|
February 2014
We’re working to reprocess pharmacy and anesthesia claims that were rejected
As of Dec. 13, 2013, for dates of service on or after Oct. 1, 2013, Health Care Procedure Coding System codes were no longer required on hospital outpatient facility claims when revenue codes 0251-0254, 0256-0259, 0370, 0379 or 0637 were reported on the claim lines. On surgery claims, service lines with 0251, 0252, 0257-0259, 0370, 0379 or 0637 will continue to be bundled with surgery services.
Blue Cross Blue Shield of Michigan will reprocess the pharmacy and anesthesia claim lines that were rejected between Oct. 1, 2013, and Dec. 12, 2013. The reprocessing, however, may not be completed until late in the first quarter of 2014. If hospitals don’t want to wait for their claims to be reprocessed, they can resubmit the rejected claims.
Description |
Revenue codes that require HCPCS codes |
Surgery (including maternity) |
0360, 0361, 0369, 0490, 0499, 0750, 0769, 0790
Codes that require a surgical HCPCS if surgery is performed in this room: 0450, 0451, 0452, 0456, 0510, 0511, 0512, 0513, 0514, 0515, 0516, 0519, 0700, 0761 |
Laboratory – clinical/anatomical |
0300, 0301, 0302, 0303, 0304, 0305, 0306, 0307, 0309, 0310, 0311, 0312, 0314, 0319, 0923, 0924, 0925 |
Other |
0270*, 0271*, 0272*, 0279*, 0280, 0289, 0380, 0381, 0382, 0383, 0384, 0385, 0386, 0387, 0389, 0390, 0391, 0392, 0399, 0410, 0412, 0413, 0419, 0450, 0451, 0452, 0456, 0459, 0460, 0469, 0470, 0471, 0472, 0479, 0480, 0481, 0482, 0483, 0489, 0500, 0509, 0510, 0511, 0512, 0514, 0515, 0516, 0517, 0519, 0530, 0531, 0539, 0540, 0545, 0621, 0622, 0623, 0730**, 0731, 0732, 0739, 0740, 0750, 0780, 0920, 0921, 0922, 0929, 0940, 0942, 0943, 0949, 0951, 0952, 2101, 2105, 2106 |
Durable Medical Equipment/Prosthetic & Orthotic |
0274, 0291, 0292, 0293, 0946, 0947 |
Drug Administration |
0260, 0331, 0332, 0335, 0771 |
Drug/Pharmacy |
0250*, 0262, 0631, 0632, 0633, 0634, 0635, 0636 |
Radiopharmaceutical |
0255, 0343, 0349 |
Radiology |
0255, 0320, 0321, 0322, 0323, 0324, 0329, 0330, 0333, 0339, 0340, 0341, 0342, 0343, 0344, 0349, 0350, 0351, 0352, 0359, 0400, 0401, 0402, 0403, 0404, 0409, 0610, 0611, 0612, 0614, 0615, 0616, 0618, 0619, 0860, 0861 |
Emergency room & trauma |
0450, 0451, 0452, 0459, 0681, 0682, 0683, 0684, 0689 |
Surgery (Maternity) |
Refer to “Surgery” |
Treatment Room |
0761 |
Observation Room |
0762 |
Physical Therapy, Occupational Therapy, Speech and Language Pathology Evaluation |
0424, 0434, 0444 |
Physical Therapy, Occupational Therapy, Speech and Language Pathology Visit |
0421, 0431, 0441 |
*This code may not have a HCPCS code that can be reported with it.
**Ambulatory surgery facilities must report the applicable EKG HCPCS code when reporting revenue code 0730. Other applicable revenue codes and HCPCS code information for laboratory, radiology and surgery services are included above. |
