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Ophthalmology Coding Alert

You Be the Coder:
Prep for Potential Avastin Denials

Question: I’m suddenly getting denials from Aetna for Avastin. Are you aware of why this might be? Supercoder.com Subscriber Answer: It appears that Aetna quietly updated its Avastin billing policy in November, and began denying claims for some ophthalmic uses of the product shortly thereafter. According to the policy, Avastin is payable for treating diabetic macular edema, macular edema after retinal vein [...]