Anthem Outpatient Facility Edit Implementation

February 2020 ~

Effective April 26, Anthem Blue Cross Blue Shield (Anthem) will make changes to its outpatient facility edits for revenue codes, CPT® codes, HCPCS, and modifiers.

According to the insurer, these edits will include changes to appropriate use of various code combinations that can include but are not limited to, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier.

Anthem provided a list of the following coding resources to use for guidance:

  • CPT codebook, HCPCS codebook
  • National Uniform Billing Committee (NUBC)
  • Uniform Billing (UB) Editor codebook

Anthem notes it will begin adoption of the National Correct Coding Initiatives (NCCI) for outpatient facilities to include industry-standard column one and column two procedure-to-procedure codes. These edits are based on national correct coding guidelines and principles.

CPT® is a registered trademark of the American Medical Association.
Source(s): Anthem Provider News;