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PAP242

Bundle/Rebundle of Codes


Provider Administrative Policy

Section
Claims Submission
Policy Date
August 2008
Status/Date
Revised/December 2011
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

Bundle/Rebundle of Codes

Prior to processing a claim, Blue Cross of Idaho reviews it using clinical editing software that may bundle or rebundle codes based on the National Correct Coding Initiative (NCCI) or other national specialty society standards.

For example, when a single code or series of codes better describes two or more codes submitted together, Blue Cross of Idaho will transfer the original code combination into the more appropriate code or code combinations. This practice is most prevalent with pathology and laboratory codes commonly billed as single codes when a comprehensive panel code is more appropriate. If a provider bills the majority of codes contained within a panel individually, the software removes those line items from the claim and replaces them with the comprehensive panel code. That panel will be the line item that processes on the claim.

Billing code combinations follow guidelines in NCCI, CPT and national specialty society reference material.  Modifiers that may be used under appropriate clinical circumstances to bypass certain code bundling edits include:

Anatomic modifiers:  E1-E4, FA, F1–F9, TA, T1-T9, LT, RT, LC, LD, RC
Global surgery modifiers: 25, 58, 78, 79
Other modifiers: 59, 91

If you have a question regarding your edited claim, please view your claim at bcidaho.com

  • Log in to the secure provider portal
  • Select Clinical Edit 
  • Choose Live Claim
  • Enter your claim number. The resulting information includes sourcing and disclosure behind the edits and allows you to see how codes bundled.

If you still do not agree with the edit after reviewing your claim and disclosure on our Web site, you may contact your provider representative or follow the instructions on PAP236 for sending a letter with supporting documentation to:

Blue Cross of Idaho
Attn:  Provider Appeals
PO Box 7408
Boise, ID  83707

Please mark your envelope “Confidential.” 

Note: If you do not attach supporting documentation, we will return your request without consideration.


Policy History

Date Action Reason
December 2011 Revised Language revision
January 2010 Revised Modifiers added

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