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  • Wiki - Aetna Medicare Denials LCD for office visit 99213
    Has anyone had denials for LCD on a office visit for 99213 from Aetna Medicare? This just started Oct 1, 2022 so I'm assuming new fiscal years Claims are being denied for LCD on an office visit with psychiatric DX codes, (these are not dementia or cognitive impairment codes) Medicare
  • Wiki - Aetna downcoding of E M claims - AAPC
    Is anyone else noticing Aetna E M claims being randomly downcoded without any justification? We have had many 99214 downcoded to 99213, even though the MDM supported the 99214 If you are experiencing this and likely appealing, have you had any success in getting these decisions overturned?
  • Fee Schedule for BCBS | Medical Billing and Coding Forum - AAPC
    I access our Anthem (our local BCBS) fee schedule in Availity through Claims Payments > Fee Scheduling Listing > Additional Fee Schedules and it's listed there Alternatively, I can go to Payer Spaces > Anthem Ohio and Fee Schedule is one of the options under Applications
  • understanding remark codes | Medical Billing and Coding Forum - AAPC
    I've been getting claim denials with the following remark codes - 16 - claim service lacks information which is needed for adjudication Claim submitted like we usually do On the same claim - N521 MISMATCH BETWEEN SUBMITTED PROV INFO PROV INFOR STORED IN SYSTEM And N152 -
  • 90471 is getting denied | Medical Billing and Coding Forum - AAPC
    Good Day I would like to know how to properly report codes for 90471 for immunization Patient went to outpatient office because of chest pain It is then confirmed by the doctor that the chest pain is a contusion front wall of thorax Patient was given ibuprofen oral for the pain Patient
  • Wiki - Payer ID 54704 | Medical Billing and Coding Forum - AAPC
    We have not changed anything in our submission process which is done via a billing vendor who uses the Availity clearinghouse Somewhere in this process the claims are not being routed to the correct payer ID, 54704, and are instead going out with a header of ISA08 So every single claim is being rejected as being sent to the wrong payer
  • Auvelity: New Oral Fast Acting FDA Approved Antidepressant
    On Aug 19, 2022 Axsome Therapeutics announced the FDA Approval of Auvelity, as the first and Only Oral NMDA Receptor Antagonist for the treatment of Major Depressive Disorder in adults We have summarized this FDA-approved medication in the following Psychiatry Education Forum Academy Updates:
  • Adjustment Reason Code 107 | Medical Billing and Coding Forum - AAPC
    I am so confused on what this ARC means This was sent back to me by Blue Care Network (part of BCBS of MI) I billed a TCM (99496) and Medication Reconciliation (1111F) The claim was processed without payment due the following: CO-107: The related or qualifying claim service was not
  • Wiki - Home or Residence Services with POS 13 for Assisted . . . - AAPC
    (This is for a Family Practice - Professional Billing) As of Jan 1, 2023 the AMA Deleted all Assisted Living CPT codes Per mlnMATTERS MM13004 - We are to bill Assisted Living patients with the Home Services codes and with the correct place of service (13) for our Assisted Living patients UHC
  • Wiki - Telehealth Billing after PHE and changes to place of . . . - AAPC
    I am very confused why all of a sudden we are seeing denials using place of service 11 with modifier 95 and now they want us to use POS 10 for telehealth in patient's home and POS 02 if they are not home It seems to vary by payer and I know some are following Medicare guidelines but we are





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