BCBSTX Implementing Two ClaimsXtenTM Updates to Add-on Without Base Rule
Blue Cross and Blue Shield of Texas (BCBSTX) is updating one code and removing two others within the “Add-on without Base Rule” implemented Sept. 18, 2017. This is regarding add-on codes 01968, 01969 and 99292 denying when not billed with the parent code. This update will better address special circumstances that often happen when services are rendered. Currently, the rule doesn’t allow the base and add-on code(s) to be billed separately or by a different physician per Current Procedural Terminology (CPT®) and Centers for Medicare &Medicaid Services (CMS) guidelines.
BCBSTX recognizes that although CPT defines an add-on code as a code that is not considered “stand-alone,” certain unique circumstances may require special consideration.
Obstetric Anesthesia Services
Obstetric anesthesia often involves extensive hours and/or the transfer of anesthesia management to a second physician if/when a patient labors past midnight. As such, special consideration will be given by BCBSTX when:
- A cesarean delivery or an emergency cesarean hysterectomy is performed after a lengthy vaginal labor. The vaginal neuraxial analgesia/anesthesia (01967) and the cesarean anesthesia (01968, 01969) may be performed and billed by two separate anesthesia providers.
- The neuraxial labor analgesia/anesthesia is initiated prior to midnight, and the cesarean delivery or cesarean hysterectomy is performed after midnight. The total anesthesia service is provided as a continuous service, but the two services occur on different, sequential dates.
Critical Care Evaluation and Management Services
Research of industry resources conclude that CPT guidelines and CMS guidelines conflict with each other, and BCBSTX has found it is not unusual for partners within the same practice to assist and/or cover each other for the same patient. Therefore, special consideration will be given when:
- Critical care Evaluation and Management (E/M) add-on code 99292 is submitted as a standalone code on a claim
- Submitted by a different rendering National Provider Identifier
These changes will be implemented within an upcoming release. However, interim processes have already been established, effective immediately, to accommodate and remediate previously impacted claims that meet the above criteria. BCBSTX is reviewing previously processed claims back to Sept. 18, 2017, and they will be adjusted as appropriate for payment.
If you have any questions, please contact your Network Management Representative.
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