Friday, May 13, 2016

No need to use multiple procedure modifiers

Important Changes for Submitting Routine/Screening Colonoscopy Claims

We want to make you aware of recent changes that impact submitting claims for routine/screening colonoscopy services performed at an ambulatory surgical center.

51-Modifier
Effective April 16, 2016, you no longer need to include a 51-modifier for routine/screening colonoscopy claims if the service is performed at an ambulatory surgical center (ASC). This change ensures that routine/screening colonoscopy claims with one or more additional procedures will process according to multiple surgery guidelines.


We encourage ASCs to update their billing systems accordingly as Florida Blue no longer requires a modifier in order to apply appropriate reductions for secondary surgical procedures. ASCs should continue to place appropriate National Correct Coding Initiative and Medically Unlikely Edit modifiers in the first modifier position on the claim form.


Additional Diagnosis Code Fields

We also expanded the number of diagnosis code fields used to identify screening colonoscopy services. Claims now process according to colonoscopy screening benefits, as long as the benefit limit is not met, and there is a screening diagnosis code in position one, two, or three of the claim.

Important Tips

• A 51-modifier is no longer required for routine/screening colonoscopy claims that include one or more additional surgical procedures. A screening diagnosis code in position one, two, or three identifies the colonoscopy procedure as a screening service. If the benefit limit is not met,
routine benefits will apply.

• Be sure to place any payment modifiers, especially those for National Correct Coding Initiative and Medically Unlikely Edits, in the first modifier position as Florida Blue has not yet enhanced our claim processing system to accept up to four modifiers.

• You do not need to resubmit impacted routine/screening colonoscopy claims that processed incorrectly for multiple surgery guidelines. We will automatically reprocess these claims for you. • If a claim did not process correctly because a payment modifier was placed in a modifier

position other than the first position, please call the Provider Contact Center at (800) 727-2227 to let us know. We can change the modifier position and reprocess the claim.

If you have questions, please contact your network manager or provider solutions advisor

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