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New Changes to Existing Medical Policies Taking Effect June 2011: BCBSNC Modifier Guidelines

BCBSNC Bundling Guidelines

At Blue Cross and Blue Shield of North Carolina (BCBSNC) we make regular reviews of our online medical policies and make updates when needed. Whenever a medical policy undergoes a revision we make those revisions available on our Web site for providers in advance of a policy change taking effect. It's important that providers visit and review our medical policy Updates page to see how a new policy or change to an existing policy may apply to a service or supply they offer.

Recently two existing medical policies have been revised that may change how some claims for lumbar laminectomy, facetectomy or foraminotomy procedures are handled when reported along with lumbar spinal fusion. These two policies are:

  • Modifier Guidelines: The policy has been revised to included that Modifier -59 will not allow additional payment when appended to CPT4 codes 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048 and when performed in conjunction with 22630 and 22632. Lumbar laminectomy, facetectomy and foraminotomy procedures are typically considered incidental to the lumbar arthrodesis, posterior interbody technique; and therefore will not be eligible for separate reimbursement.

Bundling Guidelines: The policy has been revised to include that when a lumbar laminectomy, facetectomy or foraminotomy is performed with a posterior approach for a lumbar spinal fusion procedure, the laminectomy is generally incidental, and should be bundled with the fusion. When a claim is submitted reporting a posterior lumbar spinal fusion (22630/ 22632) and one of the following laminectomy procedures, 63005, 63012, 63017, 63030, 63035, 63042, 63044, 63047 and 63048, the laminectomy will be denied as incidental to the primary procedure, even if the 59 modifier is appended.

Changes for these recently reviewed medical policies become effective June 19, 2011 and will apply for services reported on and after this date.

To find out more about BCBSNC online medical policies and to access complete versions of BCBSNC medical policies covering modifier guidelines and bundling guidelines, please visit the BCBSNC Medical Policy page located at: http://www.bcbsnc.com/content/services/medical-policy/index.htm.

Providers interested in reviewing medical policy Updates can access online policies either through the Medical Policy page or connect direct at Updates: http://www.bcbsnc.com/content/services/medical-policy/updates/index.htm.

We invite you to please visit our on line medical policies located on the Providers page at bcbsnc.com. Providers having questions about BCBSNC policies covering modifier guidelines, bundling guidelines or other medical policies available from our web site are encouraged to contact their regional Network Management representative for assistance.