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PAP204

Coding Standards


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/September 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Coding Standards

When submitting claims to Blue Cross of Idaho, please complete all appropriate diagnosis and procedure codes in accordance with current coding standards. When CPT and HCPCS have identical narratives for a procedure, use the CPT code for filing a claim. If the HCPCS code contains more specific information in the narrative than the CPT code, use the HCPCS code for filing a claim

Some CPT and HCPCS procedure codes, by themselves, may not accurately represent the services performed if there are unusual circumstances that require consideration. In these cases, a modifier can help describe the circumstances surrounding the service/procedure and facilities correct claims processing. Blue Cross of Idaho uses both CPT and HCPCS modifiers. Depending on your provider type, you may use modifiers from either source on electronic and paper claims. For a complete list of modifiers, refer to the CPT and HCPCS coding manuals.

Please refer to Provider Administrative Policies in sections 200-500 for complete details about specific modifiers. Blue Cross of Idaho issues individual Provider Administrative Policies specific to modifiers that impact claim processing and allowances.

CPT, HCPCS, or revenue codes must be submitted with units. Claims received with blank or zero units are processed with zero allowance since there are no units to determine correct allowance.


Policy History

Date Action Reason
September 2014 Revised Added day/unit information
January 2014 Revised Minor language change.
January 2012 Revised Added language defining CPT and HCPCS

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