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Reminder: Importance of Correct Coding
BlueCross BlueShield of South Carolina·SC·Claims
Effective date
Jan 27, 2025
We identified it
Aug 11, 2026
Summary
South Carolina Blues issued a reminder on coding best practices to ensure accurate claim submission and timely processing. The policy highlights seven common coding errors—invalid modifiers, incorrect units, code inconsistencies, bundling violations, age mismatches, unspecified codes, and procedure-diagnosis misalignment—and requires billing teams to verify accuracy before claim submission to minimize denials.
Action Required
Immediately: Billing team must implement a pre-submission claim verification checklist to audit all claims for the seven coding errors listed: (1) invalid or missing modifiers, (2) incorrect unit counts, (3) procedure-diagnosis code inconsistency, (4) improperly filed bundled codes, (5) codes mismatched to patient age, (6) unspecified diagnosis codes, and (7) unbundled codes that should be combined. Update billing software validation rules and encounter forms to flag these issues before claims are submitted. Train all billing staff on these requirements. Implement spot-checks on submitted claims. Contact Provider Relations Consultant if questions arise. Failure to correct coding errors will result in claim denials and delayed processing.