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Aetna Policy and Practice Updates

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Aetna regularly adjusts its clinical, payment and coding policy positions as part of its ongoing policy review processes. This chart outlines coding and policy changes that are effective in August.

Procedure Change
Proper billing of parenteral infusion pumps Equipment used in conjunction with a medical and/or surgical procedure, is considered incidental to the primary procedure, and no additional payment will be made to physicians.
Dialysis training Aetna allows one complete course of dialysis training per year. 90989 should be used to report the completed course. If only a portion of the course is completed, code 90993 is reported for each session provided. A maximum of six will be allowed.  Reporting both of these codes is not appropriate, since the course will have been either completed or not completed at the end of the training sessions.
Extended opthalmoscopy Extended opthalmoscopy refers to the meticulous evaluation of the interior of the eye, and includes a drawing of the retina observed through a dilated pupil and a written interpretive report. Aetna considers extended opthalmoscopy medically necessary for evaluation of a range of posterior segment pathology, when the level of examination requires a complete view of the posterior segment, where documentation is greater than that required for a routine opthalmoscopy. Medically necessary indications include glaucoma; intraocular neoplasms; ocular trauma; certain abnormalities of the retina or choroid; and certain vitreous disorders.
Fracture care Comprehensive fracture treatment should only be billed by the provider who provides the global fracture treatment service.  Physicians providing less than comprehensive fracture care should bill using the CPT codes reflecting the specific services rendered. Aetna will pay one fracture treatment service and related services for the same fracture during the 90 day global period. The fracture treatment codes include the actual fracture care and related follow-up visits.
Nerve conduction velocity Nerve conduction velocity studies are considered experimental and investigational if performed without a concurrent or prior needle electromyography study (excluding carpal tunnel syndrome and Lambert-Eaton Myasthenic Syndrome diagnoses). Refer to Clinical Policy Bulletin #0502.
Concurrency of multiple Evaluation & Management services (same day) Aetna will apply concurrency rules (100/50) when two E&M services are billed and allowed with Modifier 25. The preventive medicine visit will be considered the primary service and payable at 100% of the allowed and eligible office, or problem-focused, E&M will be considered the secondary service payable at 50% of allowed.