News: New Cigna Z code policy requires additional provider documentation
Cigna Health will begin denying evaluation and management (E/M) codes and supporting Z codes lacking supplemental medical record documentation, according to a Cigna press release. Z codes are used to report social, environmental, and personal circumstances that impact a patient’s health status (i.e., social determinants of health.)
Starting July 14, Cigna will “administratively deny the medical evaluation and management code when billed with a preventative [E/M] code and only an International Classification of Diseases, 10th Revision, Clinical Modification diagnosis code on the claim.”
Providers documenting Z codes will now be required to “refer to multiple policies by the payer [i.e., Cigna] to utilize both preventative services and problem-oriented E/M services for new and established patients on the same date of service,” the Texas Medical Association (TMA) noted.
To best ensure complete and compliant documentation, the TMA recommends including “supporting medical record documentation with the diagnosis code for the problem E/M claim” in order for Cigna to identify why the documented service was provided.
Note that in the fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) final rule, several Z codes describing homelessness were granted CC status and the FY 2025 IPPS proposed rule includes even more such designations.
Editor’s note: To read the Cigna press release, click here. To read the TMA press release, click here. To read previous ACDIS coverage of SDOH and CC status, click here.