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In line with the NICE clinical guideline 88 'Low back pain: early management of persistent non-specific low back pain' we:
If a procedure is planned for which there is no code in this schedule, please contact the telephone number below with details or apply to www.ccsd.org.uk for a new code. Unproven or experimental procedures are excluded from cover under Cigna's Healthcare Plans.
The majority of all common clinical interventions should have a single CCSD code. This code fully describes the procedure from start to finish. The code covers the actual operation itself and all component parts and additional procedures, which are routinely or commonly performed with the operation.
Common bilateral procedures are listed in the schedule and have their own code and description and maximum fees. For non-listed bilateral and for multiple procedures performed under the same anaesthetic, the following formula should be used to calculate the maximum allowed for both the surgeon and anaesthetist.
When procedures are performed incidentally at the same time as other procedures, no supplement will be payable. Where a single procedure involves lesser procedures listed in the schedule in their own right, it should not be separated into its component parts, this is considered as unbundling.
These codes (A5210, S5210, W9040 and A7350) are not allowed as additional codes for extra benefit, either at point of pre-authorisation and at claims payment; the fee for pain relief is included in the main CCSD code.
Stand by fees will only be paid if it is clinically necessary to have a stand by surgeon and / or anaesthetist and the specialists concerned are physically present at the procedure. Details should be submitted to Cigna's Provider Affairs Department for consideration prior to the procedure being carried out.
If through clinical necessity, a second specialist is required to assist during a procedure, a separate fee may be payable. Details should be submitted to Cigna's Provider Affairs Department for consideration prior to the procedure being carried out. No additional fee is payable for the services of surgical assistants.
In this event, a supplementary fee may be payable. Details should be submitted to Cigna's Provider Affairs Department for consideration prior to the procedure being carried out.
Cigna Healthcare monitors claims by conducting claims audits and by reference to medical records. We operate a policy of zero tolerance of fraud and misrepresentation and will cease to deal with any provider who provides false, misleading or selective information. Cigna considers the following to constitute fraudulent billing:
These coding principles set out how the codes and narratives within the Cigna Fee Schedule are interpreted and used.
All CCSD Schedule users should use a single CCSD code to describe the majority of common clinical interventions. This single code fully describes the procedure from start to finish.
The code covers the actual operation itself and all component parts and additional procedures, which are routinely or commonly performed with the operation. For example:
No common clinical intervention should routinely require more than one code but occasionally, two procedures undertaken at the same attendance may legitimately require two codes to fully describe them.
In the event that there is more than one code to describe a common clinical intervention, then a new code request should be made so that an additional single code may be issued.
If a procedure code narrative does not specify whether it is an open or an endoscopic procedure, then the use of that code with another procedural narrative that does specify it as endoscopic is likely to create an inappropriate combination of codes
A combination of procedure codes that would include a smaller subset code in the main procedure code will create an inappropriate combination of codes.
Customer satisfaction is always high on the agenda at Cigna. We pride ourselves on providing the very best service to our customers. To make sure this happens we regularly carry out satisfaction surveys with our clients.
The results of our 2012 survey are now available.