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Medical - Urinalysis Dipstick and Pulse Oximetry Coding Change
After reviewing our policy related to urinalysis dipstick and pulse oximetry, and consulting with a committee comprised of state medical society representatives and members of the Physicians Advisory Board, we are implementing the following coding change.
Beginning with claims processed as of November 12, 2006, we will pay the following codes when billed with office-based evaluation and management codes (E&Ms) appended with Modifier 25:
- urinalysis dipstick CPT codes: 81002 and 81003
- pulse oximetry CPT codes: 94760, 94761, 94762
The office-based E&M codes that apply are 99201-99205, 99211-99215, 99241-99245 and 99381-99397.
All other policies will still apply and may impact the ultimate payment of the codes. These policies can be found on our secure physician website. Once logged in, registered users should select “Doing Business with Aetna,” “Policy Information,” then “Payment and Coding Policies” to view these policies.
We will reprocess previously denied claims for dates of service on or after May 1, 2006 with the above CPT codes when billed with an office-based E&M code appended with Modifier 25.
Physicians should not resubmit these claims, as they will be rejected as duplicates. No action by physicians is needed.
We believe health care professionals will see this as further evidence of our commitment to a collaborative relationship with the medical community.
