Blue Cross payment policy won’t allow separate and distinct modifiers to bypass bundling claim edits

In support of correct coding and payment accuracy, the Blue Cross Blue Shield of Michigan payment policy will no longer allow separate and distinct modifiers to bypass bundling claim edits for select services below:

Procedure codes *93798 and *93797 are considered mutually exclusive and should not be billed together. Separate and distinct modifiers will no longer override this edit.

*93798 – Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)

*93797 – Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)

Procedure codes *97975 and *93976 are considered mutually exclusive and should not be billed together. Separate and distinct modifiers will no longer override this edit.

*97975 – Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study

*93976 – Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study

Procedure code *76942 is considered incidental when billed with transrectal ultrasound (76872) and prostate biopsy procedure (*55700). Separate and distinct modifiers will no longer override this edit.

*76942 – Ultrasonic guidance for needle placement (for example, biopsy, aspiration, injection or localization device), imaging supervision and interpretation

*76872 – Ultrasound, transrectal

*55700 – Biopsy, prostate; needle or punch, single or multiple, any approach