Thank you all for your helpful responses -
I've called Anthem BCBS and spoke with a supervisor who reviewed the discrepancy between what Availity is saying and what their denials system identifies and confirmed that there is no limitation on billing 93325 with 76825. She assured me that they're working to correct the issue in their IS. Unfortunately because they've already been denied, each claim needs appeal, so off to work I go.
Connecticare still thinks that a 93325 cannot be billed with anything other than a 9xxxx series code as primary. Being part of a larger corporation with the benefit of centralized AR, I'm forwarding that issue to my physician representatives for follow-up with their contacts there.
Again, many thanks.
------------------------------
Kimberly
------------------------------
Original Message:
Sent: 10-12-2018 09:51
From: Kimberly Montero
Subject: 93325 - Prior Authorization
Hi there -
We've been seeing a lot of denials for the 93325 portion of the fetal echo exam. Has anyone been successful with the providers at BCBS and Connecticare? BCBS keeps referring us to Availity and Availity says they don't do prior auths for 93325 because it's a secondary code which only requires authorization if the primary ultrasound code also requires it. Connecticare doesn't know what a fetal echo is, forwards them to NIA and denies all of them as stress echocardiograms.
TIA!
------------------------------
Kimberly
------------------------------