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Outpatient UB92 Claims Filing Update
Notice to Outpatient Facility, Lithotripsy, Ambulatory Surgical and Colonoscopy Providers:

Effective October 1, 2004, a Health Insurance Portability and Accountability Act (HIPAA) X12N institutional 837 transaction requirement was implemented by CMS that prohibited the use of ICD-9-CM procedure codes on all institutional outpatient services. HCPCS/CPT are the HIPAA standard medical codes sets for outpatient institutional services.

BCBSNC has been operating under a contingency plan that required providers to continue to use ICD-9 procedure codes at the “situational” claim level for 837s and in form locators 80 and 81 for UB92s, when filing any of the following revenue codes: 36x, 49x, 75x, or 79x.

Effective June 17th, 2006, BCBSNC will lift the contingency and will no longer accept ICD-9-CM procedure codes at the “situational” claim level for 837s or in form locators 80 and 81 for UB92s when filing outpatient institutional claims [Bill type X4X or X3X].

Note that:

  • Effective June 17, 2006, 837 Institutional outpatient claims with an ICD-9-CM procedure code at the “situational” claim level will not pass HIPAA Implementation Guide edits.
  • Effective June 17, 2006, paper UB92s received for institutional outpatient services with an ICD-9-CM procedure code in form locators 80 and 81 will be rejected and mailed back to the provider.

As part of the transition into the June 17 cut-off implementation date, the Blue e UB92 claims entry screen has been modified to allow outpatient facility claims with bill type X3X or X4X to be billed with either HCPCS or CPT codes instead of ICD-9 codes.

Inpatient Facility claims should continue to be billed with ICD-9 codes. These changes apply to outpatient facility charges only. Providers should remediate their systems and work with their billing to avoid an increase in rejected claims.