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October 2024
Clinical editing policy updatedTo support correct coding and payment accuracy, we’re 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: Soft tissue tumor removal claims When procedure codes that represent soft tissue tumor removal are submitted, the diagnosis codes should support that level of service. The appropriate procedure codes representing benign and malignant integumentary lesion excisions should be reported for excision of cutaneous lesions and superficial subcutaneous lesions, rather than the higher-level soft tissue tumor excision codes. This editing will identify soft tissue tumor removal codes when diagnoses on the claim only describe a skin lesion, such as a sebaceous cyst or benign neoplasm. Claims that contain a procedure code for soft tissue tumor removal with a diagnosis that doesn’t support that level of service may be denied. |
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