Name of Manual - Blue Cross and Blue Shield of Minnesota

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Chapter 11 Coding Policies and Guidelines (Laboratory) Table of Contents Introduction..........................................................................................................................11-2 Organ or Disease-Oriented Panels.......................................................................................11-2 Lyme Disease Titer.............................................................................................................. 11-2 Office Visits.........................................................................................................................11-2 Standing Orders ................................................................................................................... 11-3 Venipunctures and Lab Handling ........................................................................................ 11-3 Collection and handling of specimens for Minnesota Health Care Program Subscribers only .................................................................................................................................... 11-4 Papanicolaou Smears ........................................................................................................... 11-4 Pregnancy Tests ................................................................................................................... 11-6 Purchased Services/ Outside Lab......................................................................................... 11-6 Stat Lab Charges.................................................................................................................. 11-7 Repeat Lab Services............................................................................................................. 11-7 Genetic Testing Modifiers ...................................................................................................11-7 Lab Billed through the BlueCard® Program .......................................................................11-7 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/23/12) 11-1
Coding Policies and Guidelines (Laboratory) Introduction Blue Cross and Blue Shield of Minnesota (Blue Cross) does not allow providers to bill the health plan for laboratory services or imaging studies that are not ordered by a physician or other qualified practitioner because in addition to receiving lab or radiology results, the patient also needs interpretation of the tests, recommendations for future care, and a course of action that only a physician or other qualified practitioner can deliver. In addition, tests must be medically necessary in order to be eligible for coverage. As a result, we will only issue payment for services that are coordinated by a physician or other qualified practitioner. A qualified practitioner is a practitioner recognized as an eligible provider by Blue Cross and practices within the scope of his or her licensure. Specific licensing questions should be directed to your specialty’s licensing board. Organ or Disease- Oriented Panels Laboratory and pathology procedures should be submitted using the HCPCS level I or II code that best describes the service. CPT codes 80047-89358 encompass level I codes for the majority of laboratory and pathology procedures. The services listed in the pathology and laboratory section of the CPT manual may be provided by the pathologist or alternatively by technologists who are under the supervision of the pathologist or practitioner. The guidelines outlined below should be adhered to when submitting laboratory services to Blue Cross. The tests listed under each panel (80047-80076) identify the defined components of that panel, and all tests listed must be performed in order to bill for that panel. Tests performed in addition to those specifically indicated for a particular panel can be billed separately in addition to the panel code. Lab panels should be reported as 1 line item with 1 unit per panel. Lyme Disease Titer Laboratory testing codes for Lyme disease titer are 86617 or 86618. Office Visits A level-of-service office visit may be submitted in addition to laboratory tests only when additional separately identifiable services are provided. Obtaining a specimen for a streptococcus test, for example, and relaying the results to the patient are included in the reimbursement for the test itself and may not be billed separately. A minimal level of service may be submitted if a brief history and examination is performed in addition to the laboratory test. 11-2 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/23/12)
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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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Health Care Options Double Gold Dou
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Health Care Options Medicare Basic
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Health Care Options Platinum Blue S
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Health Care Options MedicareBlue PP
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Health Care Options Inquiries and C
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Health Care Options Additional info
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Health Care Options Minnesota Senio
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Health Care Options MinnesotaCare P
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Health Care Options BlueLinkTPA Blu
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Health Care Options Delta Dental Hi
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Health Care Options Prime Therapeut
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Health Care Options Workers' Compen
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Health Care Options HICF 1500 Form
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Health Care Options Networks Blue C
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Blue Plus Member Information Introd
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Blue Plus Member Rights and Respons
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Blue Plus Member Rights and Respons
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Blue Plus Member Benefits Members
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Blue Plus Quality of Care Complaint
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Blue Plus Referral Points Remember
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Blue Plus Referral Not Required We
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Blue Plus Standing Referral Minneso
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Blue Plus Clarifications of Terms (
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Blue Plus [Date] [Name of patient]
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Blue Plus Special Member Benefits O
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Blue Plus OB/GYN Open Access Diagno
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Blue Plus OB/GYN Open Access Diagno
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BlueCard® Claim Status Inquiry ...
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BlueCard® Identifying BlueCard ®
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BlueCard® Identifying BlueCard ®
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BlueCard® BlueCard Service Claims
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BlueCard® Prior Authorization and
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BlueCard® Electronic Data Intercha
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BlueCard® Claims Processed by the
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BlueCard® Overview (continued) 3.
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BlueCard® Claim Payment Guidelines
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BlueCard® Calls from Members and O
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BlueCard® Guidelines (continued) W
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BlueCard® Types of Medicare Advant
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BlueCard® Medicare Advantage Claim
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BlueCard® Reimbursement for Medica
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Claims Filing HCPCS/ Accommodation
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Claims Filing Administrative Simpli
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Claims Filing Claims with Attachmen
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Claims Filing Claims with Coordinat
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Claims Filing Claims with Coordinat
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Claims Filing 1500 HICF Form Profes
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Claims Filing Ordering Forms and Ma
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Claims Filing Site of Service (cont
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Claims Filing Institution (837I) /F
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Claims Filing Treatment Room Blue C
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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 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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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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Drug Programs Coding Policies and G
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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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Assistant Surgeons (continued) Assi
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