Code Auditing Upgrade & Modifier 59 Exempt Auditing

May 13, 2010 Update

Update: The implementation date for the modification described in the March 16 disclosure notice below will be July 26, 2010.

In accordance with Texas law and regulation, Blue Cross and Blue Shield of Texas (BCBSTX) hereby gives notice that changes will be made to the claims processing system that affects our bundling logic. We will be upgrading to McKesson ClaimCheck Version 45 effective on or after June 14, 2010 for all lines of business. Due to our licensing agreement with McKesson, mass lists or spreadsheets of bundling combinations cannot be distributed.

Additionally, effective on or after June 14, 2010, BCBSTX will implement changes for modifier 59 exempt code pairs into the claim processing system through ClaimCheck. These changes are based on CMS National Correct Coding Initiative (NCCI).

NCCI guidelines state, "Each NCCI edit has an assigned modifier indicator. A modifier indicator of "0" indicates that NCCI associated modifiers cannot be used to bypass the edit." BCBSTX will continue to use ClaimCheck as the code pair default. NCCI edits (either Incidental or Mutually Exclusive) that are currently not part of the ClaimCheck database will NOT be added.

For further information about current bundling methodologies, or to request specific code to code bundling you may access this information via the online tool, Clear Claim Connection™. Clear Claim Connection™ (CCC), a web-based code auditing reference tool, is available to all contracted Blue Cross and Blue Shield of Texas (BCBSTX) providers. It is available at Clear Claim Connection