Create a plan to defend modifier 25 claims ahead of new Cigna policy

Why This Topic Matters

Modifier 25 claims can trigger documentation requests, denials, and payer-specific coverage changes. Understanding the article helps practices prepare documentation processes and internal review steps to support compliant billing and reimbursement.

Article Sections

1. Coding

   Introduces the article’s focus on compliance and reimbursement issues related to same-day E/M reporting and payer scrutiny.

2. Train with the descriptor and the cross-out test

   Discusses coder and provider training, documentation review concepts, and general education practices for understanding modifier 25 usage.

3. Create a plan to defend your claims

   Outlines practice-wide roles in monitoring payer policies, responding to denials, and supporting documentation and appeals processes.

4. Resources

   Lists reference materials and external resources cited by the article.