Clinical editing policies updated

To ensure correct coding and payment accuracy, we’re sharing the below information about forthcoming payment policy updates, new policies and coding reminders. 

Blue Cross Blue Shield of Michigan commercial

Modifier “AS” is required for assistant at surgery billing

The modifier “AS” is used to indicate that the assistant at the time of surgery was a physician's assistant, certified nurse practitioner, clinical nurse specialist or doctor of podiatric medicine.

Claims submitted without the modifier may be denied when major surgical procedures have also been billed by a physician. In August, we plan to add a new line appending modifier AS to ensure services are reimbursed at the correct rate.

Don’t bill multiple anesthesia codes

Only one anesthesia code should be reported per anesthesia administration encounter and when multiple surgical procedures are performed during a single anesthesia administration. Claims submitted for more than one anesthesia code may receive a denial.

Blue Care Network commercial

Preadmission testing

Testing that is related to an inpatient admission is considered inclusive to the inpatient stay. Claims submitted for preadmission testing when related to inpatient admission may receive a denial.

BCN Advantage℠

Frequency limit for subsequent visits
In alignment with the Centers for Medicare & Medicaid Services, BCN Advantage has removed frequency limits for subsequent inpatient visits, subsequent nursing facility visits and critical care consultation when reported with modifiers 93, 95, FQ, GT and GQ. This applies to telehealth place of service (02 and 10).

BCN commercial and BCN Advantage

Reporting multiple visits

Both BCN commercial and BCN Advantage don’t reimburse more than one emergency room visit on the same day. Multiple visits reported on the same day, with same revenue code, without condition code GO aren’t allowed.