Payer Reverses Course on Controversial Documentation Policy

Cigna is taking heed at its "burdensome" documentation requirement.

Just days before it was to take effect, Cigna announced it would delay implementation of a strict new policy requiring submission of office notes with all claims including evaluation and management (E/M) codes 99212, 99213, 99214, and 99215 and modifier -25 when a minor procedure is billed.

At the time, Cigna announced it would deny payment for these E/M services reported with modifier -25 if records documenting a significant and separately identifiable service are not submitted with the claim, and medical groups were quick to respond.  

For background, the revenue cycle coding staff report modifier -25 for E/M services on the same day of another service or procedure when it is performed by the same physician or provider.

The payer first unveiled the policy last summer, then postponed its activation after more than 100 medical associations said the policy would be too administratively burdensome and would negatively impact patient care.

The payer announced this year that it would go live with the policy on May 25. But on May 23, Cigna announced it would postpone the requirement, and did not supply a new implementation date. “Cigna will continue to review for future implementation,” the insurance company stated.

All this back and forth means that staying compliant with payers has been, and will continue to be, a burden on the revenue cycle workforce. With already strained staff it can be hard to find extra hands, and money, to keep up with payer requirements and policy changes.