Wiki Antibiotic Beads!!! 11981 Help!!

[along06]

Does anybody have any ideas on how to get these paid? I have an Aetna claim being denied. thanks

 

[dstruve]

11981 is for non-biodegradable drugs. Antibiotic beads are generally biodegradable.

 

[thomas7331]

Denials can be for many different reasons - reimbursement policy, patient benefits, payer processor error, etc. - if you could share the reason that Aetna denied the claim, we'd be more likely to be able to help.

 

[along06]

Aetna denial states that 11981 is denying due to benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. We charged 27030 (I&D) and Aetna is saying 11981 is included in that procedure.

 

[thomas7331]

11981 does not bundle to 27030 per NCCI, but Aetna may have its own bundling policies (or it could just be a processing error). If you have documentation to support that the services billed with 11981 were unrelated to the I&D and that would support using a modifier to unbundle this, you can submit a correct claim, or else send an appeal or otherwise challenge this denial if you think it is in error.