Starting July 14th
Cigna Healthcare will deny certain claims that are billed with a Z-code and without documentation. A move that could add to your administrative burden.
Cigna will deny claims when practices bill certain evaluation and management (E/M) codes (99202-99215) with a preventive service code and a supporting Z diagnosis code – but not supplemental medical record documentation.
Physicians will need to refer to multiple policies by the payer to utilize both preventive services and problem-oriented E/M services for new and established patients on the same date of service, which Texas Medical Association billing and code experts caution could add to practices’ workload. Moreover, these services will not be payable by Cigna when billed with a Z diagnosis code alone.
TMA experts recommend including supporting medical record documentation with the diagnosis code for the problem E/M claim to identify why a preventive service – like dietary counseling, for example – was performed.
Physicians can also check Cigna’s preventive services policy for examples of Z codes or refer to Cigna’s E/M Reimbursement Policy for more payment information from the payer.