Commercial Code Bundling

Overview

Note: For Professional Claims Only

BlueCross BlueShield of Tennessee applies code bundling rules to evaluate the accuracy and adherence of medical claims to accepted national standards. These rules are based on code bundling guidelines such as:

bundling guidelines from sources such as but not limited to:
National Correct Coding Initiative (NCCI)
American Medical Association (AMA)
Centers for Medicare and Medicaid Services (CMS)
Medical Societies and Associations
BlueCross BlueShield of Tennessee Reimbursement Policies
BlueCross BlueShield of Tennessee clinical expertise
Reimbursement Rule Indicators and RBRVS

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Definitions

Comprehensive Code (Column 1) Generally represents the major procedure or service when reported with another code.

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Code Changes

Below, please find effective code changes:

CPT

Remittance Explanation

Surgical Procedure

Bundling Rationale

BlueCross BlueShield of Tennessee uses a clinical editing database. The clinical editing rationale supporting this database is provided here to assist you in understanding the rationale behind certain code pairs in the database.

Code pairs reported here are updated quarterly based on the following schedule.

Date Data Effective for Source

Date Change Is Applied by BCBST

January 1

April 1

April 1

July 1

July 1

October 1

October 1

January 1

 

These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes.

Code Bundling Rationale 2014 Q4

CPT® Codes

Code Bundling Rationale 2014 Q3

CPT® Codes

Code Bundling Rationale 2014 Q2

CPT® Codes

Code Bundling Rationale 2014 Q1

CPT® Codes

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Summary of Changes

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