Wiki Help Cigna Denials

[lcoleman101]

Is anyone else receiving crazy Cigna denials? We are getting denials after they updated their system on 2/12/22 and they are saying they removed some DX codes. They are now denying our vaccine charges and well visits because they removed Z23 and Z00.129. When I call they tell me to submit a corrected claim with a correct DX but there are no other codes.

 

[AthensCoder]

Is anyone else receiving crazy Cigna denials? We are getting denials after they updated their system on 2/12/22 and they are saying they removed some DX codes. They are now denying our vaccine charges and well visits because they removed Z23 and Z00.129. When I call they tell me to submit a corrected claim with a correct DX but there are no other codes.

I work in Gastro. I just got my first denial for a colonoscopy with no biopsies or polyp removals billed with Z12.11 denied as invalid diagnosis. I ran the claim through tthe Cigna clear claim connection checker and it came back with the following reasoning for the denial...

Cigna follows the ICD-10-CM official guidelines for coding and reporting to determine codes which should never be billed as the principal/primary diagnosis. Cigna will not reimburse claims when the only ICD-10-CM code billed is considered an unacceptable principal diagnosis.

I don't recall their being any changes this year. Seems like Cigna may have a glitch in their system.

 

[isapra]

We are also getting similar denials for LARC. They ask us to review CMS guideline for unacceptable as a principal diagnosis. I have no idea what ICD-10 to us for LARC.