The Record

Coding Advisor outreach to educate providers about appropriate use of procedure codes

What you need to know

In January, Change Healthcare will reach out by phone or letter to health care providers who submit claims to Blue Cross Blue Shield of Michigan and Blue Care Network. Coding Advisor will compare the billing of CPT codes to those used by a provider’s peers through a physician profile. (An example of a physician profile is at the end of this article.)

It can be challenging for health care providers and their office staff to select the CPT^® code that best reflects the complexity of a patient visit. That’s why Blue Cross Blue Shield of Michigan contracted with Change Healthcare, an independent company, to implement our Coding Advisor program in 2019.

Change Healthcare reviews evaluation and management codes billed and other scenarios — such as use of modifier 25, observation care and nursing facility care — on claims submitted to Blue Cross. While Change Healthcare won’t review E/M services for BCN and BCN Advantage℠ because they use a repricing program that’s already in place, the company will review other modules that include services provided by BCN and BCN Advantage. The program offers useful data insights to the provider community and maximizes coding efficiency and accuracy through upfront education, rather than through a traditional post-claim review process.

Effective Jan. 1, 2023, the Coding Advisor program will expand to include the review of home health services to help ensure the Domiciliary Rest Home or Custodial Care Services procedure codes *99324-*99337 and Home Services procedure codes *99341-*99350 are used and billed appropriately.

Throughout this program, Coding Advisor will continue to monitor billing practices and send updated reports periodically. Coding Advisor may contact your practice to discuss coding variances and offer one-on-one coding education. You’ll receive all correspondence from Change Healthcare.

If you have questions, call Coding Advisor Customer Support at 1-844-592-7009 and select option 3.

Here’s an example of a physician profile:

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2021 American Medical Association. All rights reserved.