April 8, 2026
On or after July 8, 2026, we’ll update the Lyric software database to better provider coding with industry standards for accurate billing and proper reimbursement. If your claim receives a primary edit, it will reflect ineligible reason codes with an alpha character of “G.”
These are the changes:
| Laterality Diagnosis Check | This rule recommends the denial of claim lines if all the claim header or line diagnoses are inconsistent with the modifier (LT, RT, 50) or quantity (quantity=2) submitted on the claim line; e.g., an LT only diagnosis is submitted with an RT modifier. This rule is appropriate for professional claims and outpatient facility claims identified with any of the following bill types 012X-014X, 022X-023X, 032X, 034X, 043X, 071X-079X, 081X-085X, 087X and 089X. |
| Revenue Code and Procedure | This rule will look at Healthcare Common Procedure Coding System code(s) submitted with an implant revenue code to determine if the HCPCS code is applicable to the service(s) described by revenue codes 275, 276 or 278. This rule is appropriate for outpatient facility claims only. |
To determine how coding combinations may be evaluated during claim adjudication, use Clear Claim ConnectionTM (C3). Learn more about ClaimsXtenTM and C3.
ClaimsXten and Clear Claim Connection are trademarks of Lyric, an independent company providing coding software to Blue Cross and Blue Shield of Oklahoma. Lyric is solely responsible for the software and all the contents. BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.