Practice Management Alert

If you bill to Blue Cross Blue Shield, take note. The provisions of a settlement agreement between physicians and the Blue Cross Blue Shield Association that require the settling BCBS companies to follow most CPT rules went into effect on January 21, 2009.

The provisions now effective include:

- Payment of add-on codes without reduction for multiple procedure logic

- Separate recognition and payment of E/M codes appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when billed with a service procedure or surgical code

- Separate recognition and payment for supervision and interpretation and radiologic guidance codes

- Payment for codes submitted with modifier 59 (Distinct procedural service) to the extent they follow CPT rules regarding designation of separate procedures

- Prohibition on global periods for surgical procedures longer than CMS-

- Prohibition on automatic reduction of CPT codes to codes of lesser intensity.

There were other additional provisions of the settlement, such as a prohibition on collecting an alleged overpayment beyond 18 months, that went into effect prior to Jan. 21 as well.