Physicians shouldering the burden of unfair coding practices may breathe a little easier if they have a contract with Aetna. As of Feb. 11, two evaluation and management coding changes that the Academy has been fighting for take effect.
Specifically, Aetna has made modifications to its coding policy regarding payment for two E/M codes on the same date of service, and payment of an E/M code in conjunction with surgery.
In a letter to the Academy detailing the specifics of the changes, Chris Jagmin, M.D., Aetna regional medical director wrote, "Because your advice has played an instrumental role in the process of changing these policies, we want to both thank you and inform you of these changes before they are communicated to a broader audience."
The adjustment in Aetna coding policy will allow for
Aetna Modifies Policy Regarding Bundling of E/M Codes
By News Staff
2/7/2006
- reimbursement for a problem-focused E/M service when billed with modifier 25 and a preventive E/M service on the same date, and
- reimbursement of an E/M code with modifier 57 when the service is performed in conjunction with a major surgical procedure.
According to Aetna, physicians may resubmit claims for payment for services delivered within 180 days prior to Feb. 11, provided the original claim was submitted within the timely filing period as defined by the provider's contract. Late interest and penalty payments will not apply to these claims.
Late last year, AAFP called on 44 health insurance plans to "do the right thing" and quit bundling certain CPT codes. Aetna was singled out as a payer that was acting on the Academy's concerns.
Late last year, AAFP called on 44 health insurance plans to "do the right thing" and quit bundling certain CPT codes. Aetna was singled out as a payer that was acting on the Academy's concerns.
