ClaimsXten^TM System Edit Updates, Effective in June

In mid-June, Blue Cross Blue and Shield of Texas (BCBSTX) enhanced the ClaimsXten code auditing tool with the following changes to the bundling logic in our claim processing system:

• Anesthetic nerve blocks will bundle to American Society of Anesthesiologists Current Procedural Code Terminology (CPT^®) codes. This is in accordance with CPT, Centers for Medicare & Medicaid Services National Correct Coding Initiative (CMS NCCI) and industry auditing guidelines.

• Surgical procedure codes submitted with any evaluation and management, anesthesia, surgical, medical or therapeutic procedure code will now be subject to CPT, CMS NCCI and industry auditing guidelines.

• Venipuncture codes 36410, 36415 and 36416 will now bundle to all medical, surgical, laboratory procedure codes.

• Evaluation and management procedure codes submitted with any anesthesia, surgical, medical or therapeutic procedure code will now be subject to CMS global surgical package bundling logic.

• Medical/therapeutic procedure codes submitted with any anesthesia, surgical, medical or therapeutic procedure code will now be subject to CPT, CMS NCCI and industry auditing guidelines.

• Radiological procedure codes submitted with any anesthesia, surgical, medical or therapeutic procedure code will now be subject to CPT, CMS NCCI and industry auditing guidelines.

• Supply codes submitted with any anesthesia, surgical, medical or therapeutic procedure code will now be subject to CPT, CMS NCCI and industry auditing guidelines

• Therapeutic procedure codes submitted with any anesthesia, surgical, medical or therapeutic procedure code will now be subject to CPT, CMS NCCI and industry auditing guidelines.

In accordance with CPT/HCPCS guidelines, use of modifiers may impact the outcome of the final adjudication of claims for the changes listed above. Consult your CPT codebook appendix A or HCPCS codebook for guidance in the appropriate use of modifiers.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim Connection^™ (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSTX’s code-auditing software. Refer to the Education & Reference/Provider Tools/ Clear Claim Connection section of our website for additional details on C3 and ClaimsXten. Information also may be published in the News and Updates, as well as upcoming issues of Blue Review.

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent, third-party vendor that is solely responsible for its products and services.

CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Checks of eligibility and/or benefit information are not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.