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.