Providers Urged to Ensure E&M Codes are Filed Correctly

BlueCross BlueShield of South Carolina and BlueChoice HealthPlan are asking providers to ensure claims with Evaluation and Management (E&M) CPT codes are submitted correctly.

Some providers are submitting new-patient office visit or other outpatient codes for established patients. This error can lead to delays in claims processing or denials.

BlueCross and BlueChoice define a new patient as one who has not received an E&M or other face-to-face service from a physician (or from another physician of the same specialty in the same group practice) within the previous three years.

If a physician (or a physician of the same specialty within your practice) has seen a patient within the previous three years, please submit the appropriate established-patient visit code when filing claims for that member. Please do not submit a new-patient code.

If you have questions about this bulletin, you may contact Provider Education at 803-264-4730 or submit your question using the Provider Education Contact Form.