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

It can be challenging for health care providers and their office staff to select the Current Procedural Terminology, or 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 modifier 25, observation care and nursing facility care — on claims submitted to Blue Cross. The program provides useful data insights to the provider community and works to maximize coding efficiency and accuracy through up-front education, rather than a traditional postclaim review process.

Effective Jan. 1, 2022, the Coding Advisor program will expand to include Blue Care Network and BCN Advantage℠. 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

In January, Change Healthcare will reach out by phone or letter to providers who submit claims to Blue Cross and BCN. Coding Advisor will compare the billing of CPT codes to the codes used by a provider’s peers through a physician profile.

For your reference, we’ve included an example of a physician profile at the end of this article.

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

If you have any questions, call the Coding Advisor customer support line at
1-844-592-7009 and select option 3.

Example of a physician profile: