Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Medical Services)
Locum Tenens A substitute physician who takes over another physician’s practice
when that regular physician is absent for specific reasons (e.g.,
illness, maternity leave, military duty or sabbatical) is generally
referred to as a “locum tenens” physician. The services rendered
by the locum tenens physician may be submitted under the absent
physicians’ provider number or NPI. The modifier Q6 should be
appended to these services. Additional or replacement physicians
not substituting for an absent physician must be credentialed and
submit claims with their own NPI.
Natural Family
Planning
The natural family planning (NFP) code H1010 (Non-medical
family planning education, per session) is restricted only to those
participating non-clinic providers contracted as a NFP provider.
Clinics/medical practitioners providing NFP would bill their
services using the appropriate evaluation and management code.
Nicotine Dependence Blue Cross covers services for the treatment of tobacco
dependence. However, coverage for these services depends on the
type of provider submitting the claim, the procedure/service and
diagnosis codes submitted, and the patient’s contract with Blue
Cross. Due to these many variables, exact payment can not be
determined until we receive the claims for processing.
Diagnosis Codes
If the primary reason for the outpatient visit to the clinician is
tobacco use, claims should be submitted with one of the following
diagnosis codes:
305.1 tobacco use disorder
V15.82 history of tobacco use
Procedure/Service Codes
Clinicians should submit the HCPCS code that reflects the service
furnished. Claims may process differently depending on the code
submitted. The difference reflects the application of the member’s
contract benefits.
Evaluation and Management (E/M) codes 99201-99215:
Claims submitted using these problem-related visit codes will
process according to the illness portion of the patient’s
contract.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)
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