Accident and Injury Billing
Provider Administrative Policy
DisclaimerOur 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.
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.
|August 2012||Revised||Codes updated|
|March 2012||Revised||Added FEP's defiintion of an accident|
|January 2011||Revised||Codes updated|