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BlueCross BlueShield – Submitting over 12 Diagnosis

How to Submit Claims with Additional/Supplemental Diagnoses  

If your practice management system limits the number of diagnoses, you can submit a supplemental claim to capture all diagnoses for Risk Adjustment and Healthcare Effectiveness Data and Information Set (HEDIS® 1)/Stars performance measures. This process can also be used to submit supplemental diagnoses after an original claim for an evaluation and management (E&M) service is billed.

 

How to Capture All Diagnoses

Submit a second claim and use procedure code 99080. For practice management systems that are unable to submit 99080, then procedure code 99499 will be accepted.  We can accept a zero dollar charge ($0.00). For practice management systems that do not allow a zero-dollar charge, then a penny charge ($0.01) is acceptable. If the claim is electronic, use frequency code “0.” This code will deny as incidental to the procedure code submitted on the primary claim and no payment will apply. Billing with a penny charge needs no reconciliation on the outstanding balance for providers.

Enter at least one clinical ICD-10 code from the original claim in position 1 and all additional ICD-10 codes in positions 2 through 12. Be sure to update your medical record documentation for the additional ICD-10 codes in accordance with CMS guidelines.

 

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