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Policy and Practice Updates

Clinical payment, coding and policy changes

We regularly adjust our clinical, payment and coding policy positions as part of our ongoing policy review processes. In developing our policies, we may consult with external professional organizations, medical societies and the independent Physician Advisory Board, which provides advice to us on issues of importance to physicians. The accompanying chart outlines coding and policy changes:

Procedure

Implementation Date

What’s changed

Nerve conduction velocity

New effective date: 11/15/2009

In the May 2009 newsletter, we reported 8/17/09 as the effective date for this policy. The new effective date is 11/15/2009.

Nerve conduction velocity studies are considered experimental and investigational if performed without a concurrent or prior needle electromyography study (excluding carpal tunnel syndrome and Lambert-Eaton Myasthenic Syndrome diagnoses). Refer to Clinical Policy Bulletin #0502 for additional information.

Breast reconstruction

11/15/2009

Rounding policy

11/15/2009

19340 will be allowed when billed with 19380.

As a result of consolidating our calculations for assistant surgeon pricing into one system, you may see an additional one cent payment for claims with dates of service after 11/15/2009 due to our ability to round to the third digit.

Echocardiography

12/01/2009

When code 93307 is billed with either or both 93320 and 93325, these codes will be re-bundled into 93306, which is inclusive of these procedures.

When code 93306 is billed with either or both 93320 and 93325, both 93320 and 93325 will not be paid because those services are included in the payment of 93306.

Polymerase chain reaction testing – Clinical Policy Bulletin #0650

12/01/2009

CPT code 87801 is reported for infectious agent detection of multiple organisms by nucleic acid (DNA or RNA), using techniques such as polymerase chain reaction (PCR). Aetna considers this test conditionally eligible for specific diagnoses outlined in Clinical Policy Bulletin #0650 – Polymerase Chain Reaction Testing.

Prolonged services

(99354, 99355, 99356, 99357, 99358, 99359)

N/A – policy clarification

Prolonged services codes are allowed when billed with appropriate E&M codes per CPT guidelines. These services will be allowed even if there are other E&M codes, not defined by CPT, billed with the prolonged services codes 99354-99359.

Help ensure accurate reimbursement for immunizations

A review of submitted claims indicates that many offices are not properly coding and billing for immunization services.

n

Best Coding Practices for Immunization Services*: This recorded event offers a comprehensive review of coding for immunizations

For example, some practices are billing for office visits but n for the vaccine, while others bill for the vaccine but not for the administration.

ot

To promote more accurate submission and payment, we encourage you to review Aetna’s immunization and coding guidelines through these resources:

n

Immunization Billing Reminder: This flyer is posted on o

ur

and immunization services. It also includes suggestions for developing a best practices clinical/business model for the primary care practice. Log in to Aetna’s Education Site for Health Care Professionals at www.AetnaEducation.com. Select “Course Catalog,” then “Recorded Events.”

*This event is presented by Joel F. Bradley, M.D., F.A.A.P., and sponsored by Sanofi Pasteur.

secure provider website via NaviNet® under “Aetna Support Center.” Select “Clinical Resources” then “Immunization Resource Center.”

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Aetna Officelink Updates

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