Author Topic: Aetna billing difficulties with 97140-59 and 97010  (Read 3657 times)

2012billingrep

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Aetna billing difficulties with 97140-59 and 97010
« on: July 02, 2013, 05:46:41 PM »
We have noticed Aetna has been rejecting all our chiropratic claims involving 97140-59. Apparently they no longer cover this code because it was being used too often by chiropractors. We have also noticed very recently that they are not paying for 97010. Is there a reason for this? Is there another code that can be used for heat and also for manual therapy?

DMK

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #1 on: July 03, 2013, 10:35:42 AM »
There was a notice sent out stating that as of 3/1/13 Aetna would no longer pay on 97140.  If the "manual therapy" is trigger point or massage you can bill it as 97124-59 and they will pay.  OR you can appeal with notes indicating what the manual therapy was, and they might pay. 

We don't bill heat, so I can't speak to that particular code.

Blue Shield also messed up with 97140 in their system, but they have corrected it.

PMRNC

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #2 on: July 03, 2013, 11:11:40 AM »
http://www.strategicdc.com/aetna-denials-for-97140-manual-therapy-and-chiropractic-adjustments-again/
Good articles on this subject:

http://www.strategicdc.com/aetna-denials-for-97140-chiropractic-adjustments-part-2/

http://www.aetna.com/newsletters/provider/OfficeLinks/2012/December/clinical-coding-changes.html

"The December issue of Aetna’s Newsletter of the Ridiculous Policy Changes (not it’s official name – but click link to read and weep) spells it out clearly.  If you don’t want to read their trash, here it is:

    Effective March 2013, Aetna will not pay for CMT and 97140 on the same day.

Doesn’t matter if you use modifiers correctly, complete your claim form properly, document everything in gory detail and include a 5 spot with your claim – they ain’t paying. "
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #3 on: July 03, 2013, 11:40:53 AM »
Not to get on a tirade.....but......where do they get off?  Do they want the doc to just see them more often (because some will do that)?

I also got into it with provider relations at Blue Shield because a "committee" determined that chiros don't need to EVER bill 99203, 99204 or 99205 (New patient exams), so they won't pay it. 

I told her "we get in trouble for upcoding or downcoding, why don't you?  We have to bill what's APPROPRIATE for the service, and some cases are more complex that others."  She just said that the Chiro who was on the committee (another instance of chiros feeding on each other, I hate it) said that since the chiro can't treat a complex case, he can't bill for one.  Huh?  :o

PMRNC

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #4 on: July 03, 2013, 12:43:45 PM »
Quote
Not to get on a tirade.....but......where do they get off?  Do they want the doc to just see them more often (because some will do that)?

I'm not known for dancing around.. but i don't do chiropractic for this very reason <g>

Don't want to reply rant to your rant <g> but sometimes it's good with ANY specialty to remember WHERE insurance came from ... I was just explaining this very thing to someone in response to Obama extending the deadline for applying penalties to companies with 50 or more employee's for a year.. Insurance companies are in the business of LOSS ratio's.  It absolutely SHOULD be up to the employers/plan on what they cover and don't cover. Again.. Insurance companies are in the business of risk and loss.. Somehow in this country it became an entitlement ::) ::) ::)   I know also sometimes I can be biased because I worked many years for insurance companies so it does sometimes get tricky for me to jump to the other side sometimes. People forget that insurance companies are similar to banks.. they try to make money while giving money away. It's really THAT simple.  Our country has become a nation of people who think they are entitled to insurance.. that's where the system began to fail.. sounds brutal but it's the truth.   I think employers should have a right to exclude certain things like chiropractic care. (just an example)  I think insurance companies also have a right to exclude certain losses that we take for granted. I'm not saying certain treatments by Chiropractors are not beneficial.. I'm saying that the carriers right now are under the gun and they are going to indeed find ways to combat the losses they will see with the ACA.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #5 on: July 03, 2013, 01:01:47 PM »
I completely agree with you, and understand the bias against Chiropractors, so many are unscrupulous.  I also agree that more and more things will be cut to save money (but wait everything's free right?).  The general public has no idea what's coming.  The pendulum has swung and it's going to be harsh for patients and providers (if any even stay in practice!).

2012billingrep

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #6 on: July 03, 2013, 04:43:37 PM »
Thanks for all the responses.

DMK, I thought 97124 was for massage and that trigger point therapy fell under the 97140 code?

DMK

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #7 on: July 08, 2013, 12:52:19 PM »
Correct 97124 IS for massage (but some insurance companies want it coded 97140) and 97140 is the appropriate code for trigger point.  I don't make the rules, but I will do my best to code procedures as the insurance companies want them coded.

Our Aetna clients all raised a fuss with their HR depts. and Aetna and were told how the provider should fix the claims and re-submit.

PMRNC

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Re: Aetna billing difficulties with 97140-59 and 97010
« Reply #8 on: July 08, 2013, 01:16:28 PM »
Quote
Our Aetna clients all raised a fuss with their HR depts. and Aetna and were told how the provider should fix the claims and re-submit.

I'd be interested to know how they were told to "fix" <g> insurance carrier reps are really NOT allowed to give coding advice or even advise on coding issues leading to "reimbursement". 

ERISA health plans however have more leeway with insureds.. they can actually make administrative decisions with regards to these kind of denials.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com