Insurance

Aetna 97140 Update

by Matt Minnella, ANJC Director of Insurance & Regulatory Affairs

Following the ANJC’s successful settlement of our law suit against Aetna for inappropriately denying 97140 codes when billed with CMT, we are still pursuing the fulfillment of Aetna’s obligations under the agreement.

The latest victory in these efforts is Aetna’s publication in their online newsletter as well as on Navinet the list of approved ICD-10 diagnosis codes that will allow 97140 to be billed with CMT and be paid without submitting notes for review.

If you perform Manual Therapy (97140) on a patient’s extremity for one of the agreed upon extra-spinal diagnosis codes AND use the diagnosis pointer on the claim form to point the 97140 to said diagnosis code, the 97140 claim should be paid without having to submit notes.

Below is a link to the newsletter where the description is shown (its on page 15 under the heading Northeast News – New Jersey).  Also below is a link directly to the list of codes, instructions to find the policy on Navinet and a webinar by Dave Klein, ANJC Coding and Compliance Consultant and Matt Minnella, ANJC’s Director of Insurance & Regulatory Affairs explaining the history of this case, the -59 modifier and the billing process you should follow for this procedure.

Newsletter:

http://www.aetna.com/healthcare-professionals/assets/documents/olu-ne-march2017.pdf

List:

http://www.aetna.com/assets_aetnaCom/documents/DX-codes-Manual-Therapy-Techniques-ICD10.pdf

Navinet instructions:

Under Claims, Claims Tools, Scroll down and select Claim Payment and Coding Policies, select Modifier 59, Click the link to the exceptions code combinations, Scroll Down to Manual therapy Techniques 97140. There is a link with the eligible diagnosis codes.

ANJC Webinar Aetna-97140:

http://videostream.ssvmedia.com/2017/02/anjcaetnanewprocess20170217.php

The information provided is for general guidance on matters of interest only and may not take into account particular facts relevant to your individual situation. The application and impact of laws and health care can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in these materials. Accordingly, the information you receive is provided with the understanding that the presenters and the A.N.J.C. are not herein engaged in rendering legal, accounting, tax, health care or other professional advice and services nor are they providing specific advice with regard to your practice, the treatment of any specific illness, disease, deformity or condition, or any other matter that affects trade, commerce, or legal rights of others.

As such, this email should not be used as a substitute for consultation with professional accounting, tax, legal, health care, or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional.