AdministrativeMedicare AdvantageNovember 1, 2023

Updates to correct coding editing

Effective for claims processed on or after December 1, 2023, the editing systems at Anthem Blue Cross and Blue Shield will be updated to align with the American Medical Association (AMA) CPT® Manual, HPCPS Level II Manual, and Centers for Medicare & Medicaid Services (CMS) correct coding guidelines, for the following services:

  • Ulcer debridement and ulcer staging:

    • According to the ICD-10 Diagnosis Coding Manual, specific diagnosis codes that reflect the stage of the ulcer should be billed with the appropriate CPT code. For example, if billing a stage 3 pressure ulcer code, a stage 4 diagnosis code should not be reported.
    • According to the AMA CPT Manual, a debridement of an ulcer should be reported with the appropriate diagnosis code that reflects that service.
  • Billing of anatomical modifiers:

    • According to the AMA CPT and HCPCS Level II manuals, the appropriate anatomical modifier is required to be appended to the appropriate procedure code. If not, the claim line will be denied. These modifiers designate the body part that a service is being performed on (for example, FA: Left hand, thumb, TA: Left foot, great toe).
  • Billing of interprofessional telephone/internet consultations:

    • These billed procedure codes will follow the AMA CPT Manual coding guidelines.

Claim lines not billed in accordance with the correct coding guidance outlined above will be denied.

If you disagree with a claim reimbursement decision, please follow the claim dispute process (including submission of such documentation with the dispute) as outlined in the Provider Manual.

If you have questions about this communication or need assistance with any other item, contact your provider relationship management representative.

With your help, we can continually build towards a future of shared success.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-038660-23, MULTI-BCBS-CR-046278-23-CPN45683

PUBLICATIONS: November 2023 Provider Newsletter, December 2023 Provider Newsletter