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Aetna billing difficulties with 97140-59 and 97010
2012billingrep:
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:
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:
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. "
DMK:
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:
--- 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)?
--- End quote ---
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.
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