Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Coding)
Coding
Overview Blue Cross and Blue Shield of Minnesota (Blue Cross) requires
submission of valid codes to report medical services and supplies
on both professional and institutional claims. This includes
Healthcare Common Procedural Coding System (HCPCS) codes,
International Classification of Diseases, 9th Revision, Clinical
Modification (ICD-9-CM) diagnosis and procedure codes and
Revenue codes.
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The Health Insurance Portability and Accountability Act (HIPAA)
Transaction and Code Set regulation stipulates submission and
acceptance of approved medical code sets. HCPCS and ICD-9-CM
codes are among the approved HIPAA medical code sets and must
be valid for the actual date of the service. If a HCPCS or ICD-9-
CM code is not valid for the date of service, the claim will be
returned or denied.
Revenue codes are a data element of the institutional claim (837I
or UB-04) and must be valid for the date of submission. If a
Revenue code is not valid on the date submitted, the claim will be
returned or denied.
HCPCS Codes The HCPCS coding system was developed by CMS (Centers for
Medicare and Medicaid Services) to standardize coding systems
used to process claims for all payers, including Medicare and
Medicaid. HCPCS is a two level coding system-Level I, a.k.a.,
CPT, and Level II, alpha-numeric codes.
All nationally developed codes are accepted; however, coverage is
not guaranteed and other restrictions may apply. Services may
deny for various reasons including a subscriber contract exclusion
or service limitation, Blue Cross corporate or medical policy, or
subject to standardized coding edits.
HCPCS codes are updated several times throughout the year. The
primary update is January of each year. CMS provides updates to
Level II codes on a quarterly basis. In addition to January, code
updates are done in April, July, and October. CPT codes are
generally updated only in January; however, the AMA can release
codes early and make codes slated for the next year’s publication
available in the prior July.
You will be notified of coding updates by Bulletin or the Provider
Press newsletter as to effective date of acceptance by Blue Cross.
Reimbursement of new HCPCS/CPT codes billed on professional
claims (CMS HICF/837P) will be based on of the then current
standard Blue Cross fee schedule allowed amount unless explicitly
stated otherwise.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)