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 on this site 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 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.
| Topic | Applicable States | Article Title | Originally Published | Status |
|---|---|---|---|---|
| Ambulance | All | Rural Air Ambulance Protocols for ID, NC, and TN | 04.08.05 | Current |
| Chiropractic | All | NC Article for Documentation Needed for Chiropractic Claims (A22813) | 9.14.04 | Current |
| Chiropractic | All | Progressive Corrective Action on Chiropractic Manipulative Treatments | 07.06.06 | Current |
| Chiropractic | All | Update on Probe Reviews of Chiropractic Manipulative Treatments | 08.13.07 | Current |
| Diagnostic Services | All | Article for PET Scans Payable Diagnosis Codes (A23528) | 10.15.04 | Removed 12.12.06 |
| Diagnostic Services | All | Important Notice for Providers Ordering and Rendering Bone Mineral Density Testing | 02.10.06 | Current |
| Drugs & Biologicals | All | Article for Bevacizumab (Avastin) in the Treatment of Neovascular (Wet) Macular Degeneration | 02.14.06 | Current |
| Drugs & Biologicals | All | Article for Bexxar® (Tositumomab and Iodine131 Tositumomab) | 02.15.06 | Removed 12.03.08 |
| Drugs & Biologicals | ID | Article for Bevacizumab (Avastin) in the Treatment of Neovascular (Wet) Macular Degeneration | 02.14.06 | Current |
| Drugs & Biologicals | NC | Article for Bevacizumab (Avastin) in the Treatment of Neovascular (Wet) Macular Degeneration | 02.14.06 | Current |
| Drugs & Biologicals | TN | Article for Bevacizumab (Avastin) in the Treatment of Neovascular (Wet) Macular Degeneration | 02.14.06 | Current |
| E&M | All | E/M Coding: Volume of Documentation versus Medical Necessity | 6.03.04 | Current |
| E&M | All | Evaluation and Management Visit Prior to Screening Colonoscopy | 08.22.03 | Current |
| E&M | All | Follow-up Consultation Codes | 03.08.04 | Removed 12.03.08 |
| E&M | All | Non-Physicians Acting as Scribes for Physicians | 11.21.06 | Current |
| E&M | All | Progressive Corrective Action on Established Office Visit, CPT Code 99215 | 07.13.05 | Removed 12.03.08 |
| E&M | All | Progressive Corrective Action on Subsequent Hospital Care CPT Code 99233 | 09.09.03 | Current |
| E&M | All | Progressive Corrective Action on Initial Hospital Visits, CPT Codes 99221-99223 | 10.25.04 | Current |
| E&M | All | Pronouncement of Death | 3.23.04 | Current |
| ESRD | All | 2004 Changes to Codes for ESRD Services | 01.07.04 | Removed 12.03.08 |
| Home Health | All | Inappropriate Use of Home Health Certification and Recertification | 10.02.03 | Removed 12.03.08 |
| Home Health | All | Overview of the Medicare Home Health Benefit | 10.02.03 | Removed 12.03.08 |
| Home Health | All | The Definition of Homebound for Home Health Patients | 10.02.03 | Current |
| Incident To | All | Incident to Physician's Professional Services | 02.19.10 | Current |
| Miscellaneous | All | Article for Modifier 22 | 12.08.05 | Removed 12.03.08 |
| Miscellaneous | All | Article for Requests for Consultations from Nursing Facilities | 03.13.06 | Removed 12.03.08 |
| Miscellaneous | All | Documentation Pointers Including Correcting Errors and/or Making Late Entries to the Medical Record | 01.16.07 | Current |
| Miscellaneous | All | Low Osmolar Contrast Media (LOCM) - Coding Guidelines | 04.01.05 | Removed 12.03.08 |
| Miscellaneous | All | Services and Procedures in Nursing Homes | 01.04.99 | Removed 12.03.08 |
| Procedures/Therapies | All | Article for Correct Billing Procedure for Temporary CPT Code 0083T Stereotactic Body Radiation Therapy, Treatment Management (A40119) | 05.19.06 | Removed 12.03.08 |
| Procedures/Therapies | All | Article for Implantable Pumps for Use in Spasticity or Pain Management (A24293) | 12.03.04 | Current |
| Procedures/Therapies | TN | Article for Non-Biodegradable Drug Delivery Implant Services | 01.18.06 | Current |
| Procedures/Therapies | NC | Article for Non-Biodegradable Drug Delivery Implant Services | 01.18.06 | Current |
| Procedures/Therapies | ID | Article for Non-Biodegradable Drug Delivery Implant Services | 01.18.06 | Current |
| Procedures/Therapies | TN | Article for Sentinel Node Biopsy | 12.13.05 | Current |
| Procedures/Therapies | NC | Article for Sentinel Node Biopsy | 12.13.05 | Current |
| Procedures/Therapies | ID | Article for Sentinel Node Biopsy | 12.13.05 | Current |
| Procedures/Therapies | All | Brachytherapy of Prostate Cancer in an Ambulatory Surgical Center (ASC) | 9.30.04 | Current |
| Procedures/Therapies | All | Cryoplasty Considered Investigational | 04.24.07 | Current |
| Procedures/Therapies | All | GRAFTJACKET™ Regenerative Tissue Matrix | 03.17.05 | Current |
| Procedures/Therapies | All | Important Notice for Providers Billing Unlisted Codes | 07.21.08 | Current |
| Procedures/Therapies | All | Kyphoplasty Update | 10.17.03 | Removed 01.11.06 |
| Procedures/Therapies | All | Mobile Cardiac Outpatient Telemetry | 12.10.04 | Current |
| Procedures/Therapies | All | Mobile Cardiac Outpatient Telemetry Pricing (Revised) | 01.19.05 | Current |
| Procedures/Therapies | TN | Photoselective Vaporization of the Prostate - The GreenLight PVP Laser Procedure (A25949) | 03.07.05 | Current |
| Procedures/Therapies | ID | Progressive Corrective Action Review - 11721 | 12.03.04 | Removed 12.03.08 |
| Procedures/Therapies | All | Progressive Corrective Action Review - Chelation Therapy | 11.24.04 | Removed 12.03.08 |
| Procedures/Therapies | All | Radiofrequency Energy Delivery to the Gastroesophageal Junction (The Stretta Procedure) | 12.10.04 | Removed 12.03.08 |
| Procedures/Therapies | All | Radiofrequency Energy Delivery to the Gastroesophageal Junction (The Stretta Procedure) | 03.16.04 | Removed 12.03.08 |
| Procedures/Therapies | All | Removal and Destruction of Benign Skin Lesions - Important Reminder About Correct Billing | 04.19.07 | Removed 12.03.08 |
| Procedures/Therapies | All | Submitting Claims for Cardiac Pacemaker Evaluation Services | 10.26.04 | Removed 12.03.08 |
| Procedures/Therapies | All | Surgical Wound Catheter for Post-Operative Pain Control | 04.04.05 | Removed 12.03.08 |
| Procedures/Therapies | All | Transpupillary Thermotherapy (TTT) for Age-Related Macular Degeneration (AMD) - Investigational | 12.02.04 | Removed 12.03.08 |
| Psychiatric | All | Ordering and Performing Psychotherapy Services in Nursing Facilities | 3.23.04 | Current |
