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Accident and Injury Billing


Provider Administrative Policy

Section
Claims Submission
Policy Date
July 2007
Status/Date
Revised/August 2012
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

Accident and Injury Billing

If any of the following diagnosis codes are primary for any of the lines of service on your claim, Blue Cross of Idaho will require accident information.

 V71.3 - V71.4
800.00 - 999.9

Exceptions (codes listed below do not require accident date):

989.9 990 991.0 - 991.9 992.0 - 993.3
993.8 - 993.9 994.2 - 994.6 994.9 - 996.99 997 - 999.9

We need this information for third party liability claims as well as BlueCard® claims. Reimbursement is subject to accident benefits available in the member’s coverage.

If the service provided relates to a recent injury or accident, use the appropriate diagnosis codes and complete fields 10 and 14 on CMS 1500. Please do not use these codes if the service is not the result of an accident or injury. If the service relates to an old injury, be sure to verify the diagnosis code in ICD-9 to determine if you should use a non-accident diagnosis code.

Example:     tear meniscus (knee)
                    current injury – 836.2
                    previous injury review – 717.0 section

If the only appropriate diagnosis code is in the above series and your patient cannot recall any injury or accident date, please submit your claim to Blue Cross of Idaho following these steps:

• Document in your patient's chart.
• Use the first date of service for this diagnosis as the date of injury/accident.
• Use other for accident indicator on CMS 1500.

Please read the ICD-9 descriptions for 800 and 900 series to see if they give an excluded diagnosis, such as congenital, pathological or recurrent. If you determine that one of the excluded diagnoses fits the patient circumstance, you may use that diagnosis. In which case, the accident information is not necessary.

Federal Employee Program (FEP)

FEP claims may process differently based on the policy definition of an accident.

  • FEP considers and accidental injury to be one caused by an external force or element such as a blow or fall which requires immediate medical attention, including animal bites and poisonings. The definition applies even if there is no injury to the outside of the body, as in the case of medication overdoses.


Policy History

Date Action Reason
August 2012 Revised Codes updated
March 2012 Revised Added FEP's defiintion of an accident
January 2011 Revised Codes updated

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