Notices and Announcments

Claims with More Than One Unit Count for Drug Test Codes
Blue Cross and Blue Shield of Texas (BCBSTX) periodically reviews claims submitted by providers to help ensure that benefits provided are for services that are included in our member’s benefit plan and meet BCBSTX’s guidelines. Some providers are submitting claims with more than one unit count for drug test codes (80300, 80301, 80303, 80320-80328 and 80345-80377) which should be a single date of service.

Effective Jan. 1, 2016, the following range of codes will allow only one unit on a single date of service: 80300, 80301, 80303, 80320-80328 and 80345-80377. Services should be provided in the most cost effective manner and in the least costly setting required for the appropriate treatment of the member.

Important Notice Regarding Category II Codes
BCBSTX periodically reviews procedures to ensure that benefits provided are for services that are included in our member's benefit plan and meet BCBSTX's guidelines.

Effective Dec. 15, 2015, the performance measurement/demonstration Category II codes listed below will no longer be reimbursed by BCBSTX.

Online Predetermination of Benefits Coming Soon
Beginning in early 2016, iExchange^® will support submission of online requests for predetermination of benefits, along with all required documentation. Watch the Blue Review/Capsule News for further information, including dates and times for educational webinars.

Using DSM-5 to Identify ICD-10 Codes
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was published in May 2013 by the American Psychological Association (APA). This manual represents the industry standard used by health care providers for the classification and diagnoses of behavioral health disorders.

Here is a description from the APA website:

DSM-5 contains the standard criteria and definitions of mental disorders now approved by the American Psychiatric Association (APA), and it also contains both ICD-9-CM and ICD-10-CM codes (in parentheses) selected by APA. Since DSM-IV only contains ICD-9-CM codes, it will cease to be recognized for criteria or coding for services with dates of service of Oct, 1, 2015, or later. Updates for DSM-5 criteria and their associated ICD-10-CM codes (identified by APA) can be found at DSM5.org.

View a brief tutorial on using DSM-5 in the transition to ICD-10.

Note: This material is provided for informational purposes only and is not an endorsement of any particular site or resource. The owners/operators of each website are solely responsible for the content on their respective websites.

Considering mobile apps for ICD-10?
Mobile apps downloaded to smart phones and tablets may be a great way to bring ICD-10 to your fingertips at the point of care. However, like all mobile apps, ease of use and quality can vary significantly.

While BCBSTX cannot endorse any particular vendor product, we wanted to offer some quick tips, if you are considering using mobile apps to assist in your transition to ICD-10:

• Look for an app that provides key word search capability.
• Make sure the app is using 2015 or 2016 ICD-10 codes.
• Look for an app that helps you look up ICD-10 codes directly, without always requiring you to first enter an ICD-9 code to get a similar ICD-10.
• Look at both free and for-purchase apps. Be aware that some apps have a free trial period, with a monthly or annual subscription fee required after the trial period ends.
• Be wary of elaborate registration processes – some vendors may use the information gathered at registration to try to sell you other products later.
• Visit the parent company’s website to verify credibility – look for a vendor that employs certified coders and has a large user base.