December 2024
Clinical editing guidance updated
In support of correct coding and payment accuracy, we are providing the information below to keep you informed about forthcoming payment policy updates, new policies and coding reminders.
Blue Cross Blue Shield of Michigan commercial
In the November 2024 Record, we published the reminder below. We’d like to clarify that this information applies to professional claims only.
Reminder: JZ, JW modifier conflict
In 2023, the Centers for Medicare & Medicaid Services recommended that health care providers place new modifier JZ (zero drug amount discarded/not administered to any patient) on all claims for drugs supplied in single-dose containers, vials and packages where there is no discarded amount. Modifier JW is used to report drug wastage, indicating that some portion of the drug was not administered to the patient.
These modifiers are mutually exclusive. When both JZ and JW are billed on the same claim for the same date of service, claims may be denied, beginning in December 2024.
Blue Care Network commercial
- HCPCS code C8930 has been added as an acceptable base code for procedure code *93356.
- Procedure code *93356 is currently denying with message code e14 when reported with C8930.
- System updates to accommodate this will occur at the end of November.
- Current appeals related to this issue will receive priority handling.
- New patient evaluation and management procedure codes *99202-*99205 will not receive a 50% reimbursement when reported with a new patient prevent visit.
- System updates to accommodate this will take place mid-December.
- Appeals that have been submitted for this issue will be upheld.
BCN Advantage℠
HCPCS codes G0438 and G0439 are being updated to no longer require modifier 25 when reported with an evaluation and management code that also includes modifier 25.
- The system will be updated at the end of November to accommodate this.
- For expedited claims payment, providers should resubmit related claims that have been denied.
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