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:
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. |