Wiki TAVR Denials from Aetna

[coop22]

Is anyone experiencing Aetna Denials for Transcatheter Aortic Valve Replacement Codes 33361 due to Services of an Assist Surgeon, Co Surgeon, or Surgical Team are not covered.

Per NCD Guidelines 33361 must always be billed with modifier 62 because a cardiac surgeon and interventional cardiologist must jointly participate in the intra-operative aspects of the procedure. (Denials are coming from Aetna Medicare Advantage and Aetna Medicare

The claims have always been sent Manually and now they are being denied. Appeals stating this information are denied. This has all just started about 6 months ago. Before that Aetna has always paid them.

Any ideas on how to approach this situation? Our physicians are the Cardiac Surgeons in a Private Practice. The cardiologist is part of the facility.

 

[aasavattere1]

TAVR Denials

Is there any chance the ICD-10 code is not matching up with the reason for the patients procedure (medical necessity) therefor Aetna is denying payment for the service?

 

[coop22]

No all of the procedures are billed with the same code every time. They are specifically denied due to the 62 modifier.

 

[conleyclan]

Everyone of my TAVRs are recently denying by Aetna. I print out their online appeal form. Fill it out and fax both cardiology and cardiac notes, along with Medicare policy. It normally pays every time. You also have to watch and make sure the CT number is on the claim. They will deny it if that is not on the claim. They will state it has to go to Medicare to be paid. Good luck.