Blue Cross and Blue Shield of Alabama encourages all vendors to receive the maximum number of diagnosis codes at the claim level without any dependencies on the number of lines/procedures. However, results from the diagnosis code exercise identified some practice management system limitations that require providers to enter multiple lines/procedures in order to submit the maximum allowed 12 diagnosis codes on professional claims, as allowed by the ASC X12 5010 Type 3 Technical Reports (TR3).

Since this may require enhancements for some practice management vendor systems, the use of Current Procedural Terminology (CPT) code 99080 or 99499 is an acceptable interim solution. This enables a provider to submit additional claim lines with $.00 or $.01 charges, if necessary, in order to accommodate the need to send additional diagnosis codes. This procedure code can be submitted to Blue Cross in cases where your patient has multiple medical conditions but only has one procedure performed in a provider's office on a date of service (i.e., E&M codes only).

Note: It is important for a physician's office to fully code each encounter and only report diagnosis codes that were actively addressed or have a material impact on the health status of the patient. 

For additional information, contact Healthcare Information and Technology at Ask-EDI@bcbsal.org or 205-220-6899.