We designed the BlueCross BlueShield of South Carolina claims auditing system to identify services that are considered incidental, mutually exclusive and integral to the primary service rendered or part of a global allowance. This automated process identifies injections – such as J codes – which may have been filed separately from surgical procedures.
This guideline addresses the proper way to file surgical procedure claims. You should expect a denial for J3301 when you file charges for lab, X-ray or medical procedures separately. This code is not eligible for separate reimbursement. Use procedure code 20610 in place of J3301. This procedure code combines these services into one procedure. You should not balance bill members for these services.
You can find additional information about our medical policy, CAM 564, that gives guidance on Surgical Guidelines (Secondary, Multiple Procedures, Co-Surgeons, Assistant Surgeons, Stand-By Physicians, Microsurgery/Midsection) by visiting Medical Policies page.
Please contact Provider Education for information about this bulletin at firstname.lastname@example.org or toll free at 800-868-2510.