Name of Manual - Blue Cross and Blue Shield of Minnesota

Freestanding
Ambulatory Surgery
Center Billing
(continued)
K3 Segment Usage
Instructions for
Condition Codes
Claims Filing
Payment of Individual Procedures – APC methodology
determines which services are included/excluded from separate
reimbursement, including implants/devices and tissue. Services
excluded from separate reimbursement are listed on the
provider fee schedule with a zero allowance. Professional
services, including anesthesia, should not be billed under this
agreement. Individual provider NPI numbers are not required.
Corneal tissue – Claims that contain corneal tissue charges
must be submitted with an attachment containing a copy of the
invoice for that corneal tissue.
99199 – The code 99199 (unlisted special service, procedure or
report) will not be considered for separate reimbursement when
submitted by an ASC. 99199 will be denied as provider
liability. No additional reimbursement will be considered on
appeal.
L8699 - Code L8699 (prosthetic implant, not otherwise
specified) will not be considered for separate reimbursement
when submitted by an ASC as it is not part of the ASC
contracted fee schedule. L8699 will be denied as provider
liability. No additional reimbursement will be considered on
appeal.
Condition Code
The NUBC has added condition codes to their code set to identify
situations where workers’ compensation requires duplicate or
appeal submissions. The 837P format does not include a
standardized way of reporting condition codes. To report
applicable condition codes on a professional claim, the K3
segment should be used.
BG is the qualifier to indicate this value and should be followed by
the appropriate condition code (refer to the NUBC Guide and Code
Set available from the National Uniform Billing Committee at
nubc.org.
Report at 2300 loop only.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (05/10/12) 8-17