Claim editing update coming later this year to Medicare Plus Blue actinotherapy and photochemotherapy claims

To promote correct coding and assist with payment accuracy, Blue Cross Blue Shield of Michigan will enhance its claim editing process later this year for Medicare Plus Blue℠ claims to align with American Academy of Dermatology guidelines for actinotherapy and photochemotherapy services.

According to the AAD, there are specific diagnoses that are appropriate indications for CPT codes *96910-*96912 (photochemotherapy; PUVA), including atopic dermatitis, lichen planus, psoriasis and vitiligo. The photochemotherapy codes aren’t considered billable services unless an appropriate diagnosis is reported.

Following are appropriate ICD-10 codes that can be used: C84.0-C84.09, C84.1-C84.19, C84.A-C84.A9, C96.2-C96.29, D45, D89.81-D89.813, L11.1, L20-L20.9, L28.1, L29.8, L29.9, L30.0, L30.1, L40-L40.9, L41-L41.9, L42, L43-L43.9, L44.8, L44.9, L45, L50.3, L50.8, L53.8, L56.4, L57.1, L57.8, L63-L63.9, L66.1, L80, L81.7, L90.0, L90.9, L91.9, L92.0, L94.0, L94.1, L94.3, L94.9, L98.5, Q82

We’ll provide updates on other pertinent information about these claims, including when this edit will be effective, in future communications.

Note: The appeal process won’t change. Continue to submit appeals on the Clinical Editing Appeal Form with the necessary supporting documentation. Fax one appeal at a time to avoid processing delays.