Forum - Questions & Answers

Oct 15th, 2019 - gowri.tina

Blue cross Blue shield denies office visits/E& M visits.

Blue cross Blue shield denies office visits/E& M visits as inclusive when billed with injection codes (11900/11901), destruction (17000/17004/17110), Acne surgery(10040) etc.

Is there any current or new update on office visits since we are getting denial only from the end of August '19.
Earlier billed office visits were paid.

Could any of you update me on this issue since BCBS is the major payor for our facility

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Nov 5th, 2019 - ChrisW   148  1 

re: Blue cross Blue shield denies office visits/E& M visits.

It may be that they were paying incorrectly and now are processing your claims correctly. If you look at each of the procedures you are asking about they all have a global period assigned to them.

For example, 11900 has a 000 Global – (Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable).

17000 has a 10 Day global, which also includes the evaluation and management services on the day of the procedure and during the 10-day post-op.

I have an article I will refer you to about how Medicare sees some of these injection codes as minor surgical procedures and assigns zero global days to these codes.
This means that, according to Medicare's National Correct Coding Initiative (NCCI) edits, the typical pre- and post-service work associated with the injection are considered to be part of the payment for the injection itself. In this scenario, this work does not rise to the significant, separately identifiable level of service that would justify the use of modifier 25 on a separate E/M claim.

The NCCI edits manual also explains the medical/surgical package. This information can also be found on Findacode.com under the additional code information page under "Additional Code Information". A resource like Find-A-code can save $1000's of dollars.

Billing injections on the same day as an E/M service https://www.findacode.com/articles/billing-injections-on-the-same-day-as-an-e-m-service-26638.html

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