Coding Updates

Claims submitted with ICD-10 diagnosis code R69 (Illness, unspecified) as the ONLY diagnosis code on the claim will be returned to the provider to resubmit with a more specific ICD-10 diagnosis code. Codes that describe symptoms and signs, as opposed to diagnosis, are acceptable for reporting purposes when a related definitive diagnosis has not been established. Although R69 is a valid ICD-10 diagnosis code, it does not provide enough specificity to apply medical policy and benefits appropriately. For State Covered Laboratory Services BCBSND has determined that CPT® Code 86780, (Antibody; Treponema, pallidum) identifies different lab tests. When a screening lab test is performed for the EIA/CIA (reverse algorithm), CPT® Code 86780 must be billed with modifier 33 to differentiate this test from the TP-PA or other Treponema test provided at no charge by the North Dakota Department of Health (NDDOH). Modifier 33, preventive service. Some CPT codes can be used to report either a preventive health service (as identified by US Preventive Services Task Force or Priority Health designation per our Provider Manual) or a diagnostic test for treatment or monitoring of a health condition. As a reminder, BCBSND will recognize and process professional claims with modifiers GA, GY and GZ.


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