ClaimsXtenTM System Edit Updates, Effective June 2015

Posted March 16, 2015 

Beginning on or after June 15, 2015, Blue Cross and Blue Shield of Illinois (BCBSIL) will enhance the ClaimsXten code auditing tool with the following changes to the bundling logic in our claim processing system:  

  • Electrocardiogram (ECG) studies (Current Procedural Code Terminology (CPT®) codes 93000, 93005 and 93010) will bundle to surgical and radiological CPT codes. This is in accordance with CPT, Centers for Medicare & Medicaid Services National Correct Coding Initiative (CMS NCCI) and industry auditing guidelines.
  • Surgical procedure codes submitted with codes 88302, 88304, 88305, 88307 and 88309 will now be subject to CPT, CMS NCCI and industry auditing guidelines.
  • Venipuncture codes 36400, 36405, 36406, 36410, 36415, 36416, 36420, 36425, 96523 and S9529 will now bundle to all medical, surgical and laboratory procedure codes. This is in accordance with industry standards that include consideration for phlebotomy charges in their global laboratory fee schedule.
  • Urinalysis codes 81002 and 81003 will now be subject to CMS NCCI auditing guidelines and will bundle to evaluation and management procedure codes (99201 - 99429).
  • Preventive evaluation and management codes 99381 – 99429 submitted with office/outpatient evaluation and management codes 99201-99215 will now be subject to CPT, CMS NCCI and industry auditing guidelines.

In accordance with CPT/HCPCS guidelines, use of modifiers may impact the outcome of the final adjudication of claims for the changes listed above. Consult your CPT codebook appendix A or HCPCS codebook for guidance in the appropriate use of modifiers.

To help determine how coding combinations on a particular claim may be evaluated during the claim adjudication process, you may continue to utilize Clear Claim Connection™ (C3). C3 is a free, online reference tool that mirrors the logic behind BCBSIL’s code-auditing software. Refer to the Education and Reference Center/Provider Tools/Clear Claim Connection section of our Provider website for additional details on C3 and ClaimsXten. Information also may be published in the News and Updates, as well as upcoming issues of the Blue Review. 

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services. 

CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. 

Checks of eligibility and/or benefit information are not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.