Cigna: 25 and 59 Require Documentation
Providers submitting claims to Cigna: Make sure to read the private payer’s latest Professional Claims Code Editing and Documentation Requirements Guidelines. Effective April 27, the company now requires supporting documentation for some claims containing modifiers 25 and 59.
Cigna has begun requiring documentation for a specific subset of edits the Centers for Medicare & Medicaid Services (CMS) and the National Correct Coding Initiative (NCCI) designate as “1” (allowed).
For modifier 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, supporting documentation is now required on 73 code combinations.
Exception: Documentation is not required to override the edit between problem-based and preventative office visits.
For modifier 59 Distinct procedural service, supporting documentation is now required for 121 code combinations.
Remember: Modifier 59 is not appropriate for use with E/M service codes.
To view the updated list of affected CPT® codes, log into the Cigna Web site and click Resources > Claim Editing Procedures.