hcg
Guru
I'm new to this billing practice & I need help on a claim that was denied by Aetna.
Patient is being seen in the Doctor's office for Natalizumab (Tysabri) infusion. Pt has Multiple Sclerosis, Optic neuritis, & numbness, parasthesia. Here are the codes on the claim:
Dx codes - 340, 377.30, 782.0
CPT codes - 96413, 96415, A4221, A4222
Aetna denied as: The charge for this service does not meet this requirement of the member's plan of benefits because the chemo administration codes were not billed with nonradionuclide antni-neoplastic drugs, anti-neoplastic agents used for treatment of non-cancer diagnoses, monoclonal anti-body agents & other immunomodulator drugs.
The Dr. said that this is medically necessary. He wanted me to appeal & make sure it gets paid. Our biller told me to use 96365 & 96366. Is it appropriate to use CPT 96365 & 96366 instead? I'm confused.
Your help is greatly appreciated.
Patient is being seen in the Doctor's office for Natalizumab (Tysabri) infusion. Pt has Multiple Sclerosis, Optic neuritis, & numbness, parasthesia. Here are the codes on the claim:
Dx codes - 340, 377.30, 782.0
CPT codes - 96413, 96415, A4221, A4222
Aetna denied as: The charge for this service does not meet this requirement of the member's plan of benefits because the chemo administration codes were not billed with nonradionuclide antni-neoplastic drugs, anti-neoplastic agents used for treatment of non-cancer diagnoses, monoclonal anti-body agents & other immunomodulator drugs.
The Dr. said that this is medically necessary. He wanted me to appeal & make sure it gets paid. Our biller told me to use 96365 & 96366. Is it appropriate to use CPT 96365 & 96366 instead? I'm confused.
Your help is greatly appreciated.