the NCCI edits, 95024 can be billed with a NP E/M service. Is anyone else receiving these types of denials and how are you resolving the issue. CSR has stated the NCCI edits are in place and are not sending the claims back for reprocessing.

What modifier are you using?

There is an NCCI edit. If appropriate for the visit, a modifier is allowed to override the relationship. Billed without a modifier, you'll hit the NCCI edit.

 

[absimpson721230]

What modifier are you using?

There is an NCCI edit. If appropriate for the visit, a modifier is allowed to override the relationship. Billed without a modifier, you'll hit the NCCI edit.

Modifier 25 is used on the NP E/M code,, no modifier is added to 95024.

 

[sls314]

Modifier 25 is used on the NP E/M code,, no modifier is added to 95024.

In that case, I would probably send an appeal with the documentation showing that the 2 services were distinct and separately identifiable.

I found this article on the American College of Allergy, Asthma, and Immunology website that may be helpful in your appeal:

Coding for E&M visit and allergy testing on the same day - ACAAI Member

Many third-party payers insist skin tests are a part of an office visit, but this is not the case, and these denials should be appealed.

college.acaai.org

 

[absimpson721230]

In that case, I would probably send an appeal with the documentation showing that the 2 services were distinct and separately identifiable.

I found this article on the American College of Allergy, Asthma, and Immunology website that may be helpful in your appeal:

Coding for E&M visit and allergy testing on the same day - ACAAI Member

Many third-party payers insist skin tests are a part of an office visit, but this is not the case, and these denials should be appealed.

college.acaai.org

Thank you!