Name of Manual - Blue Cross and Blue Shield of Minnesota

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OB/GYN Open Access Diagnosis (continued) Code Description 780.01-780.99 General symptoms 788.0-788.9 Symptoms involving urinary system Blue Plus 789.1-789.9 Other symptoms involving abdomen and pelvis 795.00-795.79 Nonspecific abnormal histological and immunological findings 996.32 IUD complications V01.6 Contact with or exposure to venereal diseases V07.4 Postmenopausal hormone replacement therapy V10.3 Personal history of malignant neoplasm breast V10.40- V10.44 V13.21- V13.29 Personal history of malignant neoplasm female genital organs Personal history of pre-term labor Other genital system and obstetric disorders V15.7 Other personal history presenting hazards to health-contraception V16.3 Family history of malignant neoplasms of breast V16.40- V16.49 Family history of malignant neoplasms of genital organs V22.0-V28.9 Nor mal pregnancy Supervision of high-risk pregnancy Postpartum care and examination Contraceptive management Procreative management Outcome of delivery Antenatal screening V45.51- V45.52 Presence of intrauterine contraceptive device Intrauterine contraceptive device Presence of subdermal contraceptive implant V61.5-V61.7 Multip arity Illegitimacy or illegitimate pregnancy Other unwanted pregnancy V67.00-V67.9 Follow-up examination V70.0-V70.9 General medical examination Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10) 6-25
Blue Plus OB/GYN Open Access Diagnosis (continued) Code Description V71.5 Observation following alleged rape or seduction V72.31- V72.42 Gynecological examination Pregnancy examination or test, pregnancy unconfirmed V74.5 Special screening examination for venereal disease V76.10- V76.19 Special screening for malignant neoplasms of breast V76.2 Special screening for malignant neoplasms of cervix *Includes all codes (4th or 5th digit) under this category. Vision Care Fully insured members have direct access to general eye care services rendered by Aware participating optometrists and ophthalmologists. Appropriate ophthalmologist services including eye examinations and Evaluation and Management (E/M) procedure codes as well as CPT codes 65205, 65210, 65220, 65222, and 68761 are eligible. Some self-insured groups also include this benefit. Major surgical procedures and follow-up care will continue to be coordinated through the member’s PCC. 6-26 Blue Cross Blue Shield of Minnesota Provider Policy and Procedure Manual (12/27/10)
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Blue Cross and Blue Shield of Minne
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Recent Chapter changes: Chapter 11
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Chapter 11 - Coding Policies and Gu
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Durable Medical Equipment Date Topi
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Medical Emergency Date Topic Change
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Rehabilitative Services Date Topic
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Table of Contents Chapter 1 At Your
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Introduction Provider Policy and Pr
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How to Contact Us At Your Service P
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At Your Service Claims Address Subm
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Care Management Numbers and Address
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Care Management Numbers and Address
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Company Phone Number Address Public
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At Your Service Provider Identifica
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ID Cards At Your Service Introducti
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Electronic Commerce Overview An imp
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Remote Access Services (continued)
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Provider Communications Provider Co
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Health Plan Members have the Follow
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Provider Agreements Participation a
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Provider Agreements Responsibilitie
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Provider Agreements Provider Number
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Provider Agreements Accounting for
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Provider Agreements Carrier Replace
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Table of Contents Chapter 3 Quality
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Quality Improvement Leadership Rati
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Quality Improvement Telephone Care:
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Quality Improvement Quality of Care
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Quality Improvement Written Policie
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Quality Improvement Written Policie
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Quality Improvement Patient Safety
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Quality Improvement Medical Record
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Quality Improvement Institute for C
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Quality Improvement Quality Improve
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Quality Improvement Physical Facili
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Quality Improvement Treatment Recor
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Integrated Health Management Progra
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Integrated Health Management Provid
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Integrated Health Management Utiliz
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Integrated Health Management Medica
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Integrated Health Management Overvi
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Integrated Health Management Pre-Ce
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Integrated Health Management Decisi
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Integrated Health Management Defini
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Integrated Health Management For Lo
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Integrated Health Management Appeal
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Integrated Health Management Case &
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Integrated Health Management Diseas
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Integrated Health Management Focuse
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Integrated Health Management Specia
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Integrated Health Management Overvi
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Integrated Health Management Sample
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Health Care Options Prepaid Medical
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Health Care Options Member ID Cards
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Health Care Options Blue Cross and
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Page 125 and 126: Health Care Options MedicareBlue PP
Page 127 and 128: Health Care Options Inquiries and C
Page 129 and 130: Health Care Options Additional info
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Page 135 and 136: Health Care Options BlueLinkTPA Blu
Page 137 and 138: Health Care Options Delta Dental Hi
Page 139 and 140: Health Care Options Prime Therapeut
Page 141 and 142: Health Care Options Workers' Compen
Page 143 and 144: Health Care Options HICF 1500 Form
Page 145 and 146: Health Care Options Networks Blue C
Page 147 and 148: Blue Plus Member Information Introd
Page 149 and 150: Blue Plus Member Rights and Respons
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Page 153 and 154: Blue Plus Member Benefits Members
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Page 157 and 158: Blue Plus Referral Points Remember
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Page 161 and 162: Blue Plus Standing Referral Minneso
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Page 165 and 166: Blue Plus [Date] [Name of patient]
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Page 173 and 174: BlueCard® Claim Status Inquiry ...
Page 175 and 176: BlueCard® Identifying BlueCard ®
Page 177 and 178: BlueCard® Identifying BlueCard ®
Page 179 and 180: BlueCard® BlueCard Service Claims
Page 181 and 182: BlueCard® Prior Authorization and
Page 183 and 184: BlueCard® Electronic Data Intercha
Page 185 and 186: BlueCard® Claims Processed by the
Page 187 and 188: BlueCard® Overview (continued) 3.
Page 189 and 190: BlueCard® Claim Payment Guidelines
Page 191 and 192: BlueCard® Calls from Members and O
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Page 195 and 196: BlueCard® Types of Medicare Advant
Page 197 and 198: BlueCard® Medicare Advantage Claim
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Page 201 and 202: Claims Filing HCPCS/ Accommodation
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Page 207 and 208: Claims Filing Claims with Coordinat
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Page 211 and 212: Claims Filing 1500 HICF Form Profes
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Page 215 and 216: Claims Filing Site of Service (cont
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Claims Filing Single facility claim
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Claims Filing Present on Admission
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Claims Filing Medicare Crossover Bl
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Claims Filing Cancel/Void and Repla
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Claims Filing Verifying Patient Eli
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Claims Filing Basic Character Set V
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Claims Filing Rural Health Clinics
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Claims Filing Coordination of Benef
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Claims Filing TEFRA The 1982 Tax Eq
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Claims Filing Employment As defined
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Claims Filing Surgical Technicians
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Reimbursement / Reconciliation Reim
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Reimbursement / Reconciliation Comp
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Reimbursement / Reconciliation Remi
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Ques
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Reimbursement / Reconciliation Acco
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Reimbursement / Reconciliation Fiel
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Appeals Provider Appeals Introducti
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Appeals Submitting Requests for Pos
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Appeals Coding Appeals (continued)
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Appeals Supporting Documentation (c
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Coding Policies and Guidelines (Cod
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Coding Policies and Guidelines (Cop
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Coding Policies and Guidelines (Mod
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Chapter 11 Coding Policies and Guid
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Part-time (Medically Directed) Anes
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Electroconvulsive Treatments Blue C
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Moderate (Conscious) Sedation Monit
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Coding Policies and Guidelines (Beh
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Coding Restrictions Code Restrictio
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CTSS Skills Training and Developmen
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Intensive Residential Treatment Ser
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IRTS Member Eligibility IRTS Access
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Adult Non-Residential Crisis Servic
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MH-TCM Services to Minnesota Health
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Dialectical Behavioral Therapy/DBT
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Autism Spectrum Disorder/EIBI (cont
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Autism Spectrum Disorder/EIBI (cont
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Psychiatric Consultation to Primary
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Psychiatry and Chemical Dependency
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Medication Management M0064 and 908
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Nutritional Counseling/Medical Nutr
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Practitioner Key MD = Psychiatrist
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Clinical Supervision Under Minnesot
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DIAMOND Initiative (continued) Reim
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Missed Appointments (continued) Cou
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Guidelines for Court Ordered Evalua
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Guidelines for Court Ordered Evalua
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Behavioral Health Quality Improveme
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Pre-certification and Concurrent Re
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Coding Policies and Guidelines (Chi
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Coding Policies and Guidelines (Den
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Papanicolaou Smears (continued) Dia
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Opt
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Drug Programs Coding Policies and G
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Coding Policies and Guidelines (Pub
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Coding Policies and Guidelines (Rad
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Physical Therapy Evaluation Codes C
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Hot and Cold Pack Exclusion TMJ Ort
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Massage and Manual Therapy Exclusio
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MHCP PT, OT, ST Authorization Proce
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Bilateral Services (continued) Codi
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Coding Policies and Guidelines (Sur
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Acne Treatment/ Skin Rejuvenation a
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Liposuction Edit Change Coding Poli
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Assistant Surgeons (continued) Assi
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