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What is G0379 billing guidelines?

HCPCS code G0379 is used when an individual is referred directly to observation care after being seen by a practitioner in the community and without an associated Emergency Room (ER) visit, hospital outpatient clinic visit, or critical care service on the same DOS as the initiation of observation care.

Why did Aetna deny my claim?

If your health or disability benefits have been denied, Aetna may have claimed the following: The procedure is merely cosmetic and not medically necessary. The treating physician is out of network or out of plan. The claim filed was for a medical condition that isnt authorized or covered.

What is the Aetna modifier 22?

We may ask you to submit clinical records before we pay a claim if the claim includes: A code appended with Modifier 22 (unusual procedural service). For example, we may request an operative report for surgical procedures or office notes for non surgical procedures.

What is the CPT code for observation and discharge on the same day?

CPT codes 99234-99236 are used to report hospital inpatient or observation care services provided to patients admitted and discharged on the same date of service. These codes require two or more encounters on the same date, one being an initial admission encounter and another being a discharge encounter.

What is the CPT code for observation stay?

CPT codes 99234-99236, observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date. All services provided on the day of discharge from inpatient status are coded 99238 or 99239.

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