Aetna Newsletter

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
95165 - Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens	6/1/2012	95165 will be allowed 30 times per date of service.
D9610 – Therapeutic parenteral drug, single administration	6/1/2012	D9610 will be denied as incidental when billed with codes D9220, D9221, D9241 or D9242. Modifier 59 will override the edit.
Medicare status codes (P and M)	6/1/2012	Codes designated with a P (bundled/excluded codes) or M (measurement code for reporting services only) Medicare Physician Fee Schedule status code is not payable and will be denied.
J9055 – Injection, cetuximab, 10 mg	6/1/2012	Effective 6/1/2012, cetuximab (Erbitux) will be considered experimental and investigational for the treatment of glioma and vaginal cancer. Refer to Clinical Policy Bulletin #0684 (Cetuximab (Erbitux)) for more information.
Qualitative drug screen codes G0431 & G0434	6/1/2012	Starting 6/1/2012, we will require the use of either G0431 or G0434 for the billing of qualitative drug screens. We will reimburse for 1 unit, per patient encounter, of either code when qualitative testing methods are used. Any billing of CPT codes 80100, 80101 or 80104 will be adjudicated according to this policy with appropriate mapping to one unit of G0431 or G0434 per patient encounter.
Inappropriate billing or coding	Annual reminder	We make code adjustments for inappropriate billing or coding. Examples of these adjustments include rebundling of services that are considered part of, incidental to, or inclusive to the primary procedure as well as adjustments for mutually exclusive procedures.
93224 - 93227 -- External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage	Reminder	93224 - 93227 are used to report external electrocardiographic recording services of up to 48 hours. These procedure codes should be reported once within a 48 hour time period.