Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Edits
Blue Cross Blue and Shield of Minnesota Provider Policy and Procedure Manual (07/12/12)
Coding Policies and Guidelines (Coding)
Overview Blue Cross uses an automated procedure editing tool. This tool has
been adopted and modified by Blue Cross to assist in a consistent
and fair claim review process. The procedure code edits may also
reflect Blue Cross’ Medical Coverage Guidelines, benefit plans
and other Blue Cross policies. Unbundling, fragmentation,
mutually exclusive procedures, duplicate, obsolete or invalid codes
are all identified through the use of this coding edit application.
The procedure code edits are based on CPT guidelines, a review of
the Center for Medicare and Medicaid Services (CMS) Correct
Coding Initiative policies and guidelines, specialty society
guidelines, agreed upon industry practices and analysis by an
extensive clinical consultant network. This automated review
process is designed to apply the same industry criteria consistently
across all professional claims.
Edit Descriptions Procedure Code Unbundling/Replacement
Procedure code unbundling is the submission of multiple
procedure codes for a group of specific procedures that are
components of a single comprehensive code. Procedure
unbundling may occur in one of two ways:
A professional claim could be submitted that has procedure codes
for both the individual components, and the procedure code for the
comprehensive procedure. Blue Cross would rebundle the
individual component codes into the comprehensive procedure
code for payment.
Procedure unbundling could also occur when a professional claim
is submitted with only the individual components of the
comprehensive code. In this situation, the software will recognize
the relationship between the comprehensive code and its individual
components. Then, it will automatically add the comprehensive
code to the claim and rebundle the individual components into that
comprehensive code for payment.
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