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PAP204

Coding Standards


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Reviewed/February 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 or service, 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 further consideration. In these cases, a modifier can help describe the circumstances surrounding the service/procedure and facilitate 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 and 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.


Policy History

Date Action Reason
January 2014 Revised Minor language change.
January 2012 Revised Added language defining CPT and HCPCS

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