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July 2011


Evaluation and Management Coding Review

CIGNA reviews Evaluation and Management (E&M) coding practices to monitor for potential upcoding as part of our ongoing efforts to improve health care quality and affordability. Upcoding is the practice of consistently using billing or revenue codes that describe more extensive services than those actually performed, as defined by the Centers for Medicare and Medicaid Services (CMS).

During this review, CIGNA evaluates claims and compares physicians' billing practices to those of their peers. Physicians who differ from their peer group may be contacted by letter or telephone call from a CIGNA representative. In some cases, chart review may be requested and performed. This upcoding review will not affect most CIGNA-participating health care professionals.

Consistent with standard industry practice, when submitting claims for payment, physicians should select the CPT code that most accurately represents the level of service performed.




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