Notices and Announcments

Completing the Transition to ICD-10
In accordance with the U.S. Department of Health and Human Services (HHS) mandate, valid ICD-10 codes are required on claims submitted to Blue Cross and Blue Shield of Texas (BCBSTX) for dates of service or inpatient discharge dates on or after Oct. 1, 2015.

ICD-10 codes also are required for benefit preauthorization requests submitted on or after Oct. 1, 2015. Use of other codes, such as Current Procedural Terminology (CPT^®), HCPCS and Revenue Codes, is not affected by the transition to ICD-10.

Here are some key points to keep in mind:

• Use of ICD-10 is federally mandated. All Health Insurance Portability and Accountability Act (HIPAA) covered entities must comply, regardless of each patient’s type of health insurance.
• Coding directly in ICD-10 is encouraged. Coding in ICD-9 and mapping to ICD-10 may be seen as an interim solution, but is not recommended as a best practice.
• ICD-10 is date of service/discharge date driven. Resubmission or adjustments of previously filed claims must be submitted with the code set used on the original claim.
• Only one code set per claim is allowed (all ICD-9 or all ICD-10). Claims that contain both ICD-9 and ICD-10 codes will not be accepted.
• Non-compliant claims may be rejected by your clearinghouse before reaching BCBSTX. You will need to watch electronic reports and work with your clearinghouse to correct and submit affected claims.

Visit the ICD-10 page in the Standards and Requirements section of our website at bcbstx.com/provider for answers to frequently asked questions, among other resources. Also watch the News and Updates for announcements, such as dates and times of educational webinars. If you need assistance with ICD-10 questions, email us at icd@bcbstx.com, or contact your local Network Management Representative.

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

Asthma Care Reminder
The National Institute of Health (NIH) National Asthma Education and Prevention Program recommends that patients with persistent asthma should be treated with an inhaled corticosteroid. According to the NIH National Heart, Lung, and Blood Institute guidelines, chronic inhaled corticosteroid use is safe in adults and children, and it can be the most effective and preferred first-line control therapy for asthma¹.

Inhaled corticosteroids improve asthma control more effectively than any other long-term control medications. An analysis of eight cohort and ecologic studies conducted strongly suggest that inhaled corticosteroids, when taken regularly, can decrease the number of hospitalizations for asthma by up to 80 percent².

Pharmacy claims often show that asthma patients rely on albuterol rescue inhalers as the primary treatment for their asthma. A patient refilling their albuterol rescue inhaler more than once a month may be an indication that their asthma is not being appropriately treated.

If your patients are not adherent to, or are resistant to taking their inhaled corticosteroid as directed, please discuss and address their concerns. Some reasons patients may not be taking inhaled corticosteroids are:

• Concerns about taking a steroid medication (inhaled corticosteroids have fewer and less severe systemic side effects than oral steroids),
• Lack of immediate relief that albuterol inhalers can provide,
• Difficulty remembering twice daily dosing,
• Improper inhaler technique (have your patient demonstrate their technique while in the office), and
• In rare cases, thrush (prevented by rinsing mouth after use).

It is highly recommended that you work with your patient to create an asthma action plan. An asthma action plan can be a written, individualized worksheet showing your patient the steps to take in order to prevent their asthma symptoms worsening. Also, for patients with persistent asthma, assess their symptoms and determine if an inhaled corticosteroid is appropriate.

Blue Cross and Blue Shield of Texas (BCBSTX) uses the GuidedHealth^® clinical rules platform to review claims data that it receives to help identify members who have had a claim for an asthma rescue inhaler but have not received an inhaled corticosteroid. The prescribing physicians of these identified members are sent informational letters on a quarterly basis to help increase awareness and promote patient safety.
 
BCBSTX is also committed to working with communities to help improve pediatric asthma care. Through a collaboration with the American Lung Association of the Upper Midwest (ALAUM), BCBSTX is supporting the Enhancing Care for Children with Asthma Project, a program that implements community-based interventions to improve the health outcomes of children with asthma. For more information about the Enhancing Care for Children with Asthma Project, visit the ALAUM at lung.org.
           
¹Global Strategy for Asthma Management and Prevention. Global Initiate for Asthma (GINA) 2012.

²Suissa, Samy et al. Inhaled corticosteroids: Impact on asthma morbidity and mortality. J Allergy Clin Immunol. 2001. Jun;107(6):937-44.

GuidedHealth is a registered trademark of Prime Therapeutics LLC (Prime), a pharmacy benefit management company.BCBSTX contracts with Prime to provide pharmacy benefit management and other related services. BCBSTX, as well as several other Blue Cross and Blue Shield Plans, has an ownership interest in Prime. BCBSTX makes no endorsement, representations or warranties regarding GuidedHealth. If you have any questions about this product or services, you should contact Prime Therapeutics directly.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are instructed to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitation and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.