Part B Insider (Multispecialty) Coding Alert
CIGNA Policies Limit Sinus Endoscopy
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In Tennessee, Cigna Healthcare unveiled two new draft local medical review policies with comments due by Aug. 12: * Diagnostic nasal/sinus endoscopy (CPT 31231 ) is covered to rule out obstruction of the sinus ostia and to determine if there's infection or tumor in areas that a routine rhinoscopy can't visualize. Patients should have an upper airway disease of uncertain etiology or a chronic or recurrent upper airway disease despite appropriate pharmacological therapy.
* Alefacept therapy (J3490). This treatment for psoriasis is covered only for chronic plaque psoriasis. Patients must have failed to respond to topical and UVB therapies, have a medical contraindication to such therapies, or give rise to a reasonable expectation that such therapies wouldn't be effective. The patient may repeat this therapy if the initial course results in remission and then 12 weeks elapses before a relapse.
Physicians must have CD4+ lymphocyte counts available, and they must have considered other systemic treatments and discussed them with the patient.
More specifically, Cigna will cover the treatment for patients with suspected nasal polyposis, chronic or recurrent sinusitis, persistent nasal obstruction, chronic nasal discharge of unknown etiology, recurrent epis-taxis, or the effects of chronic use of nasal steroid sprays.
Cigna stresses that nasal/sinus endoscopy shouldn't be a "modality of first resort."
Part B Insider (Multispecialty) Coding Alert
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