Blue Cross Newsletter
 

 

May 26, 2009 

 

BC-09-08
MS-09-07


 

ASC-09-07
SA-09-07

To: All Blue Cross Contracting Providers
From: Cindy Garrison, Communications Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association
Subject:

Accident Claim Guidelines

Some Blue Cross and Blue Shield of Kansas (BCBSKS) member contracts include a specific benefit which allows payment at 100% of the claim allowance for services related to an accidental injury.


When billing treatment for accidents, our claims processing system will look at four form locators on the claim to explain the date and nature of the accidental injury.  In order for your claim to be processed quickly and efficiently, preferably all four form locators, listed below, will reflect accident information.  If the information provided does not meet the definition of an accidental injury or is insufficient, the claim could be returned to you for additional information or medical benefits will be applied rather than the accidental injury benefits.


DEFINITION:  An accidental injury is defined as bodily injury effected solely through external, violent and accidental means, including the accidental inhalation of smoke or carbon monoxide. Accidental injury does NOT include: disease or infection (unless it is a pus-producing infection that occurred from an accidental cut or wound); hernia, injuries cause by biting or chewing.


Form Locators NECESSARY for accidental injury claims: 

  • Form locator 31-34 – Occurrence Code – Use 01-06 & Date
  • Form locator 66 – Accident Diagnosis Code – If the accident diagnosis is not in the primary position and you have the other three indicators, the accident diagnosis must be in the second or third position for the claim to process under the member's accident benefit.  Not all ICD-9-CM diagnosis codes (800-900 range) are considered to be ‘accident codes’.  Below is a list of diagnosis codes BCBSKS considers to be accident related.
  • Form locator 72 – Accident External Cause (E) Code – Not all E-codes are considered to be ‘accident’ codes. Look at the code description to determine if the E-code describes an injury or accident. Always make sure the ’accident’ E-code is coded before any other E-codes.
  • Form locator 80 – Remarks – Remarks/comments that indicate the nature of the accident.  Be sure the remarks specifically indicate the details of the accident.

If your facility receives a letter requesting additional information, resubmit with a copy of the letter and an updated claim.

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ACCIDENT DIAGNOSIS CODES:

Accident Diagnosis Codes – Local and Blue Card
V540.1 – V54.9
V71.3 – V71.6
692.76, 692.77
37024, 710 – 7399 *Excludes Diagnosis Codes 733.00, 733.01 and 719.98
800 – 989.9
992.3, 992.4, 992.5
994.0 – 994.8
995.81
996.9 – 996.99

*Diagnosis 370.24, 710 – 739.9 processed as accident only when there is other accident info on the claim (i.e. accident occurrence code).

FEP Accident Diagnosis Ranges
V715
692.76, 692.77
800 – 897.7
900 – 999.9

*The FEP diagnosis listing is very limited and we MUST process claims according to their guidelines.