Use correct code for outpatient hospital clinic visits

As you read in a January web-DENIS message and the February Record, Blue Cross Blue Shield of Michigan’s Medicare Advantage PPO eliminated evaluation and management Current Procedural Terminology codes *99201-*99205 and *99211-*99215 for outpatient hospital clinic visits. Following is some additional guidance.

Effective Feb. 5, 2014, claims received with these E&M CPT codes will be denied for dates of service on or after Jan. 1, 2014. Providers should use E&M CPT code G0463 instead, as instructed by the Centers for Medicare & Medicaid Services.

If you submit a claim with CPT codes *99201-*99205 and *99211-*99215 instead of G0463, it will trigger message code 10Z. This code indicates we won’t pay for this service. You’ll need to resubmit the claim using the code G0463 and we’ll reprocess it.

If you used the new procedure code for a date of service on or after Jan. 1, 2014 — and submitted the claim prior to the Feb. 5 implementation date — your BCBSM Medicare Advantage PPO claim will automatically be adjusted for payment.

As background, CMS eliminated the use of evaluation and management codes *99201-*99205 and *99211-*99215 for hospital outpatient clinic visits for all Medicare patients. CMS now requires health care providers to bill the new G0463 for E&M hospital outpatient clinic visits for all Medicare patients.