Vachette Pathology

CIGNA’s March 2009 edition of Network News states: CIGNA will apply CMS National Correct Coding Initiative (NCCI) Incidental and Mutually Exclusive edits and will adopt many CMS modifier guidelines beginning April 20, 2009. Modifier policies being updated are Modifiers 21, 22, 25, 59, 80, 81, 82 and AS. Modifier 25 and modifier 59 will require supporting documentation, beginning April 20, 2009.

What this means is in order to receive payment from CIGNA, every case filed with a 59 modifier must be accompanied with your report.

This modifier is often used when directed by the carrier for billing multiple procedures with the same cpt code. CMS requires the 59 modifier but does not require additional information for each claim submitted with this modifier. They will accept that these are distinct procedural services and pay accordingly upon initial submission. 

This policy is being sold as a way to decrease administrative costs and help support a more rapid and efficient electronic claim adjudication and payment.

Do not be fooled, this is just another tactic used by a payer to delay payments to providers.  Requiring sending manual claims with office notes attached will delay speedy payment by months and put an undue burden on your billing staff.