Effective for the date of services from August 1, 2014, Florida Blue will implement a new coding edit that affects payment for multiple diagnostic cardiology procedures performed on the same day by the same provider group. Claims processed for dates of service August 1, 2014 and after will process according to the new rule.
When multiple diagnostic cardiology procedures are performed in any setting, the primary procedure is allowed at 100 percent. However, allowances for secondary and all subsequent procedures are reduced by 25 percent of the technical component when performed on the same date of service. The primary procedure has the highest total relative value of the diagnostic procedures performed. Additionally, when the primary procedure is billed with multiple units, the first unit will allow at 100 percent and each subsequent unit will be reduced by 25 percent of the technical component.
Procedures 78452 and 93306 are submitted for the same date of service:
• 78452 with 1 unit will allow at 100 percent of the fee schedule amount because it has the highest relative value.
• 93306 with 1 unit will be reduced by 25 percent of the technical component allowance as it is the lower valued procedure.
The new coding edit is consistent with CMS payment policies for multiple procedure payment reduction.
This change affects all Florida Blue products, including BlueCare® (HMO), BlueMedicareSM HMO, BlueChoice® (Preferred Patient Care), BlueMedicareSM PPO, BlueOptionsSM
(NetworkBlue) and Traditional plans. It also applies to BlueCard® host and Federal Employee Program (FEP) claims.
For more information and FAQs please visit Coding Edit Change for Multiple Diagnostic Cardiology Procedures
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