Name of Manual - Blue Cross and Blue Shield of Minnesota

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Chapter 11 Coding Policies and Guidelines (Surgical Services) Table of Contents General Guidelines............................................................................................................... 11-2 Bilateral Services .................................................................................................................11-2 Unlisted Procedures ............................................................................................................. 11-3 Facility Fees for Office Surgery .......................................................................................... 11-3 Global Surgical Package......................................................................................................11-4 Fractures............................................................................................................................... 11-5 Incidental Surgery................................................................................................................ 11-5 Lesions ................................................................................................................................. 11-5 Surgical Trays and Supplies.................................................................................................11-5 Implanted Supplies / Devices...............................................................................................11-6 Standby Services.................................................................................................................. 11-6 Treatment of Warts .............................................................................................................. 11-6 Acne Treatment/Skin Rejuvenation and Rosacea Treatment .............................................. 11-6 Anesthetic Agent Injections.................................................................................................11-7 Intra-articular Hyaluronan Injections for Osteoarthritis ...................................................... 11-8 Liposuction Edit Change...................................................................................................... 11-9 Assistant Surgeons.............................................................................................................11-10 Co-Surgeons.......................................................................................................................11-11 Multiple Surgeries.............................................................................................................. 11-12 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12) 11-1
Coding Policies and Guidelines (Surgical Services) General Guidelines Generally, Blue Cross covers only surgical procedures performed by a physician for the treatment of illness or injury. Follow these procedures to bill surgical charges: Submit each surgical procedure on a separate line. Surgical units: Most surgical procedures should be submitted only with one unit; however, we can accept more than one unit for those surgical procedure codes whose narrative includes a unit indicator, such as “each” or “per.” For example, 11201 is an add-on code to 11200. Code 11201 indicates “each additional 10 lesions.” If 35 skin tags are removed, code 11200 would be reported with one unit for the first 15 lesions. Code 11201 could be reported with two units for the additional 20 skin tags. Submit all surgeries performed on the same date on one claim. List the appropriate procedure code for each one. Modifier -51 may be used for secondary procedures but is not required. Bilateral Services The bilateral modifier –50 is used to indicate cases in which a procedure normally performed on only one side of the body is performed on both sides. The CPT descriptors for some procedures specify that the procedure is bilateral. In such cases, the bilateral modifier should not be used. Blue Cross requires submission of one line for bilateral procedures. Correctly submitted services will be eligible for 150 percent of the procedure allowed amount. 11-2 Certain edits apply to bilateral services: If a CPT defined bilateral procedure is submitted with a -50 modifier, the service will be denied based on submission of an incorrect procedure/modifier combination. If more than one line of the same procedure code is submitted – one with the -50 modifier and one without – the unmodified line(s) will be denied as duplicative. Bilateral services on claims resubmitted will need to be submitted using the one-line reporting method regardless of the date of service. Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (03/19/12)
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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 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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Coding Policies and Guidelines (Cod
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Chapter 11 Coding Policies and Guid
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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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Pre-certification and Concurrent Re
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Prior Authorization Requirements Co
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Coding Policies and Guidelines (Dur
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Waivers and Upgraded/Deluxe DME Wai
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Hearing Aids (continued) Website Co
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Portable Oxygen Billing (continued)
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DME/Supply Internet Purchases Codin
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Coding Policies and Guidelines (Hom
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Elderly Waiver Program (continued)
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Referrals and Prior Authorization (
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Referrals and Prior Authorization (
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Adult Day Care Bath Services Coding
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Home Infusion (continued) Coding Po
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Coding Policies and Guidelines (Hom
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Rules and Regulations (continued) H
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Hospice Billing for Medicare Produc
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Coding Policies and Guidelines (Hos
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Coding Policies and Guidelines (Lab
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Coding Policies and Guidelines (Mat
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Coding Policies and Guidelines (Opt
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Coding Policies and Guidelines (Pha
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Drugs Coding Policies and Guideline
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Coding Policies and Guidelines (Pha
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