Outpatient Facility Edit Implementation Effective April 26, 2020
January 7, 2020Beginning with claims processed on and after April 26, 2020, BCBS will be enhancing their outpatient facility edits for revenue codes, Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) and modifiers. Enhanced edits include appropriate use of various code combinations that can include, but are not limited to, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier. These edits are based on national correct coding guidelines and principles.
The following coding resources are excellent resources to use for guidance: CPT codebook, HCPCS codebook, National Uniform Billing Committee (NUBC) and the Uniform Billing (UB) Editor codebook. Additionally, they will begin adoption of the National Correct Coding Initiatives (NCCI) for outpatient facilities to include industry-standard column one and column two procedure-to-procedure codes.