UCR 247: 2 New Denial Twists - 1) getting E/M, G2211 and UA paid; 2) downcoding; and revisiting coding for graft around the urethral anastomosis during prostatectomy (from Episode #234)

June 13, 2025 

In this episode, Ray, Mark, and Scott discuss recent denial issues from Aetna and Humana and offer some possible solutions. They also revisit a question covered in Episode #234: billing for amniotic tissue grafts during prostatectomy procedures, outlining strategies to address denials effectively.

Question:

Hello there
I am reaching out for some guidance please.

We have recently been getting denials from Aetna on 81003 when billed with an E&M.
Based in feedback from crowd sourcing on Dr Lins Facebook group, we starting applying modifiers 59 to 81003. That worked for a while and now it is also being denied.

Aetna wants a modifier on the E&M but that would negate G2211. Is there any work around to this or do we just surrender the G211 reimbursement?

Any advice would be appreciated

Best,
Dr. Kirin Syed DO, FACOS