Ob-Gyn Coding Alert

Don’t let a policy change disincentivize your ob-gyns from providing great care.

You may have heard about Cigna’s policy for practices seeking reimbursement on same-day procedures and established office/outpatient evaluation and management (E/M) encounters, especially given numerous advocacy groups voicing their concerns. However, you can breathe a sigh of relief. Thankfully, Cigna’s decided to delay the implementation.

Cigna said it will “continue to review for future implementation,” according to a policy update from the company on May 22. This is the second time Cigna has delayed this policy, as it tried to implement a similar one in August 2022. However, despite postponing it, it’s still a future possibility and, therefore, in your best interest for your ob-gyn practice to be conscientious about these claims.

Delve Into the Details

Cigna’s intended policy to require the submission of medical records with all established patient evaluation and management (E/M) claims submitted with CPT_® codes 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient …) and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician … on the same day of the procedure or other service) when the provider performs and bills for a minor procedure for the same encounter.

Example: An established Cigna patient comes to your office with complaints about pain. Because the ob-gyn does not know what is causing the pain, they do a full examination and determine the patient’s intrauterine device (IUD) is the cause. The ob-gyn removes it. Provided the ob-gyn provides documentation, you should be able to report 58301 (Removal of intrauterine device [IUD]) and the office visit (99212- 99215) with modifier 25. If you did not supply the required documentation, Cigna would have denied your claim.

Also, had Cigna’s policy gone forward, you would have had to either submit the office notes via dedicated fax number or via email, which is rife with potential HIPAA violations.

Many advocacy groups were concerned that submitting all this necessary documentation would tax practices already burdened with staff shortages and financial burdens, as well as suggesting patients should return at a separate encounter to undergo the minor procedure — which would incur another co-pay and demand more of both the physician and patient’s time.

Don’t Stand for Delayed Payment

Although Cigna’s policy requirements won’t be moving forward, this serves as a good reminder. If Cigna or any other payer fails to remit payment within the state’s mandated prompt payment time frame, you can file a complaint to hold them accountable to prompt payment laws. Make sure you know what your state’s laws require.

Don’t let this potential policy change disincentivize your physicians from providing efficient, medically necessary (although unscheduled) care. As long as providers are not too aggressive in billing an E/M with a minor procedure and provide clear documentation supporting the office visit as a significant and separately identifiable service, payers should reimburse accordingly. If they don’t, appeal.