Cigna has announced a delay in implementing a policy that would have required physicians to submit clinical documentation whenever they submit a claim with certain Evaluation and Management (“E/M”) CPT® codes appended with a modifier 25. Modifier 25 is used to indicate that a patient’s condition requires a significant, separately identifiable E/M service on the same day as another procedure.
The American Medical Association and over 100 state and specialty medical associations had strongly opposed the policy. In a joint letter, they urged Cigna to withdraw the policy, stating: “Our organizations are alarmed by the significant administrative burdens and costs for health care professions – and Cigna – that will result from implementation of this policy.” (emphasis in the original). The letter offered to collaborate with Cigna to ensure that physicians were using modifier 25 correctly.
In announcing the delay in implementation, Cigna stated that it was reevaluating the policy and that it would work collaboratively with providers and medical associations to ensure that modifier 25 is used appropriately.
The joint AMA and other medical associations’ letter is linked here.