Nuclear
Cardiology Today:
Clinical Innovations and Practice Integration
April
13 – 15, 2012
at the
Hyatt Regency Philadelphia at Penn’s Landing
Philadelphia, PA
www.asnc.org/nctoday
for additional
information, please contact:
Beth Hodge
American Society of Nuclear Cardiology
Director of Communications
(240) 429-9983
CIGNA Revises
Modifier (-25 and -59) Policy
CIGNA changed its policy
to require providers to submit supporting documentation for any
claims with procedures and services that are appended with a CPT
modifier 25 or 59. As of April 20, 2009, CIGNA planned to require
documentation for approximately 17,000 NCCI code pairs. After
listening to numerous providers and professional medical societies
including the American College of Cardiology and the AMA, CIGNA has
decided to significantly reducing the number of NCCI code pairs for
which it requires documentation to fewer than 500 (less than 5
percent of CIGNA's total claims). CIGNA will delay full
implementation of this program until April 27, 2009.
CIGNA will also provide
helpful hints to ensure the supporting documentation physicians
submit via fax or mail for these NCCI code pairs contains the
appropriate information to successfully match the documentation with
the electronic claim submission. In the meantime, please instruct
physicians and their practice staff to check Box 19/Loop 3200 on
their claim submission to indicate that they submitted supporting
documentation. Supporting documentation can be faxed to CIGNA at
(570) 496-2945 or sent via mail to the CIGNA address on the back of
the patient’s ID card.
Here are some
important instructions for your practice:
As of April 20:
-
CIGNA was pleased to
report the mandatory submission of documentation for NCCI code
pairs appended with CPT modifier 59 will be delayed until April
27, 2009. Beginning April 27, the list of code combinations that
require supporting documentation for modifier 59 will be
significantly reduced.
-
Documentation
submission requirements for NCCI code pair edits appended with
CPT modifier 25 will be active through April 24. Physicians and
their practice staff must choose to either submit these code
pairs with documentation or postpone submission to the following
week. Physicians and their practice staff should remember to
always appropriately document the performance of procedures and
services prior to submitting a claim. Beginning April 27, the
list of code combinations that require supporting documentation
for modifier 25 will also be significantly reduced.
Once the revised list is
released, the ACC will highlight the code pairs most frequently
billed by cardiologists.
Please instruct your
practice staff to keep visiting
www.cignaforhcp.com for the revised list of which NCCI code
pairs that will require supporting documentation with the claims
submission when appended with a CPT modifier 25 or 59. For the
complete list of current code combinations that require supporting
documentation when modifiers 25 or 59 are billed, log in to the
secure CIGNA for Health Care Professionals Web site (www.cignaforhcp.com)
and select “Resources” then “Claim Editing Procedures.” The updated
code combination lists will be available online prior to April 27.
Physicians who are not
currently registered for the CIGNA for Health Care Professionals Web
site will need to complete the registration process to log on. They
can go to www.cignaforhcp.com
and select “Register Now,” located in the left side bar.
