Blue Cross Blue Shield of North Dakota (BCBSND) continually develops and revises coding and reimbursement policies and resources in response to rapidly changing medical technology and updates to the coding sets. Our commitment is to update the provider community as coding and reimbursement policies and guidelines are added, adopted and/or revised.
The following coding and reimbursement policy updates can be located on provider website within the next 45 days. The changes below can be referenced in the updated policies.
The following policy is new:
- Evaluation and Management Policy
- This policy was created to provide clarity and centralization of evaluation and management (E/M) material based on national correct coding rules to the provider community.
- Information from the following policies/guidelines was centralized into this policy:
- Split or shared services
- Unrelated Services during Pre/Post Operative Period was added into this policy from Global Surgical Package.
- Decision for surgery services was added into this policy from Global Surgical Package .
- Multiple E/M’s on the same day was added into this policy from Correct Coding Policy - Commercial and Correct Coding Policy - Medicaid Expansion.
- Prolonged services policy was added into this policy from Correct Coding Policy - Commercial and Correct Coding Policy - Medicaid Expansion.
The following policies and/or guidelines will be updated with reference to the new policy Evaluation and Management Policy:
The following policies and/or guidelines will be updated with reference to the new policy Evaluation and Management Policy and additional changes:
- Correct Coding Policy - Medicaid Expansion
- Added modifier 59, XE, XP, XS and XU which is being archived Dec. 1, 2024, to this policy.
- Correct Coding Policy - Commercial
- Added modifier 59, XE, XP, XS and XU which is being archived Dec. 1, 2024, to this policy.
- Global Surgical Package
- Removed Decision for Surgery and unrelated services content from this policy as this information is now combined in Evaluation and Management Policy .
- Created reference in Preoperative Period to Evaluation and Management Policy.
The following policies and/or guidelines will be archived Dec. 1, 2024, as they are being combined into the new Evaluation and Management Policy:
- Coding and Billing Guidelines for Urgent Care
- Coding and Billing Guidelines for Gynecological and Rectal Exams
- Consultation Services
- Medical Care and Associated Services
The following policy will be archived Dec. 1, 2024, as it will be combined into the new Evaluation and Management Policy and also has additional updates:
- Modifiers 25, 27, 59, FT, XE, XP, XS & XU
- Archiving policy as of Dec. 1, 2024, and this is being combined into the Evaluation and Management Policy
- Modifier 59, XE,XP,XS and XU are being combined into the Correct Coding Policy - Commercial and Correct Coding Policy - Medicaid Expansion.
- Archiving guideline as of Dec. 1, 2024, and this is being combined into the Evaluation and Management Policy.
Questions?
Contact the Provider Service number on the back of the member’s card for additional information.