Effective on or about September 21, 2009, Blue Cross and Blue Shield of New Mexico (BCBSNM) will implement changes for modifier 59 exempt code pairs into the claim processing system through ClaimCheck. These changes are based on Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI).
NCCI guidelines state, "Each NCCI edit has an assigned modifier indicator. A modifier indicator of '0' indicates that NCCI associated modifiers cannot be used to bypass the edit." BCBSNM will continue to use ClaimCheck as the code pair default. NCCI edits (either Incidental or Mutually Exclusive) that are currently not part of the ClaimCheck database will NOT be added.
For further information about current bundling methodologies, or to request specific code to code bundling you may access this information via the online tool, Clear Claim Connection (CCC). CCC, a web-based code auditing reference tool, is available to all contracted BCBSNM providers. It is available through Availity*.
*We do our best to ensure that the information on the Web sites shown above is useful, but can't be responsible for the content of those sites or any information you may take from them (please read our legal disclaimer). When you click on a site link above, it will open in a new window so that you can explore that site without having to leave here. When you are through visiting the other site, you can close that window and return to the BCBSNM site.
