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Tag Archives: BCBS

BCBS – New Reimbursement Guidelines for Smoking Cessation effective from September 26, 2019

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Effective September 26, 2019, Horizon BCBSNJ will change the way consider certain professional claims for smoking cessation services provided September 26, 2019.

In accordance with CMS guidelines, Horizon BCBSNJ shall consider for reimbursement smoking and tobacco cessation counseling visits (99406 or 99407) for asymptomatic patients when billed with an approved diagnosis code.

Approved Diagnosis Codes:
  • Nicotine dependence (F17.21-F17.299)
  • Personal history of nicotine dependence (Z87.891)
  • Initial encounter, toxic effect of tobacco and nicotine (T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A,  T65.224A, T65.291A, T65.292A, T65.293A, T65.294A)

Evaluation and management (E&M) services shall be considered for reimbursement on the same day as smoking and tobacco-use cessation counseling services (99406 or 99407) only when medically necessary, as indicated by appending Modifier 25 to the E&M service.

Limitation: 

Horizon BCBSNJ shall limit smoking and tobacco-use cessation counseling (99406 or 99407) in any combination to eight times within a one-year period.

Reference:BCBSNJ


Coding Ahead

BCBS Reimbursement Policy Update: Bundled Services-Professional

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Beginning with dates of service on or after November 1, 2019, new Inter-professional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service. 

These codes have been added to policy section 1 of the Bundled Services and Supplies reimbursement policy.

Source: https://providernews.anthem.com/indiana/article/reimbursement-policy-update-bundled-services-professional


Coding Ahead

SC BCBS Blue Essentials 00811 Denials

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Hello,

We bill for CRNA’s for anesthesia in South Carolina . We recently have been getting denials for SC BCBS Blue Essentials when we bill 00811 (When screening colonoscopy procedure turns diagnostic) as the reason "Benefit Plan does not cover this service." Is anyone else experience this issue/ have a remedy? We have reviewed the medical policy on BCBS website for our state, asked provider services, and used the Snat Chat option without getting a direct answer if policy has changed. We don’t have access to any of the Blue Essentials policy details.

Thank you!

Medical Billing and Coding Forum

CPT 78492 denied – To require modifier from BCBS Florida

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We called to BCBS insurance and provided the below comments,

CPT 78492 is a Cardio imaging procedure and for its need more appropriate modifier should be obtained to indicate the clinical determination. suggested to send corrected claim with valid modifier for the CPT 78492.

DOS 02/11/2019.

We have billed only PET service for this DOS and no additional service billed on same day. Also patient does not have any global.

Can you anyone suggest what modifier require for this.

Medical Billing and Coding Forum

J100 with BCBS of LA

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I am in billing for an urgent care group in Texas. Many of our patients have Blue Cross and Blue Shield of Louisiana, and their plans invariably deny code J1100 as "invalid", even with -25 modifier appended to the E/M. Our local Blue Cross affiliate regards this as a payable code, and that is about all the information I can get from BC. Has anyone had experience with this, or have any ideas how we might get these paid?

We generally bill the J1100 with an E/M (99213 or 99214) and 96372 with a -25 modifier appended to the E/M. Most often the diagnosis is J01.90.

Thanks.

Medical Billing and Coding Forum

J100 with BCBS of LA

Posted on by
I am in billing for an urgent care group in Texas. However, many of our patients have Blue Cross and Blue Shield of Louisiana, and their plans invariably deny code J1100, even with -25 modifier appended to the E/M. Our local affiliate regards this as a payable code, and that is about all the information I can get from BC. Has anyone had experience with this, or have any ideas how we might get these paid?

Medical Billing and Coding Forum