For Blue Cross commercial members, follow ICD-10-CM laterality policy

In support of correct coding and payment accuracy, Blue Cross Blue Shield of Michigan commercial plans will apply the ICD-10-CM laterality policy for diagnosis-to-modifier comparison and diagnosis-to-diagnosis comparison. This change will take effect in March 2023.
 
One of the unique attributes of the ICD-10-CM code set is that laterality has been built into code descriptions. Some ICD-10-CM codes specify whether the condition occurs on the left or right, or is bilateral. If no bilateral code is provided and the condition is bilateral, then codes for both left and right should be assigned. If the side isn’t identified in the medical record, then the unspecified code should be assigned.

Diagnosis-to-modifier comparison

The diagnosis-to-modifier comparison assesses the lateral diagnosis associated with the claim line to determine if the procedure modifier matches the lateral diagnosis.

For example: If a diagnosis code is submitted that shows a service was performed on the right ear, but the modifier submitted shows that it was performed on the left ear, the claim may be denied due to this conflict.

Diagnosis-to-diagnosis comparison

The diagnosis-to-diagnosis comparison assesses lateral diagnoses associated with the same claim line to determine if the combination is inappropriate.

For example: If a diagnosis code is submitted on Line 1 of a claim that shows a service was performed on the right ear, but a secondary diagnosis on the same claim, a diagnosis is submitted showing the service was performed bilaterally (on both ears), the claim may be denied due to the duplicative nature of the claim.