CIGNA Opens Black Box: Get Paid With Modifiers 25 & 59
Posted on 07. May, 2009 by Editor in Hot Coding Topics
You now have clear-cut policies to apply, including 1 on 96110 pay.
Say goodbye to secret black box bundles and hello to transparent CCI edits for one more insurer.
Adhere to CCI Edits, CMS Modifier Guidelines
Effective April 20, “CIGNA will apply CMS National Correct Coding Initiative (NCCI) Incidental and Mutually Exclusive edits,” according to the payer’s March 2009 Network News. The change puts the insurer’s policy on a level playing field.
For years, CIGNA did their own thing, points out Patti DiSpazio, CPC, business manager at Island Coast Pediatrics in Fort Myers, Fla. “Following UHC’s change, they’re using CCI edits as a barometer.”
In addition, the payer will adopt many CMS modifier guidelines. “Modifier policies being updated are Modifiers 21, 22, 25, 59, 80, 81, 82 and AS,” CIGNA says.
Follow Up With Notes for Certain Combos
Get ready to have your modifier 25 (CCI incidental edits) and modifier 59 use (mutually exclusive edits) subject to increased scrutiny. Due to overuse of modifiers 25 (Significant, separately identifiable evaluation and management service on the same day of a procedure or other service) and 59 (Distinct procedural service), some code sets involving these modifiers will require supporting documentation. In these cases, such as an E/M with a surgery code, documentation must show the E/M is significant and separate.
Modifier 25 office visit (99201-99215, Office or Other Outpatient Services) claims with a preventive medicine service (99381-99397) will not require additional paper-work. But for code combinations listed on CIGNA’s Web site starting May 1, you will have to mail documentation to the CIGNA address on the back of the patient’s ID card as the insurer cannot...
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