Clinical editing policies updated

In support of appropriate coding and payment accuracy, we are providing the information below to keep you informed about payment policy updates, new policies and coding reminders. 

Blue Cross Blue Shield of Michigan commercial

Anterior nasal hemorrhage and evaluation and management, or E/M, services

Modifier 25 will no longer override claim editing for E/M services when billed with CPT code *30901 (control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method). The National Correct Coding Initiative, or NCCI, has established incidental code pairs between the E/M and minor procedure for control of nasal bleeding. Health care providers may receive a denial of E/M services when billed with *30901 beginning in September 2024.

Blue Care Network commercial

Q0091

HCPCS code Q0091 isn’t payable when reported with an E/M service. Providers are encouraged not to submit appeals for Q0091 as it is always included in the E/M service performed. Providers may see these denials as of April 2024.

QVJ denials

We previously published an alert informing providers of some claims denying in error. They were denied with code QVJ (not a covered service). These claims have since been adjusted for payment and this was completed in April 2024.

BCN Advantage℠  

Acupuncture

CPT codes *20560 and *20561 will no longer deny when reported with *97810, *97811, *97813 or *97814. As of the end of April 2024, CPT codes *97810, *97811, *97813 or *97814 will deny and *20560 and *20561 will be the payable codes.

Incorrect denials

We previously informed you in February that some claims for preventive services and hearing services were incorrectly denied. They received a QN6 denial (not a covered service). These claims have been adjusted for payment. These adjustments were completed at the beginning of April 2024.

Blue Care Network commercial and BCN Advantage

G2212

The daily allowed units for G2212 have been updated to 6. This change aligns with Centers for Medicare & Medicaid Services guidelines and was effective in April 2024.