Guest guest Posted February 18, 2011 Report Share Posted February 18, 2011 New to all this insurance stuff am I! Regarding Aetna and bundling—just got back our first claim with them. They denied fee for blood draw, stated it was part of the fee for a send out lab to monitor RA. However, I also drew blood for lipid panel, BMP as part of a new pt PE. Does Aetna ever reimburse for 36415? Could I have billed a 99201, or 99211 for E & M for the RA with modifier 25 added to the new pt physical, or just 25 modifier with physical and then the draw fee?? Or do any of you EVER do anything extra with the PE to avoid such concerns even though the pt would have to return on another day? Please note recently updated email address. Louise , MD Medical Care PLLCe-mail: lwright@... From: [mailto: ] On Behalf Of PrattSent: Thursday, February 17, 2011 1:17 PMTo: Subject: RE: Re: AETNA bundling We participate with Aetna. The last PPD that we did with a new patient visit was in March, 2010. I billed a 99203-25 and 86580. I did not bill the 90471. We were reimbursed for both the 99203 and the 86580 and I even used the wrong ICD-9 code (oops!) on the 86580. PrattOffice ManagerOak Tree Internal Medicine P.Cwww.prattmd.info From: [mailto: ] On Behalf Of drhorvitzSent: Thursday, February 17, 2011 7:21 AMTo: Subject: Re: AETNA bundling I have patients with Aetna.They don't bundle the PPD payment.But I think I know why...I don't participate with Aetna. My patients pay me for the visit and PPD. My patient's then submit to Aetna and it becomes their fight, not mine.My definition of practice improvement is to remove the third parties from my daily time committment and to spend it instead on patient care!the third parties are only going to get worse. you can not win the battle against them, so why not start planning your exit strategy now?just my two cents... Horvitz, D.O.Institute for Medical Wellnessstown, NJ 08057www.drhorvitz.com> >> > We don't do PPD's unless they are their own visit or in conjunction > > with a physical. Billing the placement and then a 99211 on the day we > > do the reading. Haven't seen it bundled yet.> >> > ** Pratt**> >> > Office Manager> >> > Oak Tree Internal Medicine P.C> >> > www.prattmd.info <http://www.prattmd.info>> >> > ----------------------------------------------------------> >> > *From:* > > [mailto: ] *On Behalf Of * > > Batlle, MD> > *Sent:* Wednesday, February 16, 2011 8:26 AM> > *To:* > > *Subject:* AETNA bundling> >> > AETNA is now bundling PPD's into level 99204 visit. Anyone dealt with > > this?> >> > from The Barrio> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 19, 2011 Report Share Posted February 19, 2011 I can’t answer specifically because we don’t do blood draws except for a finger-stick for INR’s, which are never reimbursed. That is bundled. That’s why we leave the blood draws to the labs. We have never been able to get reimbursement for an office visit on the same day as a PE, regardless of modifiers. I know that there are some on the list that do, so it’s probably related to geographic location. We will either code the PE or the OV, depending upon which one he spent the most time doing (typically PE). We do immunizations & EKG’s (no modifier) at the same time as PE’s and do get reimbursed for those. Just use the icd-9 codes specific to those CPT’s, leaving them off of the PE CPT code. Good luck! Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of Louise , MD Sent: Friday, February 18, 2011 2:13 PM To: Subject: RE: Re: AETNA bundling New to all this insurance stuff am I! Regarding Aetna and bundling—just got back our first claim with them. They denied fee for blood draw, stated it was part of the fee for a send out lab to monitor RA. However, I also drew blood for lipid panel, BMP as part of a new pt PE. Does Aetna ever reimburse for 36415? Could I have billed a 99201, or 99211 for E & M for the RA with modifier 25 added to the new pt physical, or just 25 modifier with physical and then the draw fee?? Or do any of you EVER do anything extra with the PE to avoid such concerns even though the pt would have to return on another day? Please note recently updated email address. Louise , MD Medical Care PLLC e-mail: lwright@... From: [mailto: ] On Behalf Of Pratt Sent: Thursday, February 17, 2011 1:17 PM To: Subject: RE: Re: AETNA bundling We participate with Aetna. The last PPD that we did with a new patient visit was in March, 2010. I billed a 99203-25 and 86580. I did not bill the 90471. We were reimbursed for both the 99203 and the 86580 and I even used the wrong ICD-9 code (oops!) on the 86580. Pratt Office Manager Oak Tree Internal Medicine P.C www.prattmd.info From: [mailto: ] On Behalf Of drhorvitz Sent: Thursday, February 17, 2011 7:21 AM To: Subject: Re: AETNA bundling I have patients with Aetna. They don't bundle the PPD payment. But I think I know why... I don't participate with Aetna. My patients pay me for the visit and PPD. My patient's then submit to Aetna and it becomes their fight, not mine. My definition of practice improvement is to remove the third parties from my daily time committment and to spend it instead on patient care! the third parties are only going to get worse. you can not win the battle against them, so why not start planning your exit strategy now? just my two cents... Horvitz, D.O. Institute for Medical Wellness stown, NJ 08057 www.drhorvitz.com > > > > We don't do PPD's unless they are their own visit or in conjunction > > with a physical. Billing the placement and then a 99211 on the day we > > do the reading. Haven't seen it bundled yet. > > > > ** Pratt** > > > > Office Manager > > > > Oak Tree Internal Medicine P.C > > > > www.prattmd.info <http://www.prattmd.info> > > > > ---------------------------------------------------------- > > > > *From:* > > [mailto: ] *On Behalf Of * > > Batlle, MD > > *Sent:* Wednesday, February 16, 2011 8:26 AM > > *To:* > > *Subject:* AETNA bundling > > > > AETNA is now bundling PPD's into level 99204 visit. Anyone dealt with > > this? > > > > from The Barrio > > > > > Quote Link to comment Share on other sites More sharing options...
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