The Record - Blue Cross Blue Shield of Michigan to change professional provider fees July 1

New edit codes, effective Oct. 1, to support ICD-10

As you know, the federal government is requiring the health care industry to use ICD-10 codes in place of ICD-9 codes beginning with dates of service on or after Oct. 1, 2015. To comply with this mandate, Blue Cross Blue Shield of Michigan will use new front-end edit codes for electronic claims that:

Have invalid ICD-10 codes and qualifiers

Contain ICD-9 codes for dates of service on or after Oct. 1

Contain ICD-10 codes for dates of service prior to Oct. 1

Contain both ICD-9 and ICD-10 codes in the same claim

The edits listed below are effective Oct. 1. Claims receiving any of these edits on 277CA reports or transactions must be corrected and resubmitted.

Edit code

FACILITY — Edit description

Logic

MF20

INVALID ICD-10 PRINCIPAL DIAGNOSIS

If qualifier ABK is reported, the principal diagnosis code reported in Loop 2300 HI01-2 must be a valid ICD-10 code.

MF21

INVALID ICD-10 OTHER DIAGNOSIS CODE

If qualifier ABF is reported, the other diagnosis code reported in Loop 2300 HI01-2 through HI12-2 must be a valid ICD-10 code.

MF22

INVALID ICD-10 PRINCIPAL PROCEDURE CODE

If qualifier BBR is reported, the principal procedure code reported in Loop 2300 HI01-2 must be a valid ICD-10 code.

MF23

INVALID ICD-10 OTHER PROCEDURE CODE

If qualifier BBQ is reported, the other procedure code reported in Loop 2300 HI01-2 through HI12-2 must be a valid ICD-10 code.

MF24

INVALID ICD-10 ADMITTING DIAGNOSIS CODE

If qualifier ABJ is reported, the admitting diagnosis code reported in Loop 2300 HI01-2 must be a valid ICD-10 code.

MF25

INVALID ICD-10 EXTERNAL CAUSE OF INJURY DIAGNOSIS CODE

If qualifier ABN is reported, the diagnosis code reported in Loop 2300 HI01-2 through HI12-2 must be a valid ICD-10 code.

MF26

INVALID ICD-10 PATIENT REASON FOR VISIT DIAGNOSIS CODE

If qualifier APR is reported, the diagnosis code reported in Loop 2300 HI01-2 through HI03-2 must be a valid ICD-10 code.

F720

BK PRINCIPAL DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BK qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date.

F721

BK PRINCIPAL DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BK qualifier not valid on or after Oct. 1, 2015. For outpatient claims, use Statement From date.

F722

BF OTHER DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BF qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date.

F723

BF OTHER DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BF qualifier not valid on or after Oct. 1, 2015. For outpatient claims, use Statement From date.

F724

BR PRINCIPAL PROCEDURE QUALIFIER INVALID AFTER 10/1/2015

BR qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date.

F725

BQ OTHER PROCEDURE QUALIFIER INVALID AFTER 10/1/2015

BQ qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date

F726

BJ ADMIT DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BJ qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date.

F727

BN EXTERNAL CAUSE OF INJURY QUALIFIER INVALID AFTER 10/1/2015

BN qualifier not valid on or after Oct. 1, 2015. For inpatient claims, use Statement Through date.

F728

BN EXTERNAL CAUSE OF INJURY QUALIFIER INVALID AFTER 10/1/2015

BN qualifier not valid on or after Oct. 1, 2015. For outpatient claims, use Statement From date

F729

PR PATIENT REASON FOR VISIT QUALIFIER INVALID AFTER 10/1/2015

PR qualifier not valid after Oct. 1, 2015. For outpatient claims, use Statement From date.

F730

ABK PRINCIPAL DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABK qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date.

F731

ABK PRINCIPAL DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABK qualifier not valid on or prior to Sept. 30, 2015. For outpatient claims, use Statement From date.

F732

ABF OTHER DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABF qualifier not valid on or prior to Sept. 30, 2015. For Inpatient claims, use Statement Through date.

F733

ABF OTHER DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABF qualifier not valid on or prior to Sept. 30, 2015. For outpatient claims, use Statement From date.

F734

BBR PRINCIPAL PROCEDURE QUALIFIER INVALID PRIOR TO 10/1/2015

BBR qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date

F735

BBQ OTHER PROCEDURE QUALIFIER INVALID PRIOR TO 10/1/2015

BBQ qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date.

F736

ABJ ADMIT DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABJ qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date.

F737

ABN EXTERNAL CAUSE OF INJURY QUALIFIER INVALID PRIOR 10/1/2015

ABN qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date.

F738

ABN EXTERNAL CAUSE OF INJURY QUALIFIER INVALID PRIOR 10/1/2015

ABN qualifier not valid on or prior to Sept. 30, 2015. For outpatient claims, use Statement From date.

F739

APR PATIENT REASON FOR VISIT QUALIFIER INVALID PRIOR 10/1/2015

APR qualifier not valid on or prior to Sept. 30, 2015. For inpatient claims, use Statement Through date.

F740

APR PATIENT REASON FOR VISIT QUALIFIER INVALID PRIOR 10/1/2015

APR qualifier not valid on or prior to Sept. 30, 2015. For outpatient claims, use Statement From date.

F741

CLAIM CANNOT HAVE BOTH ICD-9 & ICD-10 QUALIFIERS

Claims can only contain ICD-9 or ICD-10 qualifiers, not both.

F742

SPLIT CLAIM - DATES OF SVC EQUAL TO OR LESS THAN 9/30/15 AND EQUAL TO 10/1/15 OR GREATER

Submit separate claims if Statement From date is prior or equal to Sept. 30, 2015, and Statement Through date is equal to or greater than Oct. 1, 2015.

F743

PRIN PROC-BBR/OTHER PROC-BBQ NOT VALID ON AN OUTPATIENT CLAIM

BBR and BBQ procedure code qualifiers are not valid for outpatient claims.

Edit code

PROFESSIONAL — Edit description

Logic

MP09

INVALID ICD-10 PRINCIPAL DIAGNOSIS

If qualifier ABK is reported, the principal diagnosis code reported in Loop 2300 HI01-2 must be a valid ICD-10 code.

MP10

INVALID ICD-10 ADDITIONAL DIAGNOSIS

If qualifier ABF is reported, the diagnosis code reported in Loop 2300 HI01-2 through HI12-2 must be a valid ICD-10 code.

P943

SPLIT CLAIM - DATES OF SVC EQUAL TO OR LESS THAN 9/30/15 AND EQUAL TO 10/1/15 OR GREATER

Submit separate claims if service dates are prior or equal to Sept. 30, 2015 and equal to or greater than Oct. 1, 2015.

P944

BK PRINCIPAL DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BK qualifier is invalid if date of service is equal to or greater than Oct. 1, 2015.

P945

BF OTHER DIAGNOSIS QUALIFIER INVALID AFTER 10/1/2015

BF qualifier is invalid if date of service is equal to or greater than Oct. 1, 2015.

P946

ABK PRINCIPAL DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABK qualifier is invalid if date of service is prior to Oct. 1, 2015.

P947

ABF OTHER DIAGNOSIS QUALIFIER INVALID PRIOR TO 10/1/2015

ABF qualifier is invalid if date of service is prior to Oct. 1, 2015.

For questions regarding ICD-10, visit our website. For questions about electronic HIPAA transactions or front-end edits, contact the Blue Cross EDI Helpdesk at 1-800-542-0945.

Contact your software vendor or clearinghouse with questions about ICD-10 code reporting using your practice management claim system.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.