Medical societies representing radiology and other specialties say they are “alarmed” by the cost and administrative burden posed by a new policy from Cigna.
The Bloomfield, Connecticut-based health insurer recently announced that beginning May 25, it will require the submission of medical office notes when physicians seek payment in certain scenarios. Cigna’s concerns relate to the delivery of additional evaluation and management services delivered on the same day of a procedure or other similar healthcare offering.
In less than a month, physicians must submit supporting documentation when they use “modifier 25” to bill for these situations. But the American Society of Neuroradiology, Society of Interventional Radiology and 100 other medical groups believe this will only serve to further hinder already-overwhelmed provider groups.
“Our organizations are alarmed by the significant administrative burdens and costs for healthcare professionals—and Cigna—that will result from implementation of this policy,” the radiology societies wrote in an April 18 letter to Chairman and CEO David Cordani, MBA. “By bluntly requiring clinical documentation for all claims for an E/M service reported with modifier 25, physicians and other providers will be forced to submit an enormous number of office notes, and Cigna will be deluged with medical records.”
The policy change applies to CPT codes 99212-99215 when a minor procedure is billed with modifier 25—used when “distinct services are performed on the same day,” according to the AMA. In certain situations, a patient’s condition may require a “significant, separately identifiable” E/M service that goes “above and beyond” the core procedure being reported by the physician on the same day. Cigna had previously announced the update about a year ago but paused implementation in July after physicians voiced their concerns, according to the California Medical Association.
Cigna did not immediately respond to a Radiology Business request for comment on Wednesday. Physicians said the insurer has contended that the purpose of the policy is to limit the inappropriate use of modifier 25. However, the groups said that Cigna has presented zero proof this is problems warrants correction.
“Cigna has not offered data demonstrating unexpectedly high use of the modifier or details of the underlying rationale, other than indicating it resulted from a review of ‘coverage, reimbursement, and administrative policies for potential updates’ and in consideration of ‘evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services guidance, industry standards, and/[or] … other existing policies,” the physician associations wrote.
Radiology trade groups are asking Cigna to “immediately rescind” the policy and work with medical doctors on a campaign to ensure proper documentation. They listed several other issues with the policy, including possible HIPAA noncompliance and “suboptimal” data submission methods.
“All of these concerns underscore that Cigna’s policy is extremely ill-timed and will further hamper healthcare professionals already grappling with clinician burnout, workforce shortages, recovery from the COVID-19 public health emergency, and rising practice expenses due to inflation,” they wrote. “We welcome the chance to collaborate with Cigna on alternative approaches to ensuring correct usage of modifier 25 that do not unfairly punish the majority of physicians and other healthcare professionals that appropriately code, as well as tax Cigna’s administrative systems,” the letter writers added later.
Others signing the message included the American Medical Association, the American Society for Radiation Oncology and the American Society of Nuclear Cardiology. The AMA also shared a news update about the policy on Tuesday, April 25.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.