hidden value — explore our specialty companions” · specialty coding companions 5. icd -10-cm...

AAPC HEALTHCON Las Vegas, NV April 28–May 1, 2019

Nichole VanHorn, CPC, CCS-P

Hidden value — Explore our specialty companions”

© 2019 Optum, Inc. All rights reserved. Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.

Presentation disclaimer

All of the information provided is believed to be accurate and reliable; however, Optum360® assumes no responsibility for any errors. Optum360 is providing this information for educational purposes only and not as a replacement for professional judgment and experience; therefore any use of this information is at your sole risk and Optum360 neither assumes nor is responsible for its use.

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Why do we have specialty code books?

Focus on the services that are important to each specialty Give detailed information that is more beneficial because it is specialty specific Some of the Coding and Payment Guides have specialty society approval and additional

information Identify common areas of billing errors and will help prevent denials Customers requested them!

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Specialty code companions

Cardiology/Cardiothoracic/Vascular Surgery ENT/Allergy/Pulmonology General Surgery/Gastroenterology Neurosurgery/Neurology OB/GYN Ophthalmology Orthopaedics: Hips & Below

Orthopaedics: Spine & Above Plastics/Dermatology Podiatry Primary Care/Pediatrics/Emergency Medicine Radiology Urology/Nephrology

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Specialty coding companions

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© 2019 Optum360. All rights reserved.



1. CPT® codes and descriptions

CPT® codes are updated annually

New, revised, add-on codes are identified by icons

Resequenced CPT® codes enclosed in brackets

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CPT is copyrighted by the American Medical Association (AMA) and CPT is a registered trademark of the AMA.



2. Illustrations

Illustrations accompany most of the Coding Companion CPT® code sets.

Illustrations provide coders a better understanding of the medical procedures referenced by the codes and data.

Graphics offer coders a visual link between the technical language of the

operative report and the code descriptions.

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Specialty coding companions 3. Explanation

Every CPT® code or series of similar codes is presented with its official CPT® code description. o This does not always provide the coder with sufficient information to make a proper code

selection.

The Coding Companion contains an easy-to-understand, step-by-step clinical description

of the procedure.

Technical language that might be used by the provider is included and defined.

Coding Companion describes the most common method of performing each procedure.

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4. Coding tips

Coding tips provide information regarding:

The use of the code

Coding guidelines

Related CPT® codes

Offers help concerning common billing errors, modifier usage and anesthesia

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5. ICD-10-CM diagnostic codes

Lists common diagnoses or reasons the procedure may be necessary.

In most cases, lists are inclusive to the specialty.

In some instances the ICD-10-CM codes that pertain to the procedure are numerous and only one side of the body (right) will be listed with the CPT® code.

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6. Associated HCPCS codes Medicare and some other payers require the use of HCPCS Level II codes instead of CPT® codes when reporting certain services. The HCPCS codes and their description are displayed in this field.

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7. AMA references The AMA references for CPT® Assistant are listed by CPT® code, with the most recent reference listed first.

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8. Relative Value Units/Medicare Edits Medicare edits are provided for most codes. o Relative Value Units o Medicare Follow-up Days (FUD) o Status Indicator o Medically Unlikely Edits o Modifiers o Medicare Official Regulatory Information

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9. Terms to know

Some codes are accompanied by definitions of terms that are pertinent to the procedure

o Useful enhancement to coders hoping to expand their knowledge of the specialty

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Specialty coding and payment guides

Anesthesia/Pain Management Services Laboratory Services Medical Oncology/Hematology Services OMS — Oral and Maxillofacial Surgery Physical Therapy Services Behavioral Health Services Radiology Services — New for 2020

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Coding and billing guides

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5. Documentation tips

These provide code-specific tips regarding the information that should be noted

in the medical record to support code assignment.

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6. Reimbursement tips

Medicare and other payer guidelines could affect the reimbursement of a service or procedure.

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7. Associated CPT®/HCPCS code

This is a crosswalk from the CPT® code to its corresponding HCPCS Level II code where appropriate.

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Reimbursement issues

In OMS there is a section that discusses

Medicaid Coverage of Dental and Maxillofacial Services o Dental Coverage for Children o Adult Coverage

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Coding and billing guides Documentation

Example

Tooth Number and Surface — Dental claims are unique in that the specific tooth and often the areas of oral cavity involved in the treatment must be indicated to payers. The systems used to identify this information are similar to the modifiers used in the CPT®/HCPCS systems.

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CPT is copyrighted by the American Medical Association (AMA) and CPT is a registered trademark of the AMA. © 2019 Optum360. All rights reserved.


Coding and billing guides Illustrations are not found for every code, instead there is a dedicated section. This is a sampling:

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The guides also include Medicare official regulatory information pertinent to the specialty. National Coverage Determinations Manual Medicare Benefit Policies

o Pub. 100 references


AAPC HEALTHCON Las Vegas, NV | April 28–May 1, 2019

Thank you. CONTACT INFORMATION

Email: [email protected]

Nichole VanHorn, CPC, CCS-P

hidden value — explore our specialty companions” · specialty coding companions 5. icd -10-cm...

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