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:
BlueCross BlueShield of Tennessee code bundling rules will be applied during the claim payment process, when feasible. Some edits can only be applied when all associated claims are processed. In those cases, the edit will be applied during the retrospective audit process when all associated claims are available for review.
Code bundling can occur on multiple levels depending on the combination of codes reported. For example, when multiple codes are billed for one date of service, two codes could bundle into one code. That one code could then bundle into another code.
BlueCross BlueShield of Tennessee reserves the right to request supplemental information (e.g. anesthesia record, operative report, medical records, etc.) to determine appropriate application of code bundling rules.
Final reimbursement determinations are based on several factors, including but not limited to, member eligibility on the date of service, medical appropriateness, code edits, applicable member co-payments, coinsurance, deductibles, benefit plan exclusions/limitations, authorization/referral requirements and medical policy/coverage decisions.
Code bundling edits for BlueCare® and TennCareSelect were implemented March 1, 2014. Further information on these edits may be found on bluecare.bcbst.com, the BlueCare Tennessee website.
CPT® is a registered trademark of the American Medical Association.