Claim editing enhancements coming to Blue Cross commercial claims

In an August 2021 Record article, we let you know that Blue Cross Blue Shield of Michigan will be working with Optum to enhance our claim editing process to promote correct coding starting in November 2021.

Anatomical modifiers for surgical procedures

One of the enhancements we’ll be making is to require anatomical modifiers for surgical procedures.

Anatomical modifiers identify the specific area of the body where a procedure is performed. Requiring these modifiers aligns with AMA CPT guidelines and supports our commitment to implementing payment integrity solutions that enhance payment accuracy.

Surgical procedures requiring anatomical modifiers include CPT codes in the range *10000-*69999 that have a Medicare Physician Fee Schedule bilateral indicator “1,” denoting that the surgical code is eligible to be billed on both sides of the body. We’ll edit the surgical code when anatomical modifiers (50, LT, RT, E1, E2, E3, E4, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, T1, T2, T3, T4, T5, T6, T7, T8, T9, TA, LC, LD, RC, LM, RI) are appropriate, but haven’t been appended to the claim line.

Although the requirement begins later this year, we encourage you to follow the new process now.

If you have questions about the Blue Cross claim editing process, contact Provider Inquiry. Professional providers should call 1-800-344-8525, while facility providers should call 1-800-249-5103.