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Clinical Editing Customization
Clinical Editing Customization

Excellus Health Plan uses McKesson's ClaimCheck® editing software for code editing and rationale. ClaimCheck® uses National coding standards for its Clinical Code Editing. Below is a list of Excellus Clinical Editing customizations and rationale.

CURRENT EDIT RATIONALE
19318 mutually exclusive to 19300 New edit will follow Medicare
20550 incidental to 20600, 20605 or 20610 New edit will follow Medicare
20551 incidental to 20600, 20605 or 20610 New edit will follow Medicare
20600 incidental to 64470 or 64475 New edit will follow Medicare
20605 incidental to 64470 or 64475 New edit will follow Medicare
20610 incidental to 64470 or 64475 New edit will follow Medicare
73140 incidental to 73120 New edit will follow Medicare
76942 and 76872 allowed when billed on the same date of service New edit will follow Medicare
81002 is allowed with E & M Modify existing edit to allow this code combination
81003 is allowed with E & M Modify existing edit to allow this code combination
Allow 82533 twice on the same day Modify existing edit to allow 82533 twice on the same day
83721 mutually exclusive to 80061 New edit will follow Medicare
93508 is allowed when billed on the same day as 92980, 92981, 92982 Modify existing edit to allow the initial cardiac catheter placement when rendered during the same session as the coronary angiography.
99050 is allowed if billed on same day with 99201 - 99205, 99211 - 99215, 99241 - 99245, 92002 - 92004 and 92012 - 92014 Modify existing edit to allow for after posted business hours
99058 is allowed if billed on same day with 99201 - 99205, 99211 - 99215, 99241 - 99245, 92002 - 92004 and 92012 - 92014 Modify existing edit to allow for visit in the office for other than an emergency situation
99060 is allowed if billed on same day with 99201 - 99205, 99211 - 99215, 99221 - 99223, 99231 - 99233, 99241 - 99245, 99251 - 99255, 92002 - 92004 and 92012 - 92014 Modify existing edit to allow for visit out of the office for other than a scheduled visit
99173 is allowed when billed on the same day with 99381 - 99397 Per CPT Guidelines
G0375 & G0376 are allowed if billed on the same day as 99201-99205, 99211-99215, or 99241-99245 Modify existing edit to allow this code combination
Modifier 51 applied to 36415 Modify existing edit to no longer add modifier 51 to 36415

Provider acknowledges that the above customizations are intended for the disclosure of Excellus Health Plan Customized Clinical Edits. Excellus Health Plan Medical Policy guidelines must be followed. The listed customized clinical edits do not guarantee payment of claims.

Excellus Health Plan licenses Clear Claims Connection®, a code auditing reference tool on the Web that enables Excellus Health Plan to disclose its code auditing rules and associated clinical rationale to Providers. Excellus Health Plan provides access to such Software to its Providers subject to Excellus' terms and conditions.

Follow this link to access Clear Claims Connection®.

 

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