Wiki Cigna and 99215

[Aimeelb]

I keep receiving denials from Cigna where they are bundling 99215 with the chemo admins we are billing. We are applying the appropriate modifiers. The strange thing is we can bill the exact same charges with 99214 or 99213 and they do not get bundled but if its 99215 it gets bundled. when I call Cigna (their out sourced provider service dept.) they claim its a new Medicare rule. I've googled and googled and can't find any proof of this. I've submitted appeals and 1 in 5 will reprocess for payment. I can't get a access to a "local" provider rep to speak to me. I've called credentialing and that gets me no where either. I can't find any info to back up their bundling and its like my hands are tied in fighting it. has anyone else had this issue with this denial???? and Cigna is the ONLY insurance carrier we are seeing this with.

 

[Lyta2000]

Curious what modifier you are using? If it is 25 then you are telling the insurance company there is a separate identifiable E&M at a level 5 without considering the chemo admin. Is that true?

 

[KMCFADYEN]

I have encountered the same problem with Cigna. I got nowhere. I had a claim that we billed 99215 and a procedure the same day. I added the 25 mod as the services were separate. Cigna denied 99215 as bundled. When I found that there was no bundling issue with the lower levels, I called and tried to speak to someone. I spoke to at least three people who had no resolve for me. I did send an appeal making my case but they upheld it. I do not know where i go from here. It seems there is an claims edit error with this particular scenario.

 

[CatchTheWind]

I would second Lyta2000's question. Are you legitimately getting a level 5 visit? That would require an extended history, complete ROS and PFSH, comprehensive exam, and either extensive number of diagnosis or management options and/or extensive amount or complexity of data to be reviewed.