Medical Review Articles
This section represents articles published by the Medical Review department in an effort to educate the provider community on proper coding and billing related to Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and/or from issues noted in the carrier's claims and probe review activities. This section is being implemented from 12.01.04 forward. Articles prior to these dates are still available thru www.cignagovernmentservices.com via the "search" feature or as posted on the "What's New" or "What's New" archive sections. Providers may also use the coverage database on the CMS Web site to search for national or carrier-specific guidelines thru http://www.cms.hhs.gov/mcd/search.asp? Providers also have the option to submit inquiries to CIGNA via the online help inquiry tool at http://www.cignagovernmentservices.com/medicare_dynamic/customer_service/index.html provided no patient-specific or HIPAA-protected information is included.
For further Medical Review resources, please see the quarterly "Part B Medical Review Frequently Asked Questions" on the Web site at http://www.cignagovernmentservices.com/partb/faq/index.html.
Ambulance
CERT
- Comprehensive Error Rate Testing (CERT) - 3.01.04
Chiropractic
- Update on Probe Reviews of Chiropractic Manipulative Treatments - 08.13.07
- Progressive Corrective Action on Chiropractic Manipulative Treatments - 07.06.06
- NC Article for Documentation Needed for Chiropractic Claims (A22813) - 9.14.04
Diagnostic Services
- Article for PET Scans Payable Diagnosis Codes (A23528) - 10.15.04 This article removed on 12.12.06.
- Important Notice for Providers Ordering and Rendering Bone Mineral Density Testing - 02.10.06
Drugs & Biologicals
- Article for Bexxar® (Tositumomab and Iodine131 Tositumomab) - 02.15.06
- Article for Bevacizumab (Avastin) in the Treatment of Neovascular (Wet) Macular Degeneration - 02.14.06
- ID Coding Guidelines for J9202 - 8.24.04
- Injectable Anti-Emetics for Chemotherapy Related Nausea and Vomiting - 3.29.04
- Darbepoetin Alfa (Aranesp®) - 2.12.04
E&M
- Non-Physicians Acting as Scribes for Physicians - 11.21.06
- Progressive Corrective Action on Established Office Visit, CPT Code 99215 - 07.13.05
- Progressive Corrective Action on Initial Hospital Visits, CPT Codes 99221-99223 - 10.25.04
- E/M Coding: Volume of Documentation versus Medical Necessity - 6.03.04
- Pronouncement of Death - 3.23.04
- Follow-up Consultation Codes - 03.08.04
- Progressive Corrective Action on Subsequent Hospital Care CPT Code 99233 - 09.09.03
- Evaluation and Management Visit Prior to Screening Colonoscopy - 08.22.03
ESRD
- 2004 Changes to Codes for ESRD Services - 01.07.04
Home Health
- The Definition of Homebound for Home Health Patients - 10.02.03
- Inappropriate Use of Home Health Certification and Recertification - 10.02.03
- Overview of the Medicare Home Health Benefit - 10.02.03
Procedures / Therapies
- Article for Correct Billing Procedure for Temporary CPT Code 0083T Stereotactic Body Radiation Therapy, Treatment Management (A40119) - 05.19.06
- Article for Non-Biodegradable Drug Delivery Implant Services - 01.18.06
- Article for Sentinel Node Biopsy - 12.13.05
- Article for Implantable Pumps for Use in Spasticity or Pain Management (A24293) - 12.03.04
- Brachytherapy of Prostate Cancer in an Ambulatory Surgical Center (ASC) - 9.30.04
- Cryoplasty Considered Investigational - 04.24.07
- GRAFTJACKET™ Regenerative Tissue Matrix - 03.17.05
- Kyphoplasty Update - 10.17.03 NOTE: Article retired effective 1.1.06
- Mobile Cardiac Outpatient Telemetry - 12.10.04
- Mobile Cardiac Outpatient Telemetry Pricing (Revised) - 01.19.05
- Photoselective Vaporization
of the Prostate - The GreenLight PVP Laser Procedure (A25949)
(This article pertains to Tennessee providers only) - 03.07.05 - Progressive Corrective Action Review - 11721 (This article pertains to Idaho providers only) - 12.03.04
- Progressive Corrective Action Review - Chelation Therapy - 11.24.04
- Radiofrequency Energy Delivery to the Gastroesophageal Junction (The Stretta Procedure) - 12.10.04
- Radiofrequency Energy Delivery to the Gastroesophageal Junction (The Stretta Procedure)* - 03.16.04
- Removal and Destruction of Benign Skin Lesions - Important Reminder About Correct Billing - 04.19.07
- Submitting Claims for Cardiac Pacemaker Evaluation Services - 10.26.04
- Surgical Wound Catheter for Post-Operative Pain Control - 04.04.05
- Transpupillary Thermotherapy (TTT) for Age-Related Macular Degeneration (AMD) - Investigational - 12.02.04
Psychiatric
Miscellaneous
- Documentation Pointers Including Correcting Errors and/or Making Late Entries to the Medical Record - 01.16.07
- Medical Review Frequently Asked Questions – September 2006 - 09.29.06
- Medical Review Frequently Asked Questions - 06.01.06
- Article for Requests for Consultations from Nursing Facilities - 03.13.06
- Article for Modifier 22 - 12.08.05
- Low Osmolar Contrast Media (LOCM) - Coding Guidelines - 04.01.05 NOTE: Article retired effective 7.1.05
- Services and Procedures in Nursing Homes - 01.04.99
