Technical Bulletin

Subject: Date: To: BLUE DISTINCTION SPECIALTY CARE PROGRAM : IMPLEMENTATION UPDATE February 7, 2013

Bulletin # TECH-B-007

BlueCard Executives ITS Coordinators ITS Technical Coordinators National Programs Business Applications Workgroup Wendy Marinkovich Managing Director, Designation Programs, Blue Distinction Dave Tedesco Director, ITS Software Engineering

From:

Patty Simpson Director, Business Applications ______________________________________________________________________________

Action Requested
The Program Code file and Code Match file that were distributed on Jan. 22, 2013, must be installed in production by Feb. 10, 2013. An updated Code Match file, which replaces the removed CPT codes for SKH and transplant, will be distributed on Feb. 11, 2013, and must be installed in production by March 3, 2013.

Background
On Jan. 15, 2013, bulletin TECH-B-13-004 indicated that Plans must install the Blue Distinction Center (BDC) Medical code reference file (Code Match file) by Sunday, Feb. 10, 2013. Plans have provided feedback on the importance of including CPT codes within the Spine Surgery and Knee and Hip Replacement (SKH) codes to identify those procedures done on an outpatient basis. Upon review of all the codes, it was determined that certain CPT codes were necessary to be returned to the code match file for SKH and transplant. CPT Code Replacement Tables The following tables represent the codes that will be replaced with the updated Code Match file.

BDC for Spine Surgery Procedure and Diagnosis Codes Description

1. Discectomy (without compression) Decompression (without fusion) ICD-9 Procedure Codes 80.51 CPT Codes 63020, 63030, 63075, 63077

2.

03.09

63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63045, 63046, 63047, 63050, 63051, 63055, 63056, 63064

Blue Cross and Blue Shield Association l 225 North Michigan Avenue I Chicago, Illinois 60601-7680 I 312.297.6000 I Fax 312.297.6609

Technical Bulletin 2/7/2013

3.

Primary Fusion

81.00 81.08

22532, 22533, 22548, 22551, 22554, 22556, 22558, 22590, 22595, 22600, 22610, 22612, 22614, 22630

4.

Revision Fusion

81.30 81.39 ICD-9 Procedure Codes 81.51 00.70 - 00.73 81.53 81.54 00.80 00.84, 81.55

Primary fusion codes with -22 modifier CPT Codes 27130, 27132 27134, 27137, 27138 27447 27486, 27487

BDC for Knee and Hip Replacement Procedure Codes Description

1. 2. 3. 4. Total Hip Replacement Revision Hip Replacement Total Knee Replacement Revision Knee Replacement

BDC for Transplants Procedure Codes Description

1. 2. Bone Marrow or blood-derived peripheral stemcell transplantation; allogeneic Bone Marrow or blood-derived peripheral stemcell transplantation; autologous 38240 38241 CPT Codes

Technical Information
The Code Match file will be distributed on Feb. 11, 2013, and will also be available for downloading at that time. The file must be installed in production by March 3, 2013. Code Match file BZAP.ITPROD.R12V0.D130211.BDC.CODEMTCH Test: GFT10569 Production: GFT10571 The Code Match file is used in the LOADMTCH job that executes program ITCP9346, DDNAME of IMATFILE and loads the DB2 table IPP_BDC_CODE_MATCH. Once the Code Match file is loaded, Plans must load the provider table IPP_BDC_PROVIDER. This can be done by running the job BDUPDPRV executing program ITCP9005. Note: The provider table updates for BDC vs. BDC+ must still be done with the implementation of ITS Release 13.0 on April 14, 2013.

Have Questions or Need Additional Information?

If you have any questions or need assistance, please contact the IPPT Help Desk through the BCBSA Self Service Portal or by telephone at 312.297.5500.

Blue Cross and Blue Shield Association l 225 North Michigan Avenue I Chicago, Illinois 60601-7680 I 312.297.6000 I Fax 312.297.6609