Question CIGNA Documentation Requirements


Dalton, GA
Best answers
Effective 05/25/2023, CIGNA is requiring medical records for ALL claims where -25 modifier is applied. Any great ideas for catching these claims using Nextech? We have worked with tech advisors for Nextech and have devised a system using their reporting, however, it still will be cumbersome. Thanks for any and all suggestions!
From what I saw in the Cigna newsletter, it will only be applied in an office setting when codes 99212–99215 is used in conjunction with modifier 25. Is it possible for your system to flag anytime those codes are used? I don't know how heavy your practice is with follow-ups, but we are going to run reports to see which of our Cigna patients are patients with chronic medical issues and make pop-up notes on their account.
Hi TP Keith,👓
I would just inform medical coders if patient's gets anything additional to regular office visit such as injections, 96372 & J codes, lab work done in office, removal of ear cerumen CPT 69210 , vaccines, x-rays in office, smoking cessation, or skin lesion removals Etc. Also running a IT report listing any modifier 25 put on treatment before billing may help too.
Lady T :)
Under reports in Nextech there is "Charges by Service Modifier." Not sure would assist you in the way you are looking.
I am not familiar with Nextech but I would check to see if your EMR has any features where you cant set up a special rule to fire when billing claims to CIGNA with CPT codes 99212-99215, before dropping your claim to the payor. If not, create a report with those parameters to run daily to see if you've billed any of those claims. That way you can fax/email your medical records on those claims. Good luck. This is an onerous task no matter how you look at it.