At our office we are all of a sudden having Cigna deny all our x-rays 73620 and 73630. The reason code (which isn't actually on every EOB) is: Health care professional is not assessed to perform this imaging service. I had called Cigna and had a very strange interaction whereby the person said to me, "I cannot help you but I stringly advise you to use this form" he then walked me through the website to download an appeal form. I did appeal that claim and inclused the license from NY State we have hanging next to the x-ray machine but haven't heard back yet. I am wondering if this is happening to just us or is it more widespread? I see they recently settled a class action lawsuit for a mass denials but I do not see anything specific about Podiatrists and X-Rays. Thany you for any advise you may have.
No, we have not heard of this from others, at least not yet. This does not sound right. I suggest you continue to appeal these. If this continues, I suggest you coordinate with your administrative defense coverage (ADC) carrier to help in your communications with the payer and in getting this fixed. It is possible it is a credentialing problem between you and the payer which most ADC plans help with. If this continues to be a problem and they do not repair their claim processing editing for you, NYSPMA would like to hear about this.
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Certified Professional Coder
Certified Professional Medical Auditor
Lehrman Consulting, LLC