RCM Coding Supervisor: Tricia Krueger, CPC
Cigna Health will begin denying evaluation and management (E/M) codes and supporting Z codes lacking supplemental medical record documentation, according to a Cigna press release. Z codes are used to report social, environmental, and personal circumstances that impact a patient’s health status (i.e., social determinants of health.)
Cigna will “administratively deny the medical evaluation and management code when billed with a preventative [E/M] code and only an International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code on the claim.”
Providers documenting Z codes will now be required to “refer to multiple policies by the payer [i.e., Cigna] to utilize both preventative services and problem-oriented E/M services for new and established patients on the same date of service,”.
To best ensure complete and compliant documentation, the recommendation is to include “supporting medical record documentation with the diagnosis code for the problem E/M claim” for Cigna to identify why the documented service was provided.
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