CommercialBilling CodesHigh impact
Claims Editing, Code Policy, Preventive Services & More
Blue Cross Blue Shield of Wyoming·WY·Coding
Effective date
Mar 1, 2023
We identified it
Jun 19, 2026
Summary
BCBSWY has updated claims editing rules that will automatically deny certain diagnosis code combinations, including E/M services with only Z codes, external cause codes as primary diagnosis, and sequela codes in primary position. The insurer is also implementing automated claims review starting March 2023.
Action Required
Immediately: Billing team must update coding practices to avoid automatic claim denials: 1) Never use external cause codes (E codes) as the only primary diagnosis, 2) Do not bill E/M services (99381-99412, 99420, 99429) with only ICD-10 Z codes as primary diagnosis, 3) Ensure secondary diagnosis codes are not used as primary diagnosis, 4) Never place sequela codes (7th character 'S') in primary diagnosis position. Update billing software edits and train coding staff on these requirements to prevent claim denials.