RE: CPT 20611

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Has anyone come across any issues with Aetna denying CPT 20611. We are bill=
ing this for osteoarthritis of the knee and they have denied as procedural/=
experimental based on there policy.

Thank you!

Erin Knight
Medical Coder
NEXTGEN HEALTHCARE
Solutions for: Electronic Health Records * Practice Management Systems * Re=
venue Cycle Management
5200 Stoneham Rd. STE 210
North Canton, OH 44720
330-526-5289 [o] 330-470-3761 [f]
TollFree: 1-888-923-7028 ext.17234 [o]
EKnight@RCM.NextGen.com


Comments

  • edited May 2017
    Not sure what you're using the 20611 for exactly, but I do know Aetna considers ultrasound guidance to be experimental/investigational for viscosupplement injections. We obtain authorization for 20610 instead for these.

    http://www.aetna.com/cpb/medical/data/100_199/0179.html
    "Note: Ultrasound guidance and knee arthrography for viscosupplement injections is considered experimental and investigational because it has not been established that this approach will improve health outcomes. "


    Thank you,

    Leila Meeks

    Administrator
    Integrated Health Management, LLC
    254.245.9177 (p)
    254.371.7770 (c)
    254.245.9178 (f)

    The information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.

    From: Knight, Erin [mailto:EKnight@RCM.NextGen.com]
    Sent: Monday, October 03, 2016 1:10 PM
    To: Multiple recipients of list PARTB-L
    Subject: RE:[partb-l] CPT 20611

    Has anyone come across any issues with Aetna denying CPT 20611. We are billing this for osteoarthritis of the knee and they have denied as procedural/experimental based on there policy.

    Thank you!

    Erin Knight
    Medical Coder
    NEXTGEN HEALTHCARE
    Solutions for: Electronic Health Records * Practice Management Systems * Revenue Cycle Management
    5200 Stoneham Rd. STE 210
    North Canton, OH 44720
    330-526-5289 [o] 330-470-3761 [f]
    TollFree: 1-888-923-7028 ext.17234 [o]
    EKnight@RCM.NextGen.com

    [cid:image003.png@01D21D7D.432DACB0]

    Erin Knight
    Coding Team Lead
    NEXTGEN HEALTHCARE
    Solutions for: Electronic Health Records * Practice Management Systems * Revenue Cycle Management
    5200 Stoneham Rd. STE 210
    North Canton, OH 44720
    330-526-5289 [o] 330-470-3761 [f]
    TollFree: 1-888-923-7028 ext.17234 [o]
    EKnight@RCM.NextGen.com


    NOTICE: This message, and any documents attached hereto, may contain confidential or proprietary information intended only for the use of the addressee(s) named above or may contain information that is legally privileged. If you are not the intended addressee, or the person responsible for delivering it to the intended addressee, you are hereby notified that reading, disseminating, distributing or copying this message is strictly prohibited. If you have received this message by mistake, please immediately notify us by replying to the message and delete the original message and any copies immediately thereafter. Thank you for your cooperation.










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