Otolaryngology Coding Alert

Get ready for reprocessed claims to earn extra dollars from Cigna. 

With one of the biggest issues of 2014 for otolaryngologists being reimbursement for 69210 (Removal impacted cerumen requiring instrumentation, unilateral), every practice should be glad to receive some good news on that front. 

The scoop: Cigna has changed its policy regarding claims that include 69210 with an office-based E/M code (99211-99215). Any claim with these codes and modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) will be reprocessed. Going forward, Cigna will reimburse providers when they append modifier 25, with no documentation necessary with submission. 

If you receive notification from payers that they are rescinding or revising their policies or if denials persist, members of the American Academy of Otolaryngology/Head and Neck Surgery are encouraged to contact the Academy about the situation.