We’ve resolved attribution issue related to COVID‑19 testing

Last year, Blue Cross Blue Shield of Michigan released billing guidelines for COVID‑19 testing in a web‑DENIS alert titled “Billing recommendations for COVID‑19 testing, including drive through.”

In these guidelines, we instructed primary care providers to bill the evaluation and management code *99211 plus the diagnosis code Z20.828 for observing a self-administered specimen collection for COVID‑19 testing in new or established patients.

When *99211 was billed by a primary care physician in an office setting, the event was included in the Blue Cross “attribution algorithm,” which assigns members to a primary care physician. When using this code as part of the algorithm, it was possible for a member to be attributed to a primary care physician when the physician was only testing for COVID‑19.

This issue was brought to our attention, and we subsequently updated our attribution algorithm to exclude any claims that have both the CPT code *99211 and diagnosis code Z20.828.

The update was made before the October membership freeze. All year‑end reporting, including Blueprint for Affordability and value-based reimbursement analytics, will use the corrected attribution algorithm.

January 2021 reporting includes the updated attribution. Previous attribution lists won’t be restated.

Physician organization administrators can submit questions about this issue to the PGIP Collaboration Site, which can be accessed in the provider area of bcbsm.com.