Provider Remittance Advices
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1 feb, 2020

Modifier 59 Update

BCBSRI follows the Medicare National Correct Coding Initiative (NCCI) edits to ensure that all claims are coded based on recognized industry standard correct coding guidelines. In 2018 BCBSRI implemented pre-payment review for select procedure codes when submitted with Modifier 59, or XE, XP, XS, XU (X {EPSU}). Please be advised that starting on 01/20/2020, the following codes will no longer require the submission of medical records for review. However, supporting documentation for all services should be retained in the medical record.

70544-Magnetic resonance angiography, head; without contrast material(s)

76942-Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation

92250-Fundus photography with interpretation and report

Although these codes are being removed from pre-payment review, we would like to remind providers of steps that should be taken before claim submission. 

•           Verify the existence of an NCCI edit before claim submission

•           Appending an NCCI associated modifier should only be done when the documentation in the medical supports its use

•           Follow CPT guidance on proper code selection including but not limited to technique used.

We will continue to monitor the use of Modifiers 59 and XE, XP, XS, XU (X {EPSU}. If we see any change in pattern, it may warrant us to perform a post-pay review to ensure services are being coded appropriately. 

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