Representatives of Cigna informed the Academy today that they plan to delay implementation of a recently announced policy that would require submission of office notes with claims submitted with E/M codes 99212, 99213, 99214, or 99215 and modifier 25 when a minor procedure is billed.
News of the planned delay was shared with AADA Patient Access and Payer Relations Committee members Ryan Hick, MD, FAAD; Howard Rogers, MD, FAAD; and Government Affairs and Health Policy Council Chair Bruce Brod, MD, FAAD, during a call initiated as part of ongoing advocacy by the AADA.
Cigna representatives explained that they are delaying implementation of the policy because it is not in compliance with clean claims laws in 24 states, and they need to change their software and process. They did not provide a new timeline for implementation; however, they remain committed to efforts to ensure appropriate reporting of modifier 25.
The Academy continues to advocate to maintain appropriate reimbursement for claims submitted with modifier 25, a longstanding goal of the AADA. On the call, the AADA reiterated that, if implemented, the proposed plan will create significant undue burdens on dermatology practices.
The AADA has repeatedly asked for the opportunity to review and assess the claims that were audited by Cigna and found to lack documentation to support a significant and separately identified E/M service, providing the rationale for the new policy. On today’s call, Cigna also shared that there were differences in opinion among the Cigna coders as to the appropriate use of modifier 25 in dermatology. They are asking a third party to review the claims and will follow up with the AADA with their findings.
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