Summary
Nucleic acid probe CPT codes 87471-87801, 0068U and 0096U-0100U billed for the same patient on the same encounter are subject to a multiple-service reduction for dates of service on and after November 1, 2019. Individual codes billed with multiple units are paid at 100 percent for the first and second unit, 50 percent for the third unit, 25 percent for the fourth unit, and 5 percent for the fifth or any additional units. Sinus surgery codes 31253, 31257, 31259 and 31298 are bundled, so CPT code 31255 may no longer be reported with CPT codes 31276, 31287 and 31288.
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What to do
Action · 8 steps
01Already effective November 1, 2019: Nucleic acid probe claims for the same patient and encounter are subject to the multiple-service reduction described above, so check current applicability before billing these codes.
02Billing team: for sinus surgery, report the bundled codes the source lists, such as 31253 with 31287 or 31288, or 31276 with 31257 or 31259, when total ethmoidectomy is performed with both frontal sinus exploration and sphenoid sinusotomy on the same side.
03Report surgical nasal endoscopic procedures per side, for example 31255-LT and 31253-RT, and report bilateral total ethmoidectomy with frontal sinus exploration as 31253-50.
04Do not report 31296 and 31297 together, and report 31298 when ostial dilation of both the frontal and sphenoid sinuses is performed.
05For E&M codes 99201-99215, medical record documentation must prove medical necessity of the service in addition to the required components of the code, and the level should be chosen on medical decision-making.
06Bill only for services you or your staff perform.
07For unlisted codes, submit the description of service and operative report if surgery is involved, the comparable HCPCS/CPT code, the invoice if durable medical equipment is involved, and the NDC and drug name with the invoice for drug codes.
08Questions about the nucleic acid probe reduction go to network.development@bcbsla.com or 1-800-716-2299, option 1.
Codes mentioned
8747187801312533125731259312983125531276312873128831296312979920199215
Original notice
Network News - 3rd Quarter 2019
providers.lablue.com · Always check the source before changing claims.
Related changes
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