Coding Advice: Claims Coding Tips For Faster Approval

Please note the following errors that often lead to claims denial when not properly coded:

  • BCBSWY will deny Column II procedure codes billed with associated Column I procedure code by same provider and a modifier is not supported. Supporting information such as claims history and all diagnosis codes are reviewed. Please ensure you are billing all diagnosis codes to support modifiers 59 and 25.
  • J2001 will deny when used as a local anesthetic and is bundled into the service rendered at the same time.
  • Claim lines reported with mutually exclusive code combinations according to the ICD-10-CM Excludes 1 Notes guideline policy will be denied.
  • Procedures or services received with a secondary diagnosis code as a principal or primary diagnosis will be denied.
  • Any service when billed with an invalid or deactivated NPI will be denied.
  • Claim lines containing invalid NDC numbers will be denied.

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