Code substitutions available for musculoskeletal surgical procedures authorized by TurningPoint
TurningPoint Healthcare Solutions LLC authorizes musculoskeletal procedures for most Blue Cross and BCN members.
In some situations, you may not know which orthopedic or spinal procedure will be required in advance of a surgery or the surgical plan may change intraoperatively. As a result, the procedure code TurningPoint authorized may not represent the procedure that was actually performed.
Prior to submitting claims for these procedures, you'll need to determine whether you can substitute the code for the procedure that was actually performed for the code TurningPoint authorized. If you can substitute the code, you won't need to contact TurningPoint to update the procedure coding.
To learn how to determine whether you can submit a substitute code and to view the list of codes that allow substitutions, see the Musculoskeletal procedure code substitutions for orthopedic and spinal surgeries (PDF) document.
As a reminder, TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following:
- Blue Cross commercial - All fully insured groups, select self-funded group and all members with individual coverage
- Medicare Plus BlueSM members
- BCN commercial members
- BCN AdvantageSM members
Posted: March 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network