Primary Care Coding Alert

One more private insurer has kissed confusing code bundles goodbye and welcomed more lucid Correct Coding Initiative (CCI) edits. The payer is also changing its rules for reporting certain modifiers.

CIGNA Now Observes CCI, CMS Modifier Rules

Beginning April 20, CIGNA will apply CMS National Correct Coding Initiative (NCCI) Incidental and Mutually Exclusive edits, according to the payers March 2009 Network News.

CIGNAs use of the CCI edits should contribute to administrative simplification by allowing coders to use the same rules for CIGNA that they do for Medicare, explains Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan. Because the CCI edits are readily available on the CMS Web site, CIGNAs use of those edits should make CIGNAs claim processing more transparent.

Impact: If CCI bundles two codes, then CIGNA bundles two codes. The payer is also adopting CMS guidelines for modifiers 21, 22, 25, 59, 80, 81, 82, and AS, according to a CIGNA FAQ on the changes.

Include Notes on Certain Code Combos

FP coders will be most interested in the new documentation requirements for modifiers 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and 59 (Distinct procedural service).

Overuse of these modifiers prompted CIGNA to require supporting documentation for some code sets that use these modifiers, such as an E/M with a surgery code. In these cases, documentation must show the E/M is significant and separate.

Certain E/M-procedure combination claims to CIGNA will need to include proper documentation that will need to be clearly associated with a given claim, Moore explains. For code combinations listed on CIGNAs Web site starting May 1, you will have to mail documentation to the CIGNA address on the back of the patients ID card (CIGNA cannot accept electronic attachments, according to the payers FAQs).

Exception: Modifier 25 office visit (99201-99215, Office or Other Outpatient Services) claims with a preventive medicine service (99381-99397) will not require additional paperwork, according to the FAQ.

Time-saver: You can continue to file the claim electronically. Make sure you check the box in item 19 to indicate you are sending supporting documentation. For more information on CIGNAs new policies, go to www.cignaforhcp.com (you must be a member to view the Web site). Log in, click the Resources tab, and then click on Claim Editing Procedures.