Got questions about ICD-10? We’ve got answers

We’ve compiled a series of answers to some of the most frequently asked ICD 10-CM questions.

Do I have to use ICD-10-CM codes?
Yes. All providers need to start using ICD-10-CM diagnosis codes with dates of service Oct.1 2015, or later.

What are ICD-10-CM codes?
ICD-10-CM codes are replacing the ICD-9-CM diagnosis codes. As part of HIPAA guidelines, CMS has mandated the transition to ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes used by hospitals for inpatient surgical procedures.

When do I start using ICD-10 codes?
Start using ICD-10 codes for dates of service on or after Oct.1 2015.

How do I bill for multiple dates of services that span before and after Oct. 1, 2015?

• If you normally bill multiple dates of service on one claim and any of the dates of service are on or after Oct.1 2015, you must split the bill. Dates of service on or before Sept. 30, 2015, must use ICD-9 codes.
• There are some exceptions to this, depending on the provider type (such as DME providers) but for physicians, split billing is required.
• Click here** for CMS billing guidelines.

Can I start using ICD-10 codes before Oct.1 2015?
No. Claims with dates of service prior to Oct.1 2015, containing ICD-10 codes will be rejected.

Can I continue using ICD-9 codes after Sept. 30, 2015?
No. Any dates of service on or after Oct.1 2015, must have ICD-10 codes assigned.
ICD-9 codes will be used on claims with dates of service on or before Sept. 30, 2015, no matter when the claim is submitted.

Can I submit ICD-9 and ICD-10 codes on the same claim?
No. Claims with dates of service on or before Sept. 30, 2015, must be separate from claims with dates of service on or after Oct. 1, 2015.

Can I submit a file that contains both ICD-9 and ICD-10 codes?
Yes. The file can contain claims with both ICD-9 and ICD-10 codes, just not on the same claim.

If only one line on the claim is invalid or incorrect, will the one line reject or will the whole claim reject?
Professional claims are processed at the claim line level, so they will process at this level, which means just the one line would be rejected.

How descriptive are the claim rejection descriptions? Are they specific to the diagnostic code?
No. The rejection description will say if it’s an invalid code. There are several new Electronic Data Interchange edit messages related to ICD-10, See the July 2015 Record article titled “Correction: New edit codes to support ICD-10.”

I received edit codes that I have never seen before. What do these mean?
There are new edit codes related specifically to ICD-10 and the end-dating of all ICD-9 codes, See the July 2015 Record article titled “Correction: New edit codes to support ICD-10” for details on the following:

• MF20-MF26 relates to specific qualifiers and the need to report ICD-10 codes. (facility edit)
• F720-F729 relates to specific qualifiers that an ICD-9 code was reported after Oct. 1, 2015. (facility edit)
• F730-F740 relates to specific qualifiers that ICD-10 codes were submitted for dates of service prior to Oct. 1, 2015. (facility edit)
• F741-F743 other edits specific to the submission of ICD-9 or ICD-10 codes inappropriately. (facility edit)
• MP09-MP10 relates to specific qualifiers and the need to report ICD-10 codes. (professional edit)
• P943-P947 relates to specific qualifiers related to the date of service. (professional edit)

Do I need to start using ICD-10-PCS codes (procedure codes)?
ICD-10-PCS codes are used only by hospitals on inpatient claims with procedures.
HCPCS and CPT codes will continue to be used by physicians for billing procedures.

Will Blue Cross help me find the correct code for a condition?
We will not provide a mapping from an ICD-9 to an ICD-10 code or look up codes for you. Correct code selection is based on the documentation in the patient record.

Where can I obtain ICD-10 codes?
The codes are available from many sources and in many formats:

• Code books
• CD, DVD and other digital media
• Go to cms.gov/ICD10** and select 2016 ICD-10-CM and GEMS to download 2016 code tables and index.
• Practice management systems
• Electronic health record products
• Smartphone applications

Does ICD-10 apply to mental and behavioral health providers?
Yes. ICD-10 applies to all providers, including mental and behavioral health providers, and must be used to bill for services. (DSM-V code books include the corresponding ICD-10 codes.)

If the prescription was written prior to Oct. 1, 2015, and has an ICD-9 code on it and the script is brought into the pharmacy Oct. 1, what is expected of the pharmacy?
For submitting claims, the pharmacy is expected to translate the ICD-9 code to an ICD-10 code for prescriptions filled starting Oct. 1.

Will workers’ compensation agencies be ICD-10 compliant?
The State of Michigan’s workers’ compensation agency has confirmed they will be ICD-10 compliant for dates of service on and after Oct. 1, 2015.

With laterality included in ICD-10-CM, do we still need to report modifiers for left or LT, and right or RT?
Yes. The modifiers apply to CPT/HCPCS procedure codes that are not impacted by the transition to ICD-10-CM. Continue to follow the coding guidelines for these procedure code sets.

How do I report global procedure codes for prenatal care when the dates of service only span across the start date for ICD-10 of Oct. 1, 2015? (Procedure codes 59425 and 59426)
Enter date of first prenatal visit in the “From” field and last prenatal visit in the “To” field on the 1500 form. Report the diagnosis using the ICD code set, which is in effect for the date of service, in the “From” field. For example: If date of service is on or before Sept. 30, 2015, report ICD-9 codes. If date of service is on or after Oct. 1, 2015, report ICD-10 codes.

How do I report global maternity procedure codes for maternity care when the dates of service span across the start date for ICD-10 of Oct. 1, 2015?
Enter the date of the first prenatal visit in the “From” field and the date of the delivery in the “To” field. Report the diagnosis using the ICD code set, which is in effect for the date of service, in the “From” field. For example: If the date of service is on or before Sept. 30, 2015, report ICD-9 codes. If date of service is on or after Oct. 1, 2015, report ICD-10 codes. When reporting post partum care using procedure code 0503F, if the date of service is on or after Oct. 1, 2015, submit this code on a separate claim and use that date of service in the “From” field, using ICD-10 codes. Global maternity care includes antepartum care, delivery and postpartum care.

What is the replacement diagnosis for V67.2- follow-up exam following chemotherapy?
There is not a unique diagnosis code in ICD-10 for V67.2. Follow the official coding guidelines by reporting the code for encounter for chemotherapy as the first diagnosis when it’s the main reason the patient is being seen. This is code Z51.11 for encounter for antineoplastic chemotherapy. This code will establish that the patient is receiving a course of chemotherapy. Follow-up office visits apply to monitoring a course of chemotherapy. In addition, if the patient is experiencing complications that are caused by the chemotherapy, such as anemia, follow official coding guidelines and report the specific diagnosis code first, such as D64.81 for anemia to due antineoplastic chemotherapy.

What resources are available to assist me with ICD-10?

• For a general overview on ICD-10, you can view a Blue Cross webinar and download a copy.
• Go to cms.gov/ICD-10** for a variety of provider resources.
• Go to cms.gov/ICD10** and select 2016 ICD-10-CM and GEMS to download 2016 code tables and index.
• Go to the CMS-sponsored "Road to ICD-10" website for small to medium sized physician practices. Visit the CMS tool at: www.roadto10.org.**
• Visit the American Hospital Association** website.
• Specialized training resources are available at extra cost through the American Health Information Association**and the American Association Professional Coders**websites.
• Coding and documentation tips are available through ahima.org** and Californiahia.org.**
• Visit the American Medical Association**website.
• Visit the American Academy of Family Physicians** website.
• Visit the American Academy of Pediatrics** website.
• Visit the American Academy of Professional Coders at aapc.com/icd-10.**
• Medical specialty crosswalks contain the top 50 ICD-9 codes and the corresponding ICD-10 codes and is especially useful for the most commonly identified diagnosis codes for your practice. Download a PDF for any of the specialties you choose. A PDF copy is available from the AAPC by clicking here.**
• Go to bcbsm.com/ICD10 for a variety of resources.
• Check out the Michigan Department Community Health website.
• Visit the American Academy of Pediatrics**website.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

You’ll get new message regarding National Drug Code daily quantity maximums

Starting as early as November, providers will receive a new message when a submitted NDC reaches or exceeds its recommended daily quantity maximum.

This maximum determines the number of billable units an NDC can be billed on a single claim line for a specific date. Currently, there is no NDC message when a daily maximum is reached or exceeded.

When a maximum quantity is reached, this message will alert providers that they only will be reimbursed for the daily maximum quantity. For example, if the maximum is five for the reported NDC, but a quantity of 15 is submitted, the message will state that there’s been an adjustment in the reimbursement. Payment will be made for the first five only.

We’ll provide additional details in The Record later this year.

Medical Drug Utilization Management Program to include certain drug limits

Blue Cross Blue Shield of Michigan will make some changes in its Medical Drug Utilization Management Program to include limits on medical drugs administered under the professional medical benefit.

The drug limits will include the following:

• Maximum dose per day
• Interval time periods (how often a drug can be administered)
• Lifetime maximums (number of doses per lifetime)
• Number of doses per time period

These limitations are based on U.S. Food and Drug Administration, manufacturer labeling and Blue Cross medical and drug policies.

We’ll provide additional details in The Record later this year.

Preauthorization expansion to Medical Drug Utilization Management Program begins soon

Blue Cross Blue Shield of Michigan will soon be expanding its utilization management program to include medical drugs administered in hospital outpatient locations.

Prior authorization will be required for certain medical drugs, in order to be covered under a member’s medical benefits, when they’re administered in a hospital outpatient location.

You can find a current list of medications that require prior authorization, as well as a list of groups that have opted out, on web-DENIS:

• Click on BCBSM Provider Publications and Resources.
• Click on Commercial Pharmacy Prior Authorization and Step Therapy forms.
• From this page, click on Pharmacy prior authorization/Step therapy forms link at the top of the page.
• Click on Physician administered medications (on the right side under “Frequently used forms”).

We’ll provide additional details in The Record later this year.

BlueCard^® connection: reducing the number of medical record requests

As part of our ongoing series on the BlueCard program, here’s the answer to a question we recently received.

Can I reduce the number of medical record requests I receive for BlueCard claims?

Yes. You should verify eligibility, benefits and authorization requirements before the service is rendered. Doing this will confirm that:

• The member’s coverage is active for the date of service
• The service is covered under the member’s contract

Obtaining a required authorization may not only prevent a denial, but it may also eliminate the need for the plan to request additional supporting information to determine whether the claim can be paid.

Keep the following steps in mind:

• Always verify the member’s eligibility and benefits.

• Verify and obtain a required authorization, or request pre-approval for services prior to treatment. When rendering a treatment or therapy that recurs over a period of time, contact the out-of-state plan to request pre-approval for the expected treatment plan. Recurring treatments or therapies include chemotherapy, radiation treatments and physical and speech therapy.

• Use the medical policy, pre-authorization and pre-certification router to determine an out-of-state Blue plan’s medical policies and general authorization requirements. The router is available on bcbsm.com, Provider Secured Services and web-DENIS. You can also find a link to the router in the "BlueCard" chapter of every online provider manual.
  
  Note: Never apply Blue Cross Blue Shield of Michigan’s medical and benefit policies to BlueCard claims. Each Blue plan’s policy will be different.

For more information on the BlueCard program, including links and articles on online tools, reference the BlueCard chapter of the online provider manuals.

If you’re experiencing issues with the information provided in the BlueCard chapter of the online provider manuals or any of the online tools — or if you’d like more information on a particular topic — contact your provider consultant. If you’d like to suggest a topic to be covered in a future issue of The Record, send an email to ProvComm@bcbsm.com and put “BlueCard series” in the subject line.

Coding corner: coding for bipolar disorders

As you’ve read previously in The Record, the transition to ICD-10 coding begins Oct. 1, 2015. Here’s a look at coding for bipolar disorders, including what will be different when the transition to ICD-10 takes place and a review for how to handle coding while ICD-9 coding is still in effect.

About bipolar disorder
Bipolar disorder, also known as manic depression or bipolar affective disorder, causes serious mood swings with emotional highs (manias) and lows (depression). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines two types of bipolar disorder:

• Type I consists of manic and mixed manic-depressive episodes lasting at least seven days or by manic symptoms severe enough to warrant hospitalization. Depressive episodes typically last two weeks or longer.
• Type II is defined by a pattern of depressive and manic episodes, but is less severe than bipolar I disorder.

ICD-10: Fewer codes
Beginning Oct. 1, 2015, the transition to ICD-10 provides fewer code choices for bipolar disorders (28 vs. 38 ICD-9 codes). The universal fifth-digit concept used in ICD-9 is no longer applicable. Instead, each code previously requiring a fifth-digit subclassification has its own list of fifth digits.

Refer to the table below for the full list of ICD-10 subcategories and subclassifications. The red dashes you see next to some of the subcategories are used to show that a fifth digit from the right column is needed for the code to be valid. Note: For bipolar disorder, sixth- and seventh-character ICD-10 codes aren’t used.

Proper ICD-9 coding
Coding for bipolar disorders depends on specific documentation of the provider’s clinical observations and medical decisions. For proper code selection, the documentation should include:

• Type I or type II disorder designation
• Features of the current or most recent episode — manic, depressed or mixed (manic-depressive)
• The severity of the most recent episode — mild, moderate or severe
• Diagnosis of partial or complete remission if the patient is asymptomatic

Proper code selection can’t be achieved if the provider hasn’t sufficiently documented any of the items listed above.

ICD-9: Coding and the fifth digit
All codes listed below, with the exception of 296.7, require fifth-digit subclassification in order to be valid and billable. The fifth-digit red “x” refers to one of seven possible severity subclassifications. Use the key below as a code reference.

296.0x - Bipolar I disorder, single manic episode
296.1x - Manic disorder, recurrent episode
296.4x - Bipolar I disorder, most recent episode (or current), manic
296.5x - Bipolar I disorder, most recent episode (or current), depressed
296.6x - Bipolar I disorder, most recent episode (or current), mixed
296.7 - Bipolar I disorder, most recent episode (or current), unspecified
296.80 - Other and unspecified bipolar disorders, bipolar disorder, unspecified
296.89 - Bipolar II disorder

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Coding corner update: Improve medical record documentation for musculoskeletal and connective tissues disease

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. This article includes updated codes to align with the transition to ICD-10-CM.

Coding for musculoskeletal and connective tissues disease can be challenging. That’s why we’re providing some tips for the most common musculoskeletal and connective tissue diseases. Musculoskeletal and connective tissue diseases are classified in codes M00-M99 in the ICD-10-CM manual.

Lupus erythematosus
Lupus erythematosus is an autoimmune and chronic inflammatory disease that can affect many parts of the body, including skin, joints, kidneys, heart and lungs. The ICD-10-CM code category for systemic lupus is M32. Codes in this category include the organ or system involvement.

Rheumatoid arthritis
Considered a chronic condition, rheumatoid arthritis may be ascertained by reading a patient’s past medical history or by checking a problem list. Remember that joint pain or a diagnosis of arthritis is not considered rheumatoid arthritis.

According to the current American College of Rheumatology guidelines and clinical practice standards, patients with this condition require the initiation of disease-modifying anti-rheumatic drug therapy within three months of diagnosis. Accurate management and documentation are also important for HEDIS performance measurement purposes.

Chronic diseases, such as rheumatoid arthritis, which are treated on an ongoing basis, may be coded and reported as many times as the patient is receiving treatment and care for the condition. The ICD-10-CM code categories for rheumatoid arthritis include M05 and M06. Codes in these categories include specific sites and manifestations.

Osteoarthritis
The most common type of arthritis, osteoarthritis is a chronic joint disorder characterized by degeneration of joint cartilage and the adjacent bone. It usually occurs in the hands, knees, hip and spine. Osteoarthritis is also referred to as polyarthritis, degenerative joint disease, hypertrophic arthritis and degenerative arthritis. Osteoarthritis for most sites, excluding the spine, is assigned codes from categories M15 through M19. Osteoarthritis of the spine is termed spondylosis in ICD-10-CM and assigned to category M47.

• Generalized osteoarthritis (polyosteoarthritis) affects many joints and is assigned ICD-10-CM code M15.9. If it involves more than one site, but it’s not specified as generalized, code each site separately from codes in categories M16-M19. There are specific codes to identify whether the osteoarthritis is primary (M15.0), erosive (M15.4) or other type (M15.8).
• Localized osteoarthritis affects the joints of one site (unilateral or bilateral) and is further identified as either primary, secondary or post-traumatic in ICD-10-CM. Codes can be found in categories M16-M19.

  Primary: Generally occurs in individuals 55 or older and is associated with aging, affecting joints of one site (unilateral or bilateral) with no known cause (idiopathic).
  Secondary: Affects a joint of one site (unilateral or bilateral) and has a specific cause, such as an injury, another disease process, inactivity or genetics. ICD-10-CM has a separate category of codes for the reporting of post-traumatic osteoarthritis (M19.1-).

Sacroiliitis
This condition occurs when pain is caused by inflammation of the sacroiliac joint that attaches the sacrum to the pelvis. Sacroiliitis is often missed or inappropriately treated. Sacroiliitis can occur as a complication of infections in the heart, skin, joints or muscle. It also can follow a back injury. Many times, sacroiliac pain is mistaken for another cause of low back pain, such as a ruptured disk, collapsed vertebra, spinal stenosis or osteoarthritis of the joints in the spinal cord. Sacroiliitis may also be part of an inflammatory arthritic condition known as ankylosing spondylitis. For ankylosing spondylitis, the ICD-10-CM code category is M45; for sacroiliitis, use the code M46.1.

Osteoporosis
The most common bone disease, osteoporosis is a systemic condition affecting all bones and falls into two categories, primary and secondary.

• In ICD-10-CM there are two categories of osteoporosis codes: with or without a current pathological fracture:
• Age related including post-menopausal and senile. Use category M81.0 if no fracture present. Use category M80.8 if fracture present then code by site.
• Otherosteoporosis is generally caused by certain medical conditions, hormonal disorders, disuse or is drug-induced. Use category M81.0 if no fracture present. Use category M81.8 if fracture present then code by site. For drug-induced, use an additional ‘T’ code to identify the adverse effect of the drug, using 5th or 6th character of 5. Refer to the Official ICD-10-CM Guidelines for coding and reporting.

ICD coding for all conditions should follow coding conventions, chapter specific guidelines and general coding guidelines.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Coding corner update: Improve medical record documentation by using accurate diagnosis codes

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. This article includes updated codes to align with the transition to ICD-10-CM.

Accurate diagnosis code selection plays a critical role in communicating a patient’s health status to Blue Cross Blue Shield of Michigan for many purposes, including Medicare risk adjustment, quality measures, government programs and various incentive programs. However, reporting the proper diagnosis code is only possible if progress notes for the patient progress have complete and accurate documentation to support each condition.

Here are answers to some frequently asked questions to help ensure a diagnosis is properly substantiated through medical record documentation.

How often should a chronic condition be reported on a claim?
Each patient’s chronic conditions should be reported at least once a year as part of a face-to-face encounter. Providers aren’t required to report all of a patient’s chronic conditions on every claim. Instead, document chronic conditions as often as they’re assessed or treated.

What are the documentation requirements?
Each reported diagnosis must be validated by the documentation in the progress note for that specific date of service.

The progress note must document how the condition was managed, evaluated, assessed or treated, also known as MEAT. At least one component of MEAT must be documented for each condition.

• Manage: Indicate order of labs, diagnostic radiology or other tests.
• Evaluate: Document review of lab or X-ray results and pertinent exam results.
• Assess: Describe the status of a patient’s condition (stable, worsening or improved).
• Treat: Indicate if medications are prescribed or refilled, and any surgical treatments or therapy services performed.

Additionally, each progress note should link the documented MEAT components to a specific diagnosis to make the treatment plan for each condition clear to the coder.

What if a diagnosis isn’t clearly documented?
Providers should report the ICD-10-CM code that identifies the patient’s condition to the greatest specificity. However, documentation in the progress note must support this specificity by explicitly identifying the diagnosis, and the diagnosis can’t be inferred.

For example:

• If diagnosis I20.0 is reported on a claim, documentation must specify unstable angina, not just angina or chest pain.

• If I50.32 is reported on a claim, documentation must specify chronic diastolic heart failure, not congestive heart failure.

Terms such as “rule out,” “consistent with,” “possible” or “probable” should be used with caution if you’re trying to substantiate a diagnosis. These terms indicate the diagnosis isn’t definitive and consequently can’t be coded as if the condition exists in the outpatient setting.

Should the MEAT components and treatment plan be linked to the specific diagnosis or will an auditor infer the connection?
A coder can’t infer that orders and results are related to a specific condition. Providers should interpret results and link all tests and orders to a specific condition.

For example, a coder can’t assume that a lipid panel is being ordered to address a patient’s hyperlipidemia if the patient is being treated for other chronic conditions.

Always link medications to a specific diagnosis and indicate if the medication is new, to be continued or to be discontinued, and make sure to indicate the specific dose.

For example, a statement such as “continue current meds,” won’t validate a diagnosis. Instead you should say “diabetes, stable. Continue Metformin 850 mg once daily.”

Each diagnosis should have its own individual treatment plan that indicates tests ordered, referrals made, patient instructions and when the next patient visit should be scheduled.

What are correct linking words to indicate a manifestation or complication of a condition?
A cause-and-effect relationship between a condition and its manifestations may not be assumed. The relationship should be documented with correct “linking” words in the progress note. Here are some examples of how you can code for diabetes:

• End stage renal disease secondary to diabetes
• Ulceration caused by diabetes
• Polyneuropathy due to diabetes
• Diabetic polyneuropathy

Note: The term "with" isn’t an acceptable linking word in medical record documentation to demonstrate causality between two conditions. See the September 2013 Record article for more information.

Blue Cross has two resources available on web-DENIS to aid providers in accurate documentation and coding:

• BCBSM Coding Initiativepresentation (available in text or audio)
• Documentation and Coding Tips for Professional Offices, a set of tip cards

Follow these steps to locate the training aids on web-DENIS:

• Log onto web-DENIS.
• Click on BCBSM Provider Publications and Resources.
• Click on Newsletters and Resources.
• Click on Medicare Advantage Resources. The two training documents are located on this page.

Additional resources are available on the Blue Cross ICD-10 website at bcbsm.com/providers/help/faqs/icd-10.html.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Coding corner update: Improve medical record documentation for chronic kidney disease

Beginning Oct. 1, 2015, the transition to ICD-10-CM will affect every area of health care. Many codes contain much greater specificity. This article includes updated codes to align with the transition to ICD-10-CM.

The complex nature of chronic kidney disease makes accurate code selection essential. A basic understanding of chronic kidney disease, its causes and its comorbidities can help you assign the highest possible specificity of codes.

Chronic kidney disease is a condition characterized by a gradual loss of kidney function. When kidney disease gets worse, the kidney cells called nephrons that filter out wastes and other fluids from the bloodstream lose the ability to filter, causing the kidneys to lose functionality.

Complications of chronic kidney disease include high blood pressure, anemia, weak bones and nerve damage. It may also increase the risk of developing heart or blood vessel disease.

ICD-10-CM codes are based on the severity of chronic kidney disease. The provider must clearly document the stage to ensure codes are chosen to the highest level of specificity. Coders can’t assign a code based on glomerular filtration rate alone and should be as specific as possible:

Chronic kidney disease and diabetes
If the patient has chronic kidney disease caused by diabetes, the code for diabetes would be assigned first according to the conventions in the tabular list.

• Assign E08.22, E09.22, E10.22, E11.22 or E13.22 to identify the correct type of diabetes, followed by the appropriate chronic kidney disease code from the N18 category.
• Documentation must show causality between the two conditions. For example, diabetic nephropathy or CKD due to diabetes.
• Although the word “with” is considered acceptable linkage within the context of the ICD-10-CM, BCBSM does not consider the word “with” to be an acceptable linking word in provider documentation.

Chronic kidney disease and anemia
When chronic kidney disease is present, the kidneys may not make enough erythropoietin, a hormone that controls red blood cell production. This may cause anemia to develop. When documentation indicates the link between the two conditions, assign a code from category N18 first to indicate the stage of the chronic kidney disease and code D63.1 Anemia in CKD.

Chronic kidney disease and hypertension
ICD-10-CM presumes a cause-and-effect relationship, and classifies chronic kidney disease with hypertension as Hypertensive CKD whether or not it’s documented. So, when it’s present with hypertension, assign codes from category I12.-, Hypertensive CKD.

• Assign a fourth character for hypertensive CKD, I12.-, based on the stage of the chronic kidney disease
• Use an additional code to identify the stage of chronic kidney disease (N18.-)

(Note: - are used rather than Xs, as an X may be used as part of a valid code.)

Hypertensive heart and chronic kidney disease
Report hypertensive heart and chronic kidney disease with a code from the combination category code I13 when both conditions are stated in the diagnosis. The relationship between the hypertension and chronic kidney disease is still assumed, but heart disease and chronic kidney disease don’t have an assumed relationship. Documentation must state a cause-and-effect relationship.

• Assign a fourth character for hypertensive heart and CKD, I13.-, based on the stage of the chronic kidney disease.
• Also use additional codes to identify the stage of chronic kidney disease (N18.-) and to code the specific type of heart failure (I50.-), if known.

Coding kidney dialysis and transplants
Early detection and treatment can often keep chronic kidney disease from getting worse, but when kidney disease progresses it can lead to kidney failure which often requires dialysis or a kidney transplant to maintain life.

• If the patient is admitted solely for dialysis treatment, use the code to describe the condition for which the patient is having dialysis and then Z99.2 (dependence on renal dialysis). Report Z91.15 for patients who are noncompliant with renal dialysis.
• Patients who have undergone a kidney transplant may still have chronic kidney disease. A kidney transplant doesn’t always restore full kidney function.
• Assign the appropriate chronic kidney disease code (N18) for the patient’s stage followed by code Z94.0.0, kidney transplant status.
• Kidney transplant complication codes are only assigned if the complication affects the function of the transplanted organ.
• Two codes may be required to fully describe a transplant rejection or transplant complication. Use code T86.1- and a secondary code that identifies the complication if appropriate.

ICD-10-CM coding for all conditions should follow coding conventions, chapter specific guidelines and general coding guidelines.

If you have questions or need more information, contact your provider consultant.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Tell us what you think about our provider manuals and you could win a prize

Blue Cross Blue Shield of Michigan and Blue Care Network have several provider manuals as follows:

• Blue Cross
• Go to bcbsm.com and log in to Provider Secured Services.
• Click on web-DENIS.
• Click on BCBSM Provider Publications and Resources.
• Click on Provider Manual.

• BCN
• Follow the steps above to access web-DENIS.
• Click on BCN Provider Publications and Resources.
• Click on Provider Manual.

• BCBSM Medicare Plus Blue^SM PPO (Medicare Advantage)
• Blue Cross Complete (Medicaid)

Some of these manuals are presented in different formats and accessed in different ways. As part of our continuing effort to improve our service to you, we’d like your opinion on our provider manuals.

Can you spare five minutes to take an online survey? Your input will give us insight into which manuals you use, how you use them and whether you have any problems or suggestions for improving them. This will help us make them easier for you to use.

Please complete the online survey by Oct. 15 and you could win one of three $25 gift certificates.

Participation in the survey is not necessary to win. The drawing is open to all active Blue Cross or BCN providers. Enter by completing the survey no later than Oct. 15, 2015, or by sending an e-mail with your name, phone number and the words “Survey drawing” in the subject line to ProviderOutreach@bcbsm.com by Oct. 15, 2015.

All entries must be received by Oct. 15, 2015. Three winners will be selected in a random drawing from among all eligible entries. Each winner will receive a gift card in the amount of $25. The drawing will take place by the end of October. Winners will be notified by telephone or email following the dra.

Blues highlight medical, benefit policy changes

You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart.

This billing chart is organized numerically by procedure code. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which we have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which we are clarifying our guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedures.

You will also see that descriptions for the codes are no longer included. This is a result of recent negotiations with the AMA on use of the codes.

We will publish information about new BCBS groups or changes to group benefits under the Group Benefit Changes heading.

For more detailed descriptions of the BCBSM policies for these procedures, please check under the Medical/Payment Policy tab in Explainer on web-DENIS. To access this online information:

• Log in to web-DENIS.
• Click on BCBSM Provider Publications & Resources.
• Click on Benefit Policy for a Code.
• Click on Topic.
• Under Topic Criteria, click on the drop-down arrow next to Choose Identifier Type and then click on HCPCS Code.
• Enter the procedure code.
• Click on Finish.
• Click on Search.

Treatment at freestanding substance abuse facilities will require authorization in 2016

Authorization for treatment at freestanding substance abuse residential facilities will be required for Blue Cross Blue Shield of Michigan commercial PPO members, beginning in 2016. New Directions LLC will perform the authorizations.

This requirement will only apply to the substance abuse residential level of care, not outpatient. The current authorization requirements for residential treatment at hospital-based substance abuse facilities remain the same.

Also note that accounts that have behavioral health currently managed by a vendor other than New Directions will not be affected by this change. This includes, but is not limited to, the State of Michigan group account, auto groups, UAW retirees and DENSO.

Admission authorization requests from freestanding substance abuse facilities will be made in accordance with New Directions medical necessity criteria, using the New Directions WebPass application. WebPass is a secure Internet portal that enables providers to document and submit clinical information online to New Directions for initial authorizations and continued stay reviews. The New Directions medical necessity criteria can be found here, and a demonstration of WebPass is available here.

More information regarding the authorization process, training and registration for WebPass, and the transition date will be made available prior to January 2016 in The Record and in future web-DENIS Alerts.

Mental health, substance abuse benefits for FEP members hasn’t changed

Mental health and substance abuse treatment benefits for Federal Employee Program^® members didn’t change with the transition to the new behavioral health vendor New Directions Behavioral Health on April 1, 2015.

As a reminder, FEP members continue to use the same network of providers as Blue Cross Blue Shield of Michigan commercial PPO members.

Note: On Jan. 1, 2015, the preferred provider network for behavioral health services for FEP members changed to the broader TRUST PPO provider network. No contracting or registration with New Directions Behavioral Health is required to serve these members if you’re a provider in the TRUST PPO network.

For additional information on FEP behavioral health changes on Jan. 1, 2015, see the November 2014 Record.

Provider Inquiry to add new call prompt

Provider Inquiry will add a dedicated, specialty customer service team, as a pilot project Oct. 1, 2015, to support the complex needs of:

• Skilled nursing facilities
• Durable medical equipment and prosthetics and orthotics specialists
• Injection and infusion therapy service providers
• Outpatient psychiatric centers

When you call Provider Inquiry, an automated phone line will prompt you through a series of questions. Then, if your question relates to one of these areas, you’ll be routed to a representative specially trained to discuss the claims and benefit structures unique to these areas.

Your satisfaction is our business. And our team stands ready to resolve your issues as quickly and accurately as possible in a consultative, personable manner.

Note: These changes do not apply to Medicare Advantage, Blue Care Network or the Federal Employee Program^®.

Documentation guidelines updated for medical records and diagnostic and therapeutic services

Effective Aug. 1, 2015, Blue Cross Blue Shield of Michigan has updated the following sections of our documentation guidelines:

• Medical record documentation — general guidelines
• Diagnosis and therapeutic services

For detailed information, see the “Documentation Guidelines for Physicians and Other Professional Providers” chapter of your online provider manual. Follow these steps to view the provider manual:

1. From web-DENIS, click on BCBSM Provider Publications and Resources.
2. Click on Provider Manual.
3. Click on Provider Type and select yours from the Make a Selection box.
4. Click on the Search button and then on the Documentation Guidelines for Physicians and Other Professional Providers chapter.

New automated system strives to speed up processing time of adjusted facility claims

Blue Cross Blue Shield of Michigan is establishing an automated process to improve the claim processing time and accuracy of the electronic remittance you receive for adjusted facility claims. This initiative is expected to launch Sept. 14, 2015, and will include Federal Employee Program^® facility claims.

To help us improve the processing time for corrected facility claims and to avoid front-end rejections, follow these steps when submitting electronic 837 claim transactions:

1. Include the proper claim frequency code in the 837 file to indicate that the claim is an adjustment of a previously approved or denied claim. Enter one of these claim frequency codes in the CLM05-3 segment of loop 2300:

2. In the REF*F8 segment of loop 2300, include the 14- or 17-character internal claim number of the original claim.
   
   Note: Be sure to submit the correct internal claim number of the original claim with your replacement claim. Otherwise, the processing system will reject the replacement claim if it’s is unable to locate the matching claim.

We’re expecting to implement an automated process for professional claims in the third quarter of 2016.

If you have questions about submitting an 837 for an adjusted claim, contact the Electronic Data Interchange help desk at 1-800-542-0945. For assistance with reporting this information using your practice management system, contact your software vendor or clearinghouse.

Register for upcoming InterQual^® webinars

Join us in October for McKesson Health Solutions’ series of free InterQual criteria webinars. You’ll get:

• Highlights of the 2015 criteria changes
• Training on the five criteria sets: acute care, skilled nursing facilities, rehabilitation care, long-term acute care and home health care

Register by clicking here. You’ll be asked to provide the necessary registration information and select one or more sessions. Only select and attend one session per criteria so that everyone has the opportunity to attend. WebEx only supports 1,000 participants.

Prior to your scheduled session, you’ll receive a WebEx confirmation via email with the webinar details. If you prefer to participate via telephone, the dial-in number will be provided in the WebEx confirmation email.

InterQual webinar schedule

Blue Cross will begin accepting applications for new home health care providers in Traditional network Oct. 1

Blue Cross Blue Shield of Michigan is lifting the moratorium on enrollment of new home health care providers in our Traditional network, effective Jan. 1, 2016. A home health care, or HHC, provider is a public agency or private organization that provides physician-prescribed skilled nursing care and various therapeutic services to members who are confined to their homes.

Providers interested in applying can view general HHC facilities information and enrollment materials on bcbsm.com. Follow these steps to view the materials:

• Go to bcbsm.com.
• Click on Providers.
• Click on the Join the Blues Network tab.
• Click on Enrollment and Changes.
• Click on Provider Enrollment.
• Select “Hospitals and Facilities,”and click on the Next button.
• Select Home Health Care Facilities, and click on the Next button.

Enrollment applications are submitted online. Applications may be submitted beginning Oct. 1, 2015.

Hospice rate update schedule moves to March

The hospice rate update schedule that previously had an effective date of Oct. 1 each year is changing. The next update of hospice provider rate schedules will be effective March 1, 2016.

Look for more information on the upcoming rate changes in a future Record article.

Reminder: Billing changes for inpatient and outpatient services

Outpatient services that occur 24 hours before, during or after an inpatient admission should be billed with the inpatient stay. Please combine the outpatient and inpatient services and submit one bill; the admission date should be the same as the date for the inpatient stay.

Outpatient services will only be considered part of the inpatient admission if there is a similar diagnosis/condition for each. Otherwise, the outpatient service is paid separately.

We’re preparing to hit the road for provider forums

Blue Cross Blue Shield of Michigan and Blue Care Network are coming to you this fall. We’ve scheduled a series of forums focusing on our professional providers across the state. Billing and office managers and their staff are strongly encouraged to attend this event. The classes will cover such key topics as:

• ICD-10 (professional)
• Medicare Advantage
• Provider Inquiry
• BlueCard
• EviCore healthcare (formerly CareCore/Med Solutions Inc.)
• Transparency
• Provider enrollment

Here’s a schedule of events:

• Half-day classes start at 9 a.m. and end at noon, with registration at 8:30 a.m.
• To accommodate driving schedules to the Upper Peninsula, classes will begin one hour later than usual. Registration for the Marquette and Sault Ste. Marie classes will be at 9:30 a.m., with the class starting at 10 a.m. (These times are for Upper Peninsula classes only.)
• Continental breakfast will be served.

Note: The dates and locations of some of the events have changed since we communicated about them in the August Record. The venue has changed for the class in St. Joseph, and dates were changed for the Marquette and Sault Ste. Marie classes. See chart below for current venues and dates.

To register, click on the link next to the event you’d like to attend. If you have questions, contact your provider consultant.

Resolving your issues: Self-service tools can help

This is the second article in a series providing guidance on the best way to get your questions answered.

As we informed you in the August Record, it’s usually quicker and more efficient to call Provider Inquiry for answers to your questions rather than write. See last month’s article for details on when to call and when to write.

When you call Provider Inquiry to resolve an issue, you may be instructed to provide specific written documentation that supports the review of your claim. You should send this information, along with your inquiry, to the appropriate written inquiry unit for handling. (For more information on contacting Provider Inquiry, click here.)

We may ask you, for example, if you have an issue with 10 or more claims, to send information to us on a spreadsheet with the contract ID, name, service date and procedure code, along with a description of the issue.

If your inquiry results in a payment, your voucher will indicate our response. If the claim disposition doesn’t change or results in another rejection, you will receive a phone call or letter outlining the final disposition.

Note: For inquiries related to Federal Employee Program^® members, you would call the FEP customer service number at 800-482-3600.

Don’t forget that in addition to contacting us by phone or in writing, there are self-service options that may help you. See sidebar at right. Many of these tools are available on web-DENIS.

If you aren’t yet registered to use web-DENIS or want training on how to get the most out of it, contact your provider consultant. Don’t know who that is? Visit the Contact Us page on our website.

PPO provider referral to non-PPO provider may result in member sanctions

If a PPO provider refers a member to a provider who does not participate in the network, members may be responsible to pay additional out-of-pocket costs.

The PPO policy, as referenced in the provider manual, states:

Under our referral policy, we ask TRUST providers to refer PPO members to other TRUST providers when referrals are necessary. Because the TRUST network encompasses a large scope of participating providers, referrals outside the network are acceptable only in rare case — that is, when covered services are medically necessary and are not reasonably available with the TRUST network. Under those conditions, out-of-network deductibles and copayments may still apply.

For more information about referral policies or any referral forms that may be required, see the chapter titled “PPO Policies” in the provider manual and click on Referrals.

If you have any questions, contact your provider consultant.

Treatment at freestanding substance abuse facilities will require authorization in 2016

Authorization for treatment at freestanding substance abuse residential facilities will be required for Blue Cross Blue Shield of Michigan commercial PPO members, beginning in 2016. New Directions LLC will perform the authorizations.

This requirement will only apply to the substance abuse residential level of care, not outpatient. The current authorization requirements for residential treatment at hospital-based substance abuse facilities remain the same.

Also note that accounts that have behavioral health currently managed by a vendor other than New Directions will not be affected by this change. This includes, but is not limited to, the State of Michigan group account, auto groups, UAW retirees and DENSO.

Admission authorization requests from freestanding substance abuse facilities will be made in accordance with New Directions medical necessity criteria, using the New Directions WebPass application. WebPass is a secure Internet portal that enables providers to document and submit clinical information online to New Directions for initial authorizations and continued stay reviews. The New Directions medical necessity criteria can be found here, and a demonstration of WebPass is available here.

More information regarding the authorization process, training and registration for WebPass, and the transition date will be made available prior to January 2016 in The Record and in future web-DENIS Alerts.

Mental health, substance abuse benefits for FEP members hasn’t changed

Mental health and substance abuse treatment benefits for Federal Employee Program^® members didn’t change with the transition to the new behavioral health vendor New Directions Behavioral Health on April 1, 2015.

As a reminder, FEP members continue to use the same network of providers as Blue Cross Blue Shield of Michigan commercial PPO members.

Note: On Jan. 1, 2015, the preferred provider network for behavioral health services for FEP members changed to the broader TRUST PPO provider network. No contracting or registration with New Directions Behavioral Health is required to serve these members if you’re a provider in the TRUST PPO network.

For additional information on FEP behavioral health changes on Jan. 1, 2015, see the November 2014 Record.

Provider Inquiry to add new call prompt

Provider Inquiry will add a dedicated, specialty customer service team, as a pilot project Oct. 1, 2015, to support the complex needs of:

• Skilled nursing facilities
• Durable medical equipment and prosthetics and orthotics specialists
• Injection and infusion therapy service providers
• Outpatient psychiatric centers

When you call Provider Inquiry, an automated phone line will prompt you through a series of questions. Then, if your question relates to one of these areas, you’ll be routed to a representative specially trained to discuss the claims and benefit structures unique to these areas.

Your satisfaction is our business. And our team stands ready to resolve your issues as quickly and accurately as possible in a consultative, personable manner.

Note: These changes do not apply to Medicare Advantage, Blue Care Network or the Federal Employee Program^®.

Progress notes for grafting services for dentist and oral surgeons required

Blue Cross Blue Shield of Michigan is making changes to how it processes grafting services billed by dentists and oral surgeons. Procedure codes 20900, 20902, 20969, 21210 and 21215 will now require that the progress notes be submitted for payment consideration when billed by a dentist or an oral surgeon.

For more information, contact your provider consultant. You can also contact Blue Cross’s Department of Provider Enrollment and Data Management at 1-800-822-2761, by fax at 1-866-900-0250 or by email to Providerenroll@bcbsm.com.

Reminder: Submit flu shots, other vaccines as medical claims, not pharmacy claims, for non-Medicare members

Flu season will be here soon so we want to make sure pharmacies know how to submit flu shot claims. Claims for flu shots and other vaccines for Blue Cross Blue Shield of Michigan non-Medicare members should be submitted as medical (professional) claims.

Keep in mind that only pharmacies that are part of Blue Cross Blue Shield of Michigan’s Vaccine Affiliation Program can submit claims for vaccines administered to Blue Cross members.

We recently sent you an amendment to the Restated and Amended Preferred Rx Agreement that lays the groundwork to bill vaccines through the pharmacy claim system. We will notify you if we begin to allow this billing process. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid at this time.

Which members are covered?
Before giving a flu shot, be sure the member has immunization coverage. You can check coverage on web-DENIS or by calling our Provider Automated Response System, or PARS, at 1-800-344-8525.

Blue Cross Blue Shield of Michigan Provider Inquiry (physicians and other professional providers of care)

You can use the following procedure codes when checking for coverage.

How to submit claims
Be sure to submit claims for flu shots and other vaccines administered to Blue Cross Blue Shield of Michigan non-Medicare members as medical (professional) claims through the medical claim system used by your pharmacy. You can work with your claim clearinghouse vendor or IT department if you are unsure of how to bill medical claims in your system. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid.

Administering multiple injections on same day
Blue Cross only allows for payment of one initial immunization administration on the same date of service. In order to be reimbursed for multiple immunization injections on the same date of service, you’ll need to report one of the 904XX add-on codes. These include 90461, 90472 and 90474.

For members with Blue Care Network commercial coverage
Continue to follow the BCN billing process for vaccines.

For Medicare Advantage members
Continue to follow the Medicare Advantage billing process for vaccines.

For Federal Employee Program^® members
Continue to follow FEP guidelines for vaccines.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Can health care providers treat themselves or family members?

“Physician, heal thyself.”

This ancient expression, while wise, does not reflect Blue Cross Blue Shield of Michigan policy.

We’d like to remind you that it is Blue Cross Blue Shield of Michigan’s policy to not cover services that health care providers render to themselves or immediate family members. We define immediate family members as first-degree relatives, including parents, siblings, spouse and children.

For more information, contact your provider consultant.

Documentation guidelines updated for medical records and diagnostic and therapeutic services

Effective Aug. 1, 2015, Blue Cross Blue Shield of Michigan has updated the following sections of our documentation guidelines:

• Medical record documentation — general guidelines
• Diagnosis and therapeutic services

For detailed information, see the “Documentation Guidelines for Physicians and Other Professional Providers” chapter of your online provider manual. Follow these steps to view the provider manual:

1. From web-DENIS, click on BCBSM Provider Publications and Resources.
2. Click on Provider Manual.
3. Click on Provider Type and select yours from the Make a Selection box.
4. Click on the Search button and then on the Documentation Guidelines for Physicians and Other Professional Providers chapter.

Reminder: Submit flu shots, other vaccines as medical claims, not pharmacy claims, for non-Medicare members

Flu season will be here soon so we want to make sure pharmacies know how to submit flu shot claims. Claims for flu shots and other vaccines for Blue Cross Blue Shield of Michigan non-Medicare members should be submitted as medical (professional) claims.

Keep in mind that only pharmacies that are part of Blue Cross Blue Shield of Michigan’s Vaccine Affiliation Program can submit claims for vaccines administered to Blue Cross members.

We recently sent you an amendment to the Restated and Amended Preferred Rx Agreement that lays the groundwork to bill vaccines through the pharmacy claim system. We will notify you if we begin to allow this billing process. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid at this time.

Which members are covered?
Before giving a flu shot, be sure the member has immunization coverage. You can check coverage on web-DENIS or by calling our Provider Automated Response System, or PARS, at 1-800-344-8525.

Blue Cross Blue Shield of Michigan Provider Inquiry (physicians and other professional providers of care)

You can use the following procedure codes when checking for coverage.

How to submit claims
Be sure to submit claims for flu shots and other vaccines administered to Blue Cross Blue Shield of Michigan non-Medicare members as medical (professional) claims through the medical claim system used by your pharmacy. You can work with your claim clearinghouse vendor or IT department if you are unsure of how to bill medical claims in your system. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid.

Administering multiple injections on same day
Blue Cross only allows for payment of one initial immunization administration on the same date of service. In order to be reimbursed for multiple immunization injections on the same date of service, you’ll need to report one of the 904XX add-on codes. These include 90461, 90472 and 90474.

For members with Blue Care Network commercial coverage
Continue to follow the BCN billing process for vaccines.

For Medicare Advantage members
Continue to follow the Medicare Advantage billing process for vaccines.

For Federal Employee Program^® members
Continue to follow FEP guidelines for vaccines.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.

Can health care providers treat themselves or family members?

“Physician, heal thyself.”

This ancient expression, while wise, does not reflect Blue Cross Blue Shield of Michigan policy.

We’d like to remind you that it is Blue Cross Blue Shield of Michigan’s policy to not cover services that health care providers render to themselves or immediate family members. We define immediate family members as first-degree relatives, including parents, siblings, spouse and children.

For more information, contact your provider consultant.

Provider Inquiry to add new call prompt

Provider Inquiry will add a dedicated, specialty customer service team, as a pilot project Oct. 1, 2015, to support the complex needs of:

• Skilled nursing facilities
• Durable medical equipment and prosthetics and orthotics specialists
• Injection and infusion therapy service providers
• Outpatient psychiatric centers

When you call Provider Inquiry, an automated phone line will prompt you through a series of questions. Then, if your question relates to one of these areas, you’ll be routed to a representative specially trained to discuss the claims and benefit structures unique to these areas.

Your satisfaction is our business. And our team stands ready to resolve your issues as quickly and accurately as possible in a consultative, personable manner.

Note: These changes do not apply to Medicare Advantage, Blue Care Network or the Federal Employee Program^®.

Can health care providers treat themselves or family members?

“Physician, heal thyself.”

This ancient expression, while wise, does not reflect Blue Cross Blue Shield of Michigan policy.

We’d like to remind you that it is Blue Cross Blue Shield of Michigan’s policy to not cover services that health care providers render to themselves or immediate family members. We define immediate family members as first-degree relatives, including parents, siblings, spouse and children.

For more information, contact your provider consultant.

Can health care providers treat themselves or family members?

“Physician, heal thyself.”

This ancient expression, while wise, does not reflect Blue Cross Blue Shield of Michigan policy.

We’d like to remind you that it is Blue Cross Blue Shield of Michigan’s policy to not cover services that health care providers render to themselves or immediate family members. We define immediate family members as first-degree relatives, including parents, siblings, spouse and children.

For more information, contact your provider consultant.