Wiki Help!! Aetna denying hospital rounding charges when diagnostic services are performed by different specialties.

[Jennifer Willis]

Help! Is this a California thing or is Aetna applying this bundling across the country? We have either the rounding charges or the imaging charges being denied as bundled, when it's the internal medicine doctor and radiologist are each billing for their own services. Aetna wants a modifier 25 and my coder mind will not allow it.

Does anyone have suggestions or advise?

Thank you for your help,

Jennifer

 

[csperoni]

I have not come across this with Aetna, but don't personally work a lot of denials anymore. I would ask Aetna for their policy regarding this.
It would seem as though you have 2 options:
1) appeal your denied claims
2) follow their illogical and unnecessary use of -25
If you have a lot of claims this is impacting, you could always try to get the the appropriate person at Aetna who realizes how ridiculous this is AND has the power to do something about it AND is willing to do so. With various carriers, I have many times reached the right person, but they didn't seem to care, or (more often) been unable to reach the right person.