How To Write A Cigna Reimbursement Policy
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1 Cigna Reimbursement Policy Subject Robotic Assisted Surgery Table of Contents Reimbursement Policy... 1 General Background... 1 Coding/Billing Information... 2 References... 3 Policy History/Updates... 4 Last Review Date... 04/29/2014 Policy History/Updates: Reimbursement Policy Number... R04 Related Policies: INSTRUCTIONS FOR USE Reimbursement policies are intended to supplement certain standard Cigna benefit plans. Please note, the terms of an individual s particular benefit plan document [Group Service Agreement (GSA), Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which a reimbursement policy is based. For example, an individual s benefit plan document may contain specific language which contradicts the guidance outlined in a reimbursement policy. In the event of a conflict, an individual s benefit plan document always supercedes the information in a reimbursement policy. Proprietary information of Cigna. Copyright 2014 Cigna Reimbursement Policy Cigna does not provide additional or separate reimbursement for the use of robotic surgical devices (e.g., da Vinci Surgical System, ZEUS Robotic Surgical System). General Background Robotic-assisted surgery refers to an emerging technology used to assist the surgeon in controlling the surgical technique. The surgeon generally views the operative field via a terminal and manipulates robotic surgical instruments via a control panel. Views of the surgical site are transmitted from tiny cameras inserted into the body. The use of computers and robotics is intended to enhance dexterity to facilitate microscale operations. Robotic-assisted surgical devices have been proposed for various types of surgery, including, but not limited to: Cardiac Gastrointestinal Gynecology Maxillofacial Neurosurgery Ophthalmology Orthopedic Urology Cigna does not provide additional reimbursement based upon the type of instruments, technique or approach used in a procedure. Such matters are left to the discretion of the surgeon. Additional professional or technical reimbursement will not be made when a surgical procedure is performed using robotic assistance. Page 1 of 5
2 Reimbursement for procedures in which a robotic surgical system is used will be based on the contracted rate or usual and customary fee or maximum reimbursable charge for the base procedure. Separate reimbursement is not allowed for the robotic surgical technique. Reimbursement for the base procedure may be subject to medical necessity review. The following code is used in addition to the primary procedure to report the use of robotic assistance during a procedure: HCPCS Code S2900 Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure). This add-on code was released as a new code in July At that time, it was added to the list of non-reimbursable codes for Medicare. Example: A provider performs a laparoscopic prostatectomy with robotic assistance. The physician bills for the services with CPT code (laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing), with the add-on HCPCS code S2900 (indicating robotic assistance). Payment will be made only for the base procedure Use of Modifier 22 is not appropriate if the sole use of the modifier is to report and bill for the use of robotic assistance. Modifier 22 may be used to report unusual complications or complexities which occurred during the surgical procedure that are unrelated to the use of the robotic assistance system. Coding/Billing Information Note: 1.) This list of codes may not be all-inclusive. 2.) Deleted codes and codes which are not effective at the time the service is rendered may not be eligible for reimbursement 3) ICD-10-CM Procedure are for informational purposes only and are not effective until 10/01/2015. Not Separately Reimbursed: HCPCS S2900 Description Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) ICD-9-CM Description Procedure 17.41* Open robotic assisted procedure 17.42* Laparoscopic robotic assisted procedure 17.43* Percutaneous robotic assisted procedure 17.44* Endoscopic robotic assisted procedure 17.45* Thoracoscopic robotic assisted procedure 17.49* Other and unspecified robotic assisted procedure *Code first primary procedure ICD-10-CM Procedure (Effective Description Page 2 of 5
3 10/01/2015) 8E090CZ 8E093CZ 8E094CZ 8E097CZ 8E098CZ 8E09XCZ 8E0W0CZ 8E0W3CZ 8E0W4CZ 8E0W4CZ 8E0W7CZ 8E0W8CZ 8E0WXCZ 8E0X0CZ 8E0X3CZ 8E0X4CZ 8E0X4CZ 8E0XXCZ 8E0Y0CZ 8E0Y3CZ 8E0Y4CZ 8E0Y4CZ 8E0YXCZ Robotic Assisted Procedure of Head and Neck Region, Open Robotic Assisted Procedure of Head and Neck Region, Percutaneous Robotic Assisted Procedure of Head and Neck Region, Percutaneous Endoscopic Robotic Assisted Procedure of Head and Neck Region, Via Natural or Artificial Opening Robotic Assisted Procedure of Head and Neck Region, Via Natural or Artificial Opening Endoscopic Robotic Assisted Procedure of Head and Neck Region Robotic Assisted Procedure of Trunk Region, Open Robotic Assisted Procedure of Trunk Region, Percutaneous Robotic Assisted Procedure of Trunk Region, Percutaneous Endoscopic Robotic Assisted Procedure of Trunk Region, Percutaneous Endoscopic Robotic Assisted Procedure of Trunk Region, Via Natural or Artificial Opening Robotic Assisted Procedure of Trunk Region, Via Natural or Artificial Opening Endoscopic Robotic Assisted Procedure of Trunk Region Robotic Assisted Procedure of Upper Extremity, Open Robotic Assisted Procedure of Upper Extremity, Percutaneous Robotic Assisted Procedure of Upper Extremity, Percutaneous Endoscopic Robotic Assisted Procedure of Upper Extremity, Percutaneous Endoscopic Robotic Assisted Procedure of Upper Extremity Robotic Assisted Procedure of Lower Extremity, Open Robotic Assisted Procedure of Lower Extremity, Percutaneous Robotic Assisted Procedure of Lower Extremity, Percutaneous Endoscopic Robotic Assisted Procedure of Lower Extremity, Percutaneous Endoscopic Robotic Assisted Procedure of Lower Extremity References 1. American Medical Association. Coding with Modifiers: A Guide to Correct CPT and HCPCS Level II Modifier Usage American Medical Association. Current Procedural Terminology (CPT ) 2013 Professional Edition. 3. ICD-9 CM 2013, Procedures. Volume ICD-10-PCS International Classification of Diseases Procedure Coding System 2013 Transition & Training Edition. Page 3 of 5
4 Policy History/Updates Date Change/Update 04/29/2014 Policy Template updated, added ICD-10-PCS codes effective 10/01/2015, updated reference section 04/01/2013 Updated with ICD-9 Procedure and new template. 05/30/2011 Policy template updated 08/06/2009 Policy effective with CIGNA Great-West business 04/04/2008 Policy updated 09/22/2007 Policy effective for CIGNA HealthCare Page 4 of 5
5 Cigna, Cigna HealthCare and the Tree of Life logo are service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Behavioral Health, Inc., Cigna Health Management, Inc., and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. In Arizona, HMO plans are offered by Cigna HealthCare of Arizona, Inc. In California, HMO plans are offered by Cigna HealthCare of California, Inc. In Connecticut, HMO plans are offered by Cigna HealthCare of Connecticut, Inc. In North Carolina, HMO plans are offered by Cigna HealthCare of North Carolina, Inc. In Virginia, HMO plans are offered by Cigna HealthCare Mid- Atlantic, Inc. All other medical plans in these states are insured or administered by Connecticut General Life Insurance Company or Cigna Health and Life Insurance Company. Page 5 of 5
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