96110 – Great News From Cigna (I Don’t Make This Stuff Up)

During the production of this blog, I have noticed a certain amount of serendipity with the information I take the time to share. If I mention, say, the concept of concierge medicine, I’ll get a call the next day out of the blue from a client who is working on it and shares her experience with me.

Yesterday, I started the first of two or three posts about the use of the 96110 CPT code in pediatrics. It’s symbolic of a series of codes (any of the screening codes, after hours codes, telephone codes, etc.) that many pediatricians perform, but don’t record. As you can see from the graph I posted, only ~30% of PCC customers bill for it presently. Here, in her own words, is Dr. Stoller’s proof for why you should bill everything all the time:

I got good news today from … the Cigna class-action facilitator. I (and several other pediatricians) filed a grievance with Cigna stating that bundling of 96110 was not in compliance with the settlement (I have one pending with Healthnet also). Well, today I heard that effective 5/1/08 Cigna is paying pediatricians separately on this code AND I have prevailed in my grievance and will get paid for all my 96110s I submitted to Cigna retro to 2005 (or whenever I first started billing it)! I just ran ira [a PCC report program] – I will be able to submit 819 charges to Cigna – if they pay $20 per charge that’s a little extra change. I hope this help me prevail with Healthnet, too. And only the docs that actually filed the grievance get to file for all the retro charges – everyone else benefits as of 5/1/08.

Like I said, I can’t make this stuff up.

So, thank you Dr. Stoller, on behalf of the rest of us. It’s time more and more pediatricians get paid for doing this important work. And congrats on having the foresight to always bill for this, even when you weren’t getting paid…it just shows that diligence pays off. BTW, the Cigna settlement is one of the earliest things I blogged about – wow, does that seem like a long time ago. And this isn’t the first time Dr. Stoller has busted the inscos.

I like days like this.

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