BCBSNM Significant Edits

BCBSNM Significant Edits

Based on claims experience, the following procedure codes were impacted by BCBSNM significant edits in the categories represented. Each procedure code hit the edit a minimum of 250 times to be listed. The application of bundling edits is dependent on the combination of procedure codes and modifiers submitted on claims. Results can also be impacted by the periodic software updates.

For additional information about specific coding scenarios or customized edits, access Clear Claim Connection (C3) through the Availity Provider Portal. Additional codes may be denied or reduced. If you are not currently an Availity user, and therefore, don't have access to Clean Claim Connection, visit to sign up.

This service is incidental to the primary procedure code. Payment is included in allowance for the primary service.

36591 81003 93010 94150 94760

94761 96372 96523 99000 99070

99091 99144 99173 A4208 A4209

A4212 A4213 A4215 A4216 A4550

A4556 A4649 A4930 J1642 J2001

Services have been unbundled. Separately billed services have been re-bundled under a single code, as they are components of that same service.

80053 85004 85027

Services are mutually exclusive. The clinically more intense service has been reimbursed and comparable service is mutually exclusive.

93325 97002 97140 99070 G0101

A separate charge is not allowed, as it is included in another service.

99051 99203 99211

99212 99213 99214

Dec 2010

1

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.

Charges exceed the priced amount for this service (Participating Provider)

00142 00160 00170 00300 00400 00740 00790 00810 00830 00840 00944 00952 01400 01402 01480 01630 01810 01830 01960 01961 01967 10022 10060 10061 11041 11042 11100 11101 11401 11720 11721 11730 11750 11900 12001 12002 12011 12032 17000 17003

17004 17110 17111 17311 19102 19295 20550 20551 20552 20553 20600 20605 20610 25600 27130 27447 29075 29125 29405 29515 29540 29580 29826 29827 29880 29881 29888 30520 31231 31237 31575 36000 36415 36416 36471 36478 36556 36620 42820 43235

64493 64721 66984 67028 69210 70220 70450 70486 70491 70544 70551 70553 71010 71020 71100 71101 71250 71260 71275 72010 72020 72040 72050 72052 72069 72070 72072 72100 72110 72114 72125 72141 72146 72148 72156 72158 72170 72192 72193 72194

72220 73000 73020 73030 73060 73070 73080 73090 73100 73110 73120 73130 73140 73221 73500 73510 73520 73550 73560 73562 73564 73565 73590 73600 73610 73620 73630 73650 73660 73700 73718 73721 74000 74020 74022 74150 74160 74170 74220 74300

76000 76098 76376 76377 76514 76536 76645 76700 76705 76770 76775 76801 76805 76811 76813 76815 76816 76817 76818 76819 76820 76825 76827 76828 76830 76831 76856 76857 76870 76872 76880 76937 76942 77001 77002 77003 77012 77014 77051 77052

77055 77056 77057 77059 77080 77263 77280 77290 77300 77334 77336 77413 77414 77416 77417 77418 77421 77427 78223 78306 78452 78815 80048 80050 80051 80053 80055 80061 80069 80074 80076 80101 80178 80185 80197 81000 81001 81002 81003 81025

82013 82040 82043 82044 82055 82105 82106 82150 82180 82247 82248 82270 82272 82274 82306 82310 82330 82378 82465 82533 82550 82565 82570 82575 82607 82626 82627 82652 82670 82677 82679 82728 82746 82784 82785 82805 82947 82948 82950 82951

82952 82962 82977 83001 83002 83036 83037 83080 83090 83516 83518 83520 83525 83540 83550 83605 83615 83655 83690 83721 83735 83880 83891 83892 83894 83896 83898 83900 83901 83903 83907 83909 83912 83914 83970 84100 84132 84144 84146 84153

Dec 2010

2

Charges exceed the priced amount for this service (Participating Provider), continued

84154 84155 84156 84163 84165 84207 84270 84295 84305 84402 84403 84425 84432 84436 84439 84443 84446 84450 84460 84478 84479 84480 84481 84482 84484 84520 84550 84630 84702 84703 85007 85013 85014 85018 85025 85027 85045 85060 85300 85303

85306 85379 85384 85610 85613 85651 85652 85730 86003 86038 86039 86060 86140 86141 86146 86147 86160 86200 86225 86235 86255 86300 86304 86308 86318 86336 86361 86376 86403 86430 86431 86580 86592 86631 86665 86677 86695 86696 86703 86704

86706 86708 86762 86780 86787 86800 86803 86850 86900 86901 86923 87015 87040 87045 87046 87070 87075 87077 87081 87086 87088 87102 87147 87177 87184 87186 87205 87206 87209 87210 87220 87255 87324 87328 87329 87338 87340 87427 87430 87480

87491 87510 87522 87536 87591 87621 87650 87653 87660 87804 87807 87880 87899 88108 88112 88141 88142 88150 88164 88172 88173 88175 88230 88235 88262 88267 88271 88275 88280 88291 88300 88302 88304 88305 88307 88309 88311 88312 88313 88321

88331 88342 89190 90465 90466 90467 90470 90471 90472 90473 90474 90632 90633 90634 90649 90656 90657 90658 90660 90663 90698 90700 90703 90707 90715 90716 90718 90732 90734 90736 90744 90746 90801 90804 90805 90806 90807 90808 90812 90847

90853 90862 90935 90960 90961 90966 92002 92004 92012 92014 92015 92020 92083 92135 92136 92225 92226 92235 92250 92285 92507 92551 92552 92553 92557 92567 92568 92586 92587 92588 92980 93000 93005 93010 93015 93016 93018 93224 93227 93280

93303 93306 93320 93325 93351 93510 93543 93545 93555 93556 93798 93880 93922 93923 93925 93965 93970 93971 93975 93976 93978 94010 94060 94200 94240 94260 94360 94375 94640 94664 94720 94760 95004 95024 95115 95117 95165 95810 95811 95816

95819 95860 95861 95900 95903 95904 96110 96360 96361 96365 96366 96367 96368 96372 96374 96375 96409 96411 96413 96415 96416 96417 96523 97001 97002 97003 97010 97012 97014 97016 97018 97022 97024 97026 97032 97033 97035 97039 97110 97112

Dec 2010

3

Charges exceed the priced amount for this service (Participating Provider), continued

97113 97116 97124 97139 97140 97530 97535 97810 97811 97813 97814 98925 98926 98940 98941 98942 98943 99000 99050 99051 99053 99058 99070 99140 99144 99173 99183 99195 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218

99219 99220 99221 99222 99223 99231 99232 99233 99235 99238 99239 99241 99242 99243 99244 99245 99252 99253 99254 99255 99281 99282 99283 99284 99285 99291 99292 99354 99355 99381 99382 99383 99384 99385 99386 99391 99392 99393 99394 99395

99396 99397 99460 99462 99464 99469 99472 99479 99480 A4218 A4230 A4232 A4466 A4565 A4570 A4590 A4641 A4750 A6441 A6449 A6454 A6456 A7003 A7005 A7015 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7046 A9500 A9505 A9552 A9577

A9579 E0114 E0143 E0431 E0434 E0439 E0470 E0471 E0562 E0570 E0601 E1390 G0008 G0101 G0103 G0108 G0121 G0123 G0202 G0204 G0206 G0283 J0280 J0570 J0640 J0690 J0696 J0702 J0704 J1020 J1030 J1040 J1055 J1080 J1094 J1100 J1200 J1441 J1642 J1745

J1885 J2001 J2405 J2469 J2505 J2550 J2785 J2930 J3301 J3420 J3475 J3487 J3490 J7030 J7040 J7050 J7060 J7300 J7302 J7321 J7323 J7324 J7325 J9035 J9041 J9045 J9171 J9190 J9201 J9263 J9265 J9310 J9355 K0001 K0003 L1820 L1830 L1906 L3020 L3260

L3670 L3908 L4205 L4210 L4360 L4386 Q0091 Q0111 Q9966 Q9967 R0075 S0020 S0028 S9088 S9494

Dec 2010

4

Charges exceed the priced amount for this service (Non-Participating Provider)

99285 99284 99283 99233 99232 99215 99214 99213 99212 99211

99204 99203 99202 98941 98940 97811 97810 97140 97124 97110

97014 97012 97010 96372 95117 93010 93000 90807 90806 90471

87880 87340 85045 85025 84443 84132 83970 83550 83540 83036

82962 82728 82310 82108 81002 80061 80053 71020 36415 17003

Charges exceed the multiple surgery priced amount for this service (Participating/Network Provider)

11042 11100 11750

17000 20550 20552

20610 29540 29826

43239 45380 64450

64494

Dec 2010

5

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