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Thread: CIGNA denying

  1. #1

    Unhappy CIGNA denying

    AAPC: Back to School
    Can anyone help me with this? A patient had surgery in June 2008. They has the following procedures:

    31075, 31276, 31255, 31267, and 31288. Cigna has paid all but 31267. They are denying it as not typically covered on the same DOS as the other covered charges. We billed with modifiers 50 since it was bilateral and with a 51 modifier. I don't see anything in the CCI Edits that would say that we could not bill with those other services.

    I am stumped. Thanks!!

  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    I suggest reading the guidelines contained in that section under 31267. ENT is not an area that I am completely familiar with but it looks like the info there indicates not to use 31267 with some of the other procedures you note.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Join Date
    Apr 2007


    I would appeal....it is not incidental to any of the other codes......i work for ENT and been doing this for 5 years...never had a problem getting that padi, although i never use modifier 51 anymore for any codes no real need...hope this helps

  4. #4
    Join Date
    Apr 2007


    I would definitely appeal. Lately I have been receiving more denials from Cigna & Aetna for procedures that they say are incidental despite the CCI edits showing they are not. Once I appeal with the CCI edits and an explanation of the different procedures I receive payment.
    Eileen Blankenship, CPC
    Remote Coder

  5. #5
    Join Date
    Apr 2007
    Salt Lake City

    Smile Cigna Denial

    We also are recieving strange denials from Cigna - bundling procedures that should not be bundled and should clearly be paid seperately. CPT code 31267 is not inclussive in any of the other codes - all are seperate sinuses. I would definately appeal with a copy of the CCI edits attached. I have been in ENT for over 10 years and never had those codes correctly bundle. Good luck!

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