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Just days before it was to take effect, Cigna announced it would “delay implementation” of a strict new policy for E/M services billed with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same date as a procedure).
It’s not an early April Fool’s joke: CMS won’t issue National Correct Coding Initiative (NCCI) edits in April.
Missing: More than 300,000 services that had been reported with 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.)
Practices that aren’t comfortable with the guidelines for office and other outpatient E/M visits may downcode their claims because they mistakenly believe it will protect them from audits. In addition, some private payers may automatically downcode high level claims.
Cigna’s plan for unbundled office visits is likely to increase your paperwork and and slow reimbursement.


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