Wiki Cigna & 99051

[GoLeun22]

The pediatricians office I bill for uses the 99051 code for weekend or after normal business hours visits.

Now, we bill the 99051 in addition to the sick vist or well visit, but Cigna states "The procedure code represents services that are not usually performed on the same date of service, use a different surgical approach, or overlap the services of another submitted on this claim."

Other carriers seem to pay no problem... Am I missing something? Should I be billing with a modifier?

Lisa

 

[cldavenport]

In my office we have no issue with 99051. We bill 99051 with the sick visit, no modifiers attached.

Thank you

 

[Biller385]

On Cigna's webpage for providers, they have CCI edits. Put in all your procedure codes. If they return with a red denied on the code try using a modifier. If this comes back with out anything, that is what they are looking for. It's a nice tool that they have.

 

[mitchellde]

The pediatricians office I bill for uses the 99051 code for weekend or after normal business hours visits.

Now, we bill the 99051 in addition to the sick vist or well visit, but Cigna states "The procedure code represents services that are not usually performed on the same date of service, use a different surgical approach, or overlap the services of another submitted on this claim."

Other carriers seem to pay no problem... Am I missing something? Should I be billing with a modifier?

Lisa

99051 is for schedule evening weekend and holiday hours, so these are only if your contract shows that you have schedule office hours on the weekends or evenings, however if the office is normally not open during these times then you use 99050.
So you might check that also.