CODING, BILLING &
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DISCOVER THE PERFECT MIX OF OPTUM360® DIGITAL CODING
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CODING, BILLING & REIMBURSEMENT SUMMER CATALOG
TABLE OF CONTENTS:
Optum360 Edge
NEW SOLUTIONS
PRICING & COST
3
39Fees
New solutions
ICD-10 TRANSITION
CODING, BILLING & REIMBURSEMENT
5
41 Coding, billing & reimbursement
ICD-10 transition
6Physician
7Hospital
9Post-acute
BOOKSTORE
10Reference
44 Workers’ compensation
13 Mapping & documentation
improvement
14 Online digital coding solutions
MEDICARE
15Education
45Medicare
Optum360 Edge identifies
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eBooks available
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Products contained in this catalog are made
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17Training
ESSENTIAL CODING
18DRG
19CPT®
21 HCPCS Level II
ONLINE DIGITAL CODING SOLUTIONS
23, 28 Coding reference
27 Data
31 Revenue cycle
SPECIALT Y REFERENCE
33 Coding & reimbursement
35 Cross coding
36 Coding & payment
DESK REFERENCE
37 Coding & billing
V91.05XA
Burn due to canoe or kayak
on fire, initial encounter
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NEW SOLUTIONS
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2017 Coders’ Desk Reference for
ICD-10-PCS Procedures
2017 Coders’ Desk Reference
for Diagnoses
2017 ICD-10 Essentials:
Operation PCS
DESIGNED FOR HOSPITALS, PAYERS
DESIGNED FOR PHYSICIANS, HOSPITALS,
POST-ACUTE, PAYERS
DESIGNED FOR HOSPITALS, PAYERS
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Clinical Technical Editor (CTE) spotlight
Peggy Willard
CCS, AHIMA-Approved
ICD-10-CM/PCS Trainer
Employed at Optum360 for 2 years
Anita Schmidt
BS, RHIT, AHIMA-Approved
ICD-10-CM/PCS Trainer
Employed at Optum360 for 3 years
Meet the experts behind Optum360 ICD-10-CM and
-PCS content – Peggy Willard, CCS, AHIMA-Approved
ICD-10-CM/PCS Trainer, and Anita Schmidt, BS, RHIT,
AHIMA-Approved ICD-10-CM/PCS Trainer. Peggy and
Anita started their coding careers as inpatient coders at
the same level I adult and pediatric trauma hospital in
St. Paul, Minnesota. These two quickly bonded not only in
their working environment but in their personal lives when it
was discovered that they were both New Year’s babies. The
knowledge and experience they gained during their years
at the large, urban teaching hospital as well as their various
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coding responsibilities prepared them for their transition
to Optum360 and their current CTE roles.
Peggy’s past expertise was inpatient diagnosis and
procedural coding in ICD-9-CM, rehabilitation coding, and
DRG assignment, and her current focus is on ICD-10-CM
and -PCS. As the ICD-10 subject matter expert, she was
extensively trained in ICD-10-CM and -PCS and started
coding medical charts in ICD-10-CM /PCS five years
prior to the implementation date. Peggy also conducted
ICD-10-CM/PCS training of coding staff as well as clinical
documentation specialists. Training others has been a passion
throughout her career, and she loves to mentor those new to
coding or CDI. She is a member of AHIMA and the Minnesota
Health Information Management Association (MHIMA).
Anita started as an inpatient coder, gaining expertise in
ICD-9-CM diagnosis and procedural coding and DRG
assignment. She was later cross-trained to function as a
facility outpatient coder, assigning CPT® codes for
same-day surgery cases. As a facility subject matter expert
for the electronic medical record (EMR), she conducted
training for coding staff and clinical documentation specialists.
She has had extensive ICD-10-CM/PCS training and
participates in several ICD-10-CM/PCS-focused coding
round tables, one of which she co-coordinates. Anita is a
member of AHIMA and the Minnesota Health Information
Management Association (MHIMA).
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ICD-10 TRANSITION
5
PIONEER
THE NEW FRONTIER OF CODING
Optum360 has everything you need to be a pioneer in the new
frontier of coding. Be sure you’re ready for October 1, 2016, with
these trusted resources by your side.
PIONEER
CEU
CEU
THE NEW FRONTIER OF CODING
PAGES
6–9
PAGES
10-12
ICD-10-CM AND -PCS
CODE SETS
Designed for physicians,
hospitals and post-acute
care services, our 2017
editions include new features
and benefits that you won’t
find in past versions.
ICD-10 REFERENCES AND
SPECIALTY RESOURCES
With more information
about code specificity and
specialty-specific details,
these reference materials
will give you the confidence
you need to code accurately
in ICD-10.
PAGE
13
ICD-10 DOCUMENTATION
IMPROVEMENT AND
MAPPING
Ensure accurate physician
documentation and find
mapping tools to help
you navigate coding in
ICD-10-CM/PCS.
PAGES
15-17
TRAINING AND
EDUCATION
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on ICD-10 code details
to ensure accurate and
timely reimbursements?
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ICD-10 IS NOW. CHANGE WITH CONFIDENCE.
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| ICD-10 TRANSITION
PHYSICIAN
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2017 ICD-10-CM for Physicians
The 2017 ICD-10-CM resources for physicians make facing the challenge of
using the new code set easier. Use the code book that contains the latest
official government version of the ICD-10-CM code set, plus new Optum360
features and benefits that will make code selection easier and more accurate.
•NEW Optum360 Edge — Illustrations and definitions in the tabular. Assign
codes with confidence based on illustrations and definitions designed to highlight
key components of the disease process or injury.
DESIGNED FOR PHYSICIANS
Item No: ITPS17
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Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue
2017 ICD-10-CM Expert
for Physicians (Spiral)
• Optum360 Edge — Intuitive features and format. Intuitive visual alerts,
M48.5–M50.11
Chapter 13. Diseases of the Musculoskeletal System and Connective Tissue
ICD-10-CM 2016
including
our hallmark color-coding andbsymbols
that identify coding notes and
c M48.5 Collapsed vertebra, not elsewhere classified
M49 Spondylopathies in diseases classified elsewhere
Collapsed vertebra NOS
1 curvature of spine in diseases classified elsewhere
Wedging
of vertebra NOS character requirements, Medicare
deformity of spineCode
in diseases classified
elsewhere
instructions,
additional
Edits
(MCEs),
kyphosis in diseases classified elsewhere
1 current injury—see Injury of spine, by body region
scoliosis in diseases classified elsewhere
fatigue fracture of vertebra (M48.4)
manifestation codes,
other
specified
codes.
spondylopathy in diseases
classified elsewhere
pathological fracture
of vertebra
due to neoplasm codes and unspecified
Code first underlying disease, such as:
brucellosis (A23.-)
(M84.58)
pathological fracture of vertebra due to other diagnosis
Charcôt-Marie-Tooth disease
(G60.0)examples. Includes
(M84.68)
• Optum360 Edge
— Coding guideline explanations
and
enterobacterial infections (A01-A04)
pathological fracture of vertebra due to osteoporosis
osteitis fibrosa cystica (E21.0)
(M80.-)
detailed explanations
andNOSexamples
related to1
application
the[Pott's]
ICD-10-CM
pathological fracture
(M84.4-)
curvature of spine inof
tuberculosis
(A18.01)
stress fracture of vertebra (M48.4-)
enteropathic arthropathies (M07.-)
traumatic fracture of vertebra (S12-, S22-, S32-)
gonococcal spondylitis (A54.41)
coding guidelines.
neuropathic [tabes dorsalis] spondylitis (A52.11)
The appropriate 7th character is to be added to each code
from subcategory M48.5.
neuropathic spondylopathy in syringomyelia (G95.0)
neuropathic spondylopathy in tabes dorsalis (A52.11)
initial encounter
fracture
• Optum360AD Edge
— forMuscle/tendon
translation
table.
Use
this NEC
table
nonsyphilitic
neuropathic
spondylopathy
(G98.0) to
subsequent encounter for fracture with routine healing
spondylitis in syphilis (acquired) (A52.77)
G
subsequent encounter for fracture with delayed healing
spondylitis (A18.01)
S
sequela of fracture
determine muscle/tendon
action (flexor, extensor, tuberculous
other)
which
typhoid
fever spondylitis
(A01.05)is a component of
g M48.50 Collapsed vertebra, not elsewhere classified, site
c M49.8 Spondylopathy in diseases classified elsewhere
unspecifiedconditions and injuries affecting
codes for acquired
muscles
and elsewhere,
tendons.
M49.80 the
Spondylopathy
in diseases classified
g M48.51 Collapsed vertebra, not elsewhere classified,
site unspecified
M49.81 Spondylopathy in diseases classified elsewhere,
occipito-atlanto-axial region
occipito-atlanto-axial
region ICD-10-CM
g M48.52
Collapsed —
vertebra, not elsewhere classified, cervical Alerts the coder
• Optum360
Edge
to a new
region
M49.82 Spondylopathy in diseases classified elsewhere,
cervical region
g M48.53 Collapsed vertebra, not elsewhere classified,
convention, the
use ofregion
a “placeholder X.”
cervicothoracic
M49.83 Spondylopathy in diseases classified elsewhere,
cervicothoracic region
M49.84 Spondylopathy in diseases classified elsewhere,
thoracic region
M49.85 Spondylopathy in diseases classified elsewhere,
thoracolumbar region
M49.86 Spondylopathy in diseases classified elsewhere,
lumbar region
M49.87 Spondylopathy in diseases classified elsewhere,
lumbosacral region
M49.88 Spondylopathy in diseases classified elsewhere,
sacral and sacrococcygeal region
M49.89 Spondylopathy in diseases classified elsewhere,
multiple sites in spine
g M48.54 Collapsed vertebra, not elsewhere classified,
thoracic region
g M48.55 Collapsed vertebra, not elsewhere classified,
thoracolumbar region
g M48.56 Collapsed vertebra, not elsewhere classified, lumbar
region
C
g M48.57 Collapsed vertebra, not elsewhere classified,
lumbosacral region
g M48.58 Collapsed vertebra, not elsewhere classified, sacral
and sacrococcygeal region
A
c M48.8 Other specified spondylopathies
Ossification of posterior longitudinal ligament
d M48.8X Other specified spondylopathies
M48.8X1 Other specified spondylopathies,
occipito-atlanto-axial region
M48.8X2 Other specified spondylopathies, cervical
region
M48.8X3 Other specified spondylopathies,
cervicothoracic region
M48.8X4 Other specified spondylopathies, thoracic
region
M48.8X5 Other specified spondylopathies,
thoracolumbar region
M48.8X6 Other specified spondylopathies, lumbar
region
M48.8X7 Other specified spondylopathies,
lumbosacral region
M48.8X8 Other specified spondylopathies, sacral
and sacrococcygeal region
M48.8X9 Other specified spondylopathies, site
unspecified
M48.9 Spondylopathy, unspecified
2017 ICD-10-CM
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M48.5–M50.11
DESIGNED FOR PHYSICIANS
1 Not coded here
DESIGNED FOR PHYSICIANS
A
$109.95
Other dorsopathies (M50-M54)
current injury—see injury of spine by body region
discitis NOS (M46.4-)
b M50 Cervical disc disorders
0
1
Code to the most superior level of disorder.
cervicothoracic disc disorders with cervicalgia
cervicothoracic disc disorders
c M50.0 Cervical disc disorder with myelopathy
M50.00 Cervical disc disorder with myelopathy,
unspecified cervical region
M50.01 Cervical disc disorder with myelopathy,
high cervical region
C2-C3 disc disorder with myelopathy
C3-C4 disc disorder with myelopathy
M50.02 Cervical disc disorder with myelopathy,
mid-cervical region
C4-C5 disc disorder with myelopathy
C5-C6 disc disorder with myelopathy
C6-C7 disc disorder with myelopathy
M50.03 Cervical disc disorder with myelopathy,
cervicothoracic region
C7-T1 disc disorder with myelopathy
c M50.1 Cervical disc disorder with radiculopathy
2 brachial radiculitis NOS (M54.13)
M50.10 Cervical disc disorder with radiculopathy,
unspecified cervical region
M50.11 Cervical disc disorder with radiculopathy, high
cervical region
C2-C3 disc disorder with radiculopathy
C3 radiculopathy due to disc disorder
C3-C4 disc disorder with radiculopathy
C4 radiculopathy due to disc disorder
y
y
y
y
B
2017 ICD-10-CM
Professional
for Physicians (eBook)
Item No: eITPB17
Available: Sept 2016
1
2 Not included here
8 Newborn Age: 0
9 Pediatric Age: 0-17
x Maternity Age: 12-55
706
y Adult Age: 15-124
ICD-10-CM 2017
Partial sample page from ICD-10-CM Professional for Physicians
Key word(s) in green
font, our exclusive
feature
B
Excludes 1 and
Excludes 2 definition/
use reminder note
C
Optum360 Edge
placeholder X alert symbol,
our exclusive feature
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ICD-10 TRANSITION |
7
HOSPITAL
2017 ICD-10-CM for Hospitals
The 2017 ICD-10-CM resources for hospitals, featuring our hallmark
color-coding and symbols related to ICD-10 MS-DRG reimbursement edits,
make facing the challenges of accurate diagnosis coding easier.
All the great features found in our 2017 ICD-10-CM for Physicians resources, plus:
• Optum360 Edge — Supplementary appendixes (exclusive to the
Optum360 Expert edition). These appendixes provide supplementary
information, including:
2017 ICD-10-CM Expert
for Hospitals (Spiral)
DESIGNED FOR HOSPITALS, PAYERS
Item No: ITHS17
Available: Sept 2016
$114.95
– 10 steps to correct coding with
coding examples
– Valid 3-character ICD-10-CM codes
– Complication and comorbidity (CC)
code list
– Major complication and comorbidity
(MCC) code list
– Pharmacological listings by chapter
– Present on admission (POA) tutorial
• Optum360 Edge — Color-coding and symbols for the Medicare
Code Edits.
– Manifestation code alert
– Age and sex
– Hospital acquired condition
(HAC) alerts
– CC/MCC
– PDx Exclusion for CC and MCC
– PDxCC and PDxMCC
• Optum360 Edge — Exclusive PDx acting as CC and MCC alert symbols.
Alerts the coder to ICD-10-CM combination codes that act as both PDx and
CC or MCC.
• Optum360 Edge — Additional character required symbols. Know when
an additional character is required for code specificity and validity to avoid invalid
code submissions.
• AHA Coding Clinic® references. Get official coding advice and guidelines.
C
2017 ICD-10-CM Professional
for Hospitals (Softbound)
DESIGNED FOR HOSPITALS, PAYERS
Item No: ITHB17
Available: Sept 2016
$109.95
A
2017 ICD-10-CM
Professional
for Hospitals (eBook)
D
A
Unacceptable/questionable
admission code highlighting
B
Highlighted Hospital
Acquired Condition alert
C
DESIGNED FOR HOSPITALS, PAYERS
Item No: eITHB17
Available: Sept 2016
B
D
CC Excludes-list of PDx for
which the SDx code does
not act as a CC or MCC
PDx acting as CC and
MCC alert
$109.95
Partial sample page from ICD-10-CM Professional for Hospitals
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HOSPITAL
| ICD-10 TRANSITION
2017 ICD-10-PCS
•NEW Illustrations of body parts accompanying the Character
Meaning Tables. These are located at the beginning of each body
system in the Medical/Surgical section.
• Optum360 Edge — Intuitive features and format. Ease into the new
classification system using handy code tables to build the code through
character value selections that reflect the procedure performed. Now
with body part definitions included in the root operation tables for the
Medical/Surgical section.
• Optum360 Edge — Color-coding and symbols for the Medicare
Code Edits. This edition includes all our hallmark color-coding and
symbols for the most comprehensive coverage of ICD-10 MS-DRG MCEs
for procedures, including:
– Non-operating room
procedures NOT affecting
MS-DRG assignment
– Combination-only procedures
– HAC-related procedures
– Non-covered procedures
– Limited coverage procedures
– Non-operating room
procedures affecting MS-DRG
assignment
• Optum360 Edge — Procedure combination tables. Identify
ICD-10-PCS code combination requirements needed to satisfy certain
MS-DRG requirements.
Heart and Great Vessels
• Detailed information on structure and conventions of ICD-10-PCS.
For those new to ICD-10-PCS coding — learn about the unique structure
and the specific definitions and functions for each character.
A
02F–02H
0
2
F
ICD-10-PCS 2017
Medical and Surgical
Heart and Great Vessels
Fragmentation Definition: Breaking solid matter in a body part into pieces
Body Part
Character 4
N Pericardium
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DESIGNED FOR HOSPITALS, PAYERS
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02F
0
3
4
X
4
Approach
Character 5
Open
Percutaneous
Percutaneous Endoscopic
External
Device
Character 6
Z No Device
Qualifier
Character 7
Z No Qualifier
A
Non-OR 02FNXZZ
4
4
6
7
K
L
A
02FNXZZ
Medical and Surgical
Heart and Great Vessels
02H
Insertion
Definition: Putting in a nonbiological appliance that monitors, assists, performs, or prevents a physiological function but does not physically
take the place of a body part
Explanation: None
Body Part
Character 4
Coronary Vein
Atrium, Right
Atrium dextrum cordis
Right auricular appendix
Sinus venosus
Atrium, Left
Atrium pulmonale
Left auricular appendix
Ventricle, Right
Conus arteriosus
Ventricle, Left
Heart
B
Approach
Character 5
?
?
0 Open
3 Percutaneous
4 Percutaneous Endoscopic
?
0
2
3
D
J
K
M
Device
Qualifier
Character 6
Character 7
Monitoring Device, Pressure Sensor Z No Qualifier
Monitoring Device
Infusion Device
Intraluminal Device
Cardiac Lead, Pacemaker
Cardiac Lead, Defibrillator
Cardiac Lead
?
?
3
A Heart
?
N Pericardium
?
0
3
4
0
3
4
0
3
4
Open
Percutaneous
Percutaneous Endoscopic
Open
Percutaneous
Percutaneous Endoscopic
Open
Percutaneous
Percutaneous Endoscopic
Q Implantable Heart Assist System
Z No Qualifier
R External Heart Assist System
S Biventricular
Z No Qualifier
0
2
J
K
M
0
2
3
D
Monitoring Device, Pressure Sensor Z No Qualifier
Monitoring Device
Cardiac Lead, Pacemaker
Cardiac Lead, Defibrillator
Cardiac Lead
Monitoring Device, Pressure Sensor Z No Qualifier
Monitoring Device
Infusion Device
Intraluminal Device
0 Open
P Pulmonary Trunk
Q Pulmonary Artery, Right
3 Percutaneous
R Pulmonary Artery, Left
4 Percutaneous Endoscopic
Arterial canal (duct)
Botallo's duct
Pulmoaortic canal
S Pulmonary Vein, Right
Right inferior pulmonary vein
Right superior pulmonary vein
T Pulmonary Vein, Left
Left inferior pulmonary vein
Left superior pulmonary vein
V Superior Vena Cava
Precava
W Thoracic Aorta
Aortic arch
Aortic intercostal artery
Ascending aorta
Bronchial artery
Esophageal artery
Subcostal artery
DRG Non-OR 02H[4,6,7][0,4][J,M]Z
DRG Non-OR 02H[6,7]3J
DRG Non-OR 02H[K,L][0,3,4][J,M]Z
Non-OR
02H[P,Q,R][0,3,4][0,2,3]Z
Non-OR
02H[S,T,V][0,3,4]3Z
Non-OR
02HW[0,3,4][0,3]Z
HAC
02H43[J,K,M]Z when reported with SDx K68.11 or T81.4XXA or T82.6XXA or T82.7XXA
HAC
02H[6,7]3[J,M]Z when reported with SDx K68.11 or T81.4XXA or T82.6XXA or T82.7XXA
HAC
02H[K,L]3JZ when reported with SDx K68.11 or T81.4XXA or T82.6XXA or T82.7XXA
HAC
02HN[0,3,4][J,M]Z when reported with SDx K68.11 or T81.4XXA or T82.6XXA or T82.7XXA
02HA[0,3,4]QZ
3
D
Partial sample page from ICD-10-PCS
02F–02H
DESIGNED FOR HOSPITALS, PAYERS
Explanation: Physical force (e.g., manual, ultrasonic) applied directly or indirectly is used to break the solid matter into pieces. The solid matter
may be an abnormal byproduct of a biological function or a foreign body. The pieces of solid matter are not taken out.
0
2
H
C
Heart and Great Vessels
2017 ICD-10-PCS
3 Limited Coverage 4 Noncovered ? Combination Member
HAC associated procedure
Combination Only
See Appendix I for Procedure Combinations
Combo-only 02H[4,6,7,K,L][0,4][J,M]Z
Combo-only 02H[K,L]3MZ
?
02H[4,6,7]3[J,M]Z
?
02H[K,L]3JZ
?
02H[4,6,7,L][0,3,4]KZ
?
02HK[0,3,4][0,2,K]Z
?
02HA[0,4]R[S,Z]
?
02HA3RS
?
02HN[0,3,4][J,K,M]Z
B
C
D
Gray color bar indicates
codes that do not affect
DRG assignment
DVC symbol alerts coders
that the root operation
involves a device
Purple color bar indicates
non-OR procedure that
affects DRG assignment
Combo-only pink color
bar identifies components
of code combinations
affecting DRG assignment
See page 11 for details
about our ICD-10-PCS
Quick Reference Cards.
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DRG Non-OR Non-OR
New/Revised in GREEN
8
ICD-10 TRANSITION |
9
POST-ACUTE
2017 ICD-10-CM Expert for Home Health
and Hospice
With our hallmark features and content, this resource is designed
specifically to address the challenges faced by home health agencies
and hospice services using the new ICD-10-CM coding and
reimbursement system.
• Optum360 Edge — Appendixes added. Supplemental appendixes have
been added that address home health and hospice reimbursement and
coverage issues, including:
2017 ICD-10-CM Expert
for Home Health and Hospice
– Home health prospective
payment system
– Valid diagnosis/etiology
pairing list
DESIGNED FOR POST-ACUTE, PAYERS
– Clinical dimension case mix
groups
– Non-routine supplies case-mix
adjustment variables and scores
– Selection and assignment of
OASIS diagnoses
– Medicare coverage of home
health and hospice services
Item No: ITHA17
Available: Sept 2016
$179.95
2017 ICD-10-CM Expert for
Home Health and Hospice (eBook)
DESIGNED FOR POST-ACUTE, PAYERS
Item No: eITHA17
Available: Sept 2016
$179.95
• Optum360 Edge — Detailed examples of ICD-10-CM coding
conventions and coding guidelines. Introductions to each tabular
chapter provide examples and scenarios that illustrate the application of
conventions and coding guidelines to ensure correct code assignment for
home health and hospice.
• Optum360 Edge — Hospice non-cancer diagnosis codes. Use
the supplementary information in the appendixes to determine which
conditions qualify a non-cancer patient for hospice care.
2017 ICD-10-CM Expert for Skilled Nursing
Facilities, Inpatient Rehabilitation Services
and Inpatient Hospice
2017 ICD-10-CM Expert for Skilled
Nursing Facilities, Inpatient
Rehabilitation Services and
Inpatient Hospice
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$179.95
2017 ICD-10-CM Expert
for Skilled Nursing Facilities,
Inpatient Rehabilitation Services
and Inpatient Hospice (eBook)
DESIGNED FOR POST-ACUTE, PAYERS
Item No: eITSN17
Available: Sept 2016
Use the code book that contains the HIPAA-mandated ICD-10-CM
code set, plus the familiar Optum360 coding and reimbursement alerts
you have come to rely upon —
­ designed specifically to address current
coding challenges for these specialized services.
• Optum360 Edge — Hallmark page design and features. Intuitive
visual alerts highlight code groupings as well as the distinctions among
code choices.
• Optum360 Edge — Key word. Green font is used to differentiate key
words that appear in similar code descriptions in a given category.
• Optum360 Edge — Color-coding and symbols specific to the SNF,
IRF and hospice edits. Quickly identify coding and reimbursement issues
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efficiency.
See page 29 for details about ICDExpert
for Post-acute Care.
$179.95
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REFERENCE
NEW!
| ICD-10 TRANSITION
10
2017 Coders’ Desk Reference for Diagnoses
When the official ICD-10-CM code description needs further
explanation, the 2017 Coders’ Desk Reference for Diagnoses has
the answers. Reduce coding errors and improve coding confidence
by gaining a better understanding of the clinical meanings behind
the codes.
• Optum360 Edge — Detailed clinical descriptions. Access
comprehensive clinical information at the chapter, code block, category,
subcategory and code level.
2017 Coders’ Desk Reference
for Diagnoses
DESIGNED FOR PHYSICIANS, HOSPITALS,
POST-ACUTE, PAYERS
Item No: ITDRD17
Available: Dec 2016
$139.95
Also available as an eBook.
• Optum360 Edge — Code level clinical description. Code level
descriptions are provided for select diseases, injuries, external causes, other
factors influencing health status and other reasons for contact with health
care providers based on:
– Frequency of reporting of the disease, injury or other circumstance
based on review of Medicare and other claims data – Inclusion of new, more specific, clinical information captured in the
code description
• Optum360 Edge — Clinical focus points. Improve overall coding
accuracy with additional information for complex diagnoses and injuries
that require an understanding of related codes and conditions that might
better describe the documented condition.
NEW!
2017 Coders’ Desk Reference for
ICD-10-PCS Procedures
The transition from ICD-9-CM Volume 3 procedure codes to the
ICD-10-PCS coding system is proving to be very challenging for
coders. Guidelines state that it is not the responsibility of physicians
to change the common procedural terminology they use to document
their procedures, but is instead the responsibility of the coder to take
the surgeons procedural language and translate it into ICD-10-PCS
codes. The 2017 Coders’ Desk Reference for ICD-10-PCS Procedures
has been developed to address this challenge.
2017 Coders’ Desk Reference
for ICD-10-PCS Procedures
DESIGNED FOR HOSPITALS, POST-ACUTE, PAYERS
Item No: ITDRP17
Available: Dec 2016
$139.95
Also available as an eBook.
• Optum360 Edge — Lay description. Lay descriptions are provided for
the most commonly performed inpatient procedures. Corresponding
ICD-10-PCS root operations are identified and defined.
• Optum360 Edge — Clinical focus points. When more than one
root operation may apply key procedural terms differentiating the root
operations are highlighted in focus points to ensure that the correct root
operation is selected.
• Optum360 Edge — Illustrations at the chapter and code level.
Often an illustration is needed to enhance understanding. Illustrations of
pertinent anatomy and surgical procedures are included as a visual aid.
• Organized by common procedural nomenclature. Locate information
quickly with a resource developed to work hand-in-hand with your
Optum360 ICD-10-PCS code book.
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ICD-10 TRANSITION |
11
REFERENCE
2017 ICD-10-CM Fast Finder® ­— Case Mix Quick Pick
Use the Case Mix Quick Pick cards with the quick reference table format to
identify ICD-10-CM codes for covered diagnoses included in Home Health
Clinical Dimension Categories, Hospice Non-cancer Diagnoses, Skilled Nursing
RUG IV Categories and Rehabilitation Impairment Categories (RIC).
• Optum360 Edge — Post-acute care reimbursement tool. Our easy-to-use,
streamlined tables present valid code options for each reimbursement category.
2017 ICD-10-CM Fast Finder® —
Case Mix Quick Pick
DESIGNED FOR POST-ACUTE
Item No: 18624 (SNF/IRF/Inpatient Hospice)
18634 (HH/Hospice)
Available: Nov 2016
• Optum360 Edge — Separate coding tools for home- and facility-based
post-acute care services. Select the post-acute care coding tool you need
based on the site of service – item #18624 for facility-based services (SNF, IRF, and
inpatient hospice care) or item #18634 for home health and home hospice care.
• Optum360 Edge — Space-saving formatting. The Optum360 bracketing and
footnoting conventions use less space than the same code lists found in the official
CMS documents.
$34.95
2017 ICD-10-CM Fast Finder® Sheets
•NEW Optum360 Edge — Optum360 Xpress Coding Matrix™.
Our easy-to-use, streamlined tables present the valid code options for each condition.
• Facilitate training and transition. Provides the high-volume
ICD-10-CM diagnosis codes for each specialty.
• Alphabetic listing. Logical look-up of conditions makes finding the
right code easier.
• Expanded specificity. Use decision-tree logic to find the most accurate and
appropriate code.
2017 ICD-10-CM Fast Finders
DESIGNED FOR PHYSICIANS
Available: Sept 2016
$34.95
Downloadable format available.
2017 ICD-10-PCS Quick Reference Cards
This convenient set of 18 cards is the perfect tool to guide the coder
through the code-building process and includes essential definitions
and conversion tables.
• An exclusive Optum360 resource. Get ICD-10-PCS coding
assistance at your fingertips.
2017 ICD-10-PCS
Quick Reference Cards
DESIGNED FOR HOSPITALS
Item No: ITQR17
Available: Sept 2016
$49.95
• Important coding reference information is consolidated
into one place.
– Body-part key
– Anatomical region definitions
– Root operation conversion table
– Basic -PCS character definitions
– Device key and aggregation table
WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM
REFERENCE
| ICD-10 TRANSITION
12
2017 ICD-10-CM Specialty Coding Workbooks
• NEW Earn 10 CEUs. Pass the online exam and earn 10 CEUs
from AAPC.
• NEW Includes free access to two online ICD-10 coding exams. Each exam
includes 30 multiple choice questions taken from the book. Immediately get your
final grade.
• Includes 100+ specialty-specific questions and detailed answer
rationales. Focus is on codes that will significantly impact revenue.
• Get ICD-9-CM to ICD-10-CM code mapping. Connects the respective
specialty’s most important diagnostic codes to ICD-10-CM.
2017 ICD-10-CM Coding
Workbook for OB/GYN
2017 ICD-10-CM Coding
Workbook for Cardiology
DESIGNED FOR PHYSICIANS, CONSULTANTS
DESIGNED FOR PHYSICIANS, CONSULTANTS
Item No: PWO17
Available: Sept 2016
Item No: PWC17
Available: Sept 2016
$89.95
$89.95
2017 ICD-10-CM Coding
Workbook for Orthopaedics
2017 ICD-10-CM
Coding Workbook for
General Surgery
DESIGNED FOR PHYSICIANS, CONSULTANTS
Item No: PWR17
Available: Sept 2016
$89.95
DESIGNED FOR PHYSICIANS, CONSULTANTS
Item No: PWG17
Available: Sept 2016
$89.95
NEW!
2017 ICD-10 Essentials: Operation PCS
The 2017 ICD-10 Essentials: Operation PCS is a new companion resource
for ICD-10-PCS. This resource provides in-depth explanations of everything
from the basic format and structure of the ICD-10-PCS code set to use of
the supplemental appendixes to code assignment based on appropriate
application of the coding guidelines.
• Optum360 Edge — Hundreds of coding examples/case studies. Operation
PCS provides multiple case studies illustrating application of each and every
ICD-10-PCS guideline.
• Optum360 Edge — Coding rationale. Each coding example and case study:
2017 ICD-10 Essentials:
Operation PCS
DESIGNED FOR HOSPITALS, PAYERS
Item No: ITEP17
Available: Dec 2016
$139.95
– Provides rationale for each
ICD-10-PCS code assigned
– Explains the root operation(s)
performed
– Compares and contrasts similar root
operations and identifies the correct
root operation based on root
operation definitions
– Identifies and explains all applicable
coding and reporting guidelines
• Optum360 Edge — Designed for all levels of expertise. Coding examples
and case studies tackle coding concepts ranging from basic to advanced.
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ICD-10 TRANSITION |
13
MAPPING & DOCUMENTATION IMPROVEMENT
2017 Clinical Documentation Improvement Desk Reference
for ICD-10-CM and Procedure Coding
• Covers documentation for CPT®, HCPCS and ICD-10-CM coding.
Enhance your code selections with documentation requirements for all three
coding systems.
• Includes the unique “ICD-9 to ICD-10” mapping tables. Take advantage
of an exclusive documentation resource that maps ICD-9-CM clinical terminology to
the associated ICD-10-CM terms to speed finding the correct code.
• Includes the “Clinician’s Checklist for ICD-10-CM.” Provides powerful
documentation tips for the most important chronic and acute conditions
and procedures.
2017 Clinical
Documentation
Improvement Desk
Reference for ICD-10-CM
and Procedure Coding
• Get help with physician documentation training. Show physicians what they
need to document. Includes 21 detailed documentation checklists for the most
common and complex medical conditions.
DESIGNED FOR PHYSICIANS,
HOSPITALS, PAYERS
• Don’t teach your clinicians to code ICD-10-CM. Instead, show them what is
needed for optimal code assignment.
Item No: CDI17
Available: Nov 2016
• Earn 5 CEUs. Pass the online exam and earn 5 CEUs from AAPC.
$139.95
2017 ICD-10-CM Mappings
2017 ICD-10-PCS
Mappings (eBook)
DESIGNED FOR PHYSICIANS, HOSPITALS,
POST-ACUTE, PAYERS
DESIGNED FOR HOSPITALS, PAYERS
Item No: ITCM17
Available: Sept 2016
Item No: eITPM17
Available: Sept 2016
$129.95
$129.95
2017 ICD-10-CM
Mappings (eBook)
DESIGNED FOR PHYSICIANS, HOSPITALS,
POST-ACUTE, PAYERS
Item No: eITCM17
Available: Sept 2016
$129.95
2017 ICD-10-CM and -PCS Mappings
• Optum360 Edge — Forward and backward mappings.
Contains all forward and backward ICD-9-CM and
ICD-10-CM/PCS mappings contained in the most recent
GEM provided by the National Center for Health Statistics
(NCHS).
• Optum360 Edge — Scenario mappings. When two
or more ICD-10-CM/PCS codes are required to satisfy an
equivalent mapping to an ICD-9-CM code, scenarios are
grouped and highlighted for easy translation, and
and/or statements are used to identify the ICD-10-CM/PCS
code combinations needed to create equivalent mappings.
• Optum360 Edge — ICD-10-CM/PCS combination
codes. Flag icon identifies ICD-10-CM/PCS codes that
require multiple ICD-9-CM codes to satisfy the clinical
concepts described in a single ICD-10-CM/PCS code.
Plus, with the -PCS mappings:
• Validate root operation selection. Be ready to tackle
the number one challenge with ICD-10-PCS — the
selection of the correct root operation that defines the
objective of the procedure.
CPT is a registered trademark of the American Medical Association.
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ONLINE DIGITAL CODING SOLUTIONS
| ICD-10 TRANSITION
14
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Consider powerful look-up software
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Help address many of the issues that
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ICD-10 with mapping tools and an
ICD-10-PCS code builder.
Import or create a file of ICD-9-CM
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KNOWLEDGE IS POWER
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ICD-10 TRANSITION |
15
EDUCATION
Master the ICD-10 transition with educational tools for coders
2017 Detailed Instruction for
Appropriate ICD-10-CM Coding
DESIGNED FOR PHYSICIANS, HOSPITALS
Item No: ITCE17
Available: Oct 2016
$99.95
Also available as an eBook.
2017 Comprehensive Anatomy
and Physiology for ICD-10-CM
and -PCS Coding
2017 Coding from the Operative
Report for ICD-10-CM and -PCS
DESIGNED FOR PHYSICIANS, HOSPITALS
Item No: CHOP17
Available: Nov 2016
Item No: TAP17
Available: Oct 2016
$149.95
DESIGNED FOR HOSPITALS, PAYERS
$169.95
Also available as an eBook.
Also available as an eBook.
• Optum360 Edge —
Easy-to-follow guide to
ICD-10-CM. Understand the official
coding guidelines and requirements
of the ICD-10-CM coding system.
• Optum360 Edge — Detailed
color illustrations with a focus on
pathology. Visualize conditions and
key factors in ICD-10-CM and -PCS
coding.
• Optum360 Edge —
Knowledge assessments help
quantify understanding of the
ICD-10-CM system. Answers,
with answer rationale, are provided
for all test questions. These real-life
coding scenarios with the answers
explained at length sharpen the
coding skills of beginner and
expert coders.
• Optum360 Edge — Targeted
ICD-10 training. Focus on the
details of conditions, terminology and
anatomy needed to code accurately in
ICD-10, since coders need
to understand the anatomical
differences between codes.
• Real-life examples. Clarify even
the most complex coding protocols.
• Suitable for all specialties.
Covers all body systems.
• Understand where ICD-10 will
require a deeper understanding
of anatomy. Sharpen the skills
needed for front-line, everyday coding
challenges with ICD-10.
• Prepare for future documentation
needs. Educates clinical staff about
additional documentation necessary
for coding accuracy.
CPT is a registered trademark of the American Medical Association.
WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM
• Optum360 Edge — Detailed
inpatient cases. Test inpatient
coders’ ICD-10-CM/PCS coding skills.
• Optum360 Edge — Includes
answer rationale. Plus, includes 90
case studies that explain the reasons
for code choices and demonstrate
correct coding.
• Excellent for individual or
group study.
EDUCATION
| ICD-10 TRANSITION
ELEVATE YOUR
16
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CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT
17
ICD-10 TRANSITION |
TRAINING
ICD-10 IS NOW.
CHANGE WITH CONFIDENCE.
EXPERT ICD-10 TRAINING FROM OPTUM360®
GET TRAINING THAT SUITS
YOUR ORGANIZATION’S NEEDS
Whatever role you play in your medical facility, Optum360 can help you
navigate and thrive. Our training was developed by experts to fit each
and every learner. As a coder, physician or a member of the support
staff, you can choose courses based on your needs from Level 1, 2 or 3.
CODER TRAINING
Created by coders for coders, Optum360 training provides in-depth knowledge of
the ICD-10-CM and -PCS code sets, including structure, classification and guidelines.
Each module includes several layers of validation to assure accuracy and relevance.
PHYSICIAN TRAINING
Optum360 physician training offers a foundational understanding of ICD-10, how
it affects physicians, and what the major impacts will be to their documentation
requirements. The Provider Documentation Enhancement Suite focuses on various
specialties and includes modules organized by body system.
SUPPORT STAFF TRAINING
For nurses, CDI specialists, IT, financial and quality personnel, Optum360 training
provides an overview of ICD-10 coding conventions and guidelines, and how these
changes affect specific work areas.
For more information, visit optum360coding.com/ICD10training
or call 1-800-464-3649, option 1.
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DRG
| ESSENTIAL CODING
18
2017 DRG Expert (ICD-10-CM)
The DRG Expert has been a trusted and comprehensive reference to
the DRG classification system for over 25 years. This is a must-have
for those who need to verify DRG information and accurately assign
MS-DRGs concurrently or retrospectively.
• Optum360 Edge — Visual indicators notify you of special alerts.
Easily identify CC and MCC restrictions, special payment status, transfer
DRG status, surgical/medical partitioning and other requirements.
• Optum360 Edge — Medicare CMS rate structure. Provides relative
weight (RW), geometric mean length-of-stay (GMLOS), and arithmetic
mean length-of-stay (AMLOS) for each MS-DRG based on ICD-10-CM
under IPPS.
• Optum360 Edge — MS-DRG structure. Every diagnosis and procedure
code that defines each DRG is listed.
2017 DRG Expert
(ICD-10-CM)
2017 DRG Expert
(ICD-10-CM) (eBook)
DESIGNED FOR HOSPITALS, PAYERS
DESIGNED FOR HOSPITALS, PAYERS
Item No: DRG17
Available: Sept 2016
Item No: eDRG17
Available: Sept 2016
$129.95
$129.95
2017 DRG Desk Reference
for ICD-10-CM
2017 Guide to Clinical Validation,
Documentation and Coding
• Optum360 Edge — Optimizing tips. Know the major
factors involved in moving a patient from a lower-paying
MS-DRG to a higher one to receive optimal payment.
• Covers 50 of the most challenging inpatient medical
diagnoses and procedures. Know which ones are most
questioned by payers.
• Optum360 Edge — DRG Decision Trees. Clearly
understand the logic behind assigning a DRG
within an MDC.
• Provides detailed clinical criteria and physician
documentation requirements. Code assignment
justifications are thoroughly outlined.
• Optum360 Edge — RAC program resource.
Understand the types of reviews, target strategies
and targeted and top-audited DRGs.
• Helps craft physician queries. Learn how to address fine
distinctions in a patient’s medical condition and ensure
appropriate reimbursement.
2017 DRG Desk Reference
for ICD-10-CM
DESIGNED FOR HOSPITALS, PAYERS
Item No: DDR17
Available: Oct 2016
2017 Guide to Clinical
Validation, Documentation
and Coding
DESIGNED FOR HOSPITALS, PAYERS
$219.95
Item No: CDCG17
Available: Oct 2016
Also available as an eBook.
$199.95
Also available as an eBook.
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ESSENTIAL CODING |
19
CPT ®
ALSO AVAILABLE:
from the American
Medical Association
2017 Current Procedural
Coding Expert (Spiral)
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: CE17
Available: Dec 2016
2017 CPT® Standard
Edition
2017 Current Procedural Coding
Expert — Professional Edition
(Softbound)
DESIGNED FOR PHYSICIANS,
HOSPITALS, PAYERS
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: CEP17
Available: Dec 2016
$104.95
Item No: CB17
Available: Oct 2016
$89.95
$99.95
2017 Current Procedural Coding Expert
Equipped with the entire CPT® code set, as well as a comprehensive listing of annual
code additions/changes/deletions/reinstatements, new code icons and notes.
Professional
Expert
NEW Optum360 Edge — Expanded E/M guidelines for easy use
FEATURES
3
3
Optum360 Edge — Headings with detailed Optum360 subheadings
3
3
Optum360 Edge — Code-specific definitions, rules and references
3
3
Optum360 Edge — Resequenced CPT code alerts
3
3
Optum360 Edge — Extensive user-friendly index
3
3
DESIGNED FOR PHYSICIANS,
Optum360 Edge — CCI edit icon
3
3
HOSPITALS, PAYERS
New, changed and deleted codes appendix
3
3
CPT® Assistant references
3
3
Item No: CS17
Available: Sept 2016
Medically Unlikely Edits (MUEs) appendix
3
3
PQRS icons and appendix
3
3
Facility and non-facility RVUs and global/follow-up days
3
3
Helpful illustrations
3
3
Pub. 100s and National Coverage Determinations (NCDs)
3
3
Modifier appendix
3
3
Brand-name vaccinations associated with CPT® codes
3
3
Inpatient procedures
3
3
Glossary of terms
3
3
Softbound
3
®
2017 CPT® Professional
Edition
$114.95
2017 CPT® Changes: An
Insider’s View
Spiral binding
3
Interventional radiology guidance
3
PAYERS
Snap-in tabs
3
Item No: CI17
Available: Nov 2016
CPT is a registered trademark of the American Medical Association.
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DESIGNED FOR PHYSICIANS, HOSPITALS,
$77.95
CPT ®
References for CMS Pub.
100 Manual
B
Facility and non-facility
RVUs and follow-up days
C
Icons identifying
reimbursement and coding
guidelines
D
AMA CPT® Assistant
references for assistance in
coding guidelines
20
A
Did you know the American
Medical Association’s CPT®
code books don’t include
reimbursement information?
Optum360 CPT® resources
have you covered.
A
| ESSENTIAL CODING
C
B
D
Partial sample page from Current Procedural Coding Expert
Companion resources: CPT® coding
2017 Coders’ Desk Reference
for Procedures
2017 Evaluation and Management
Coding Advisor
2017 Understanding Modifiers
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
DESIGNED FOR PHYSICIANS
Item No: CDR17
Available: Dec 2016
Item No: EMCA17
Available: Feb 2017
Item No: MDFR17
Available: Dec 2016
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• Comprehensive CPT® code listing
with procedure lay descriptions.
Eliminate the need for multiple
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of more than 8,000 CPT® codes and
6,000 lay descriptions for surgery,
laboratory/pathology, radiology and
medicine codes.
• Covers every E/M service. Detailed
review of the E/M rules and protocols.
• Includes detailed and advanced
guidance on selecting the
appropriate E/M codes. Offers
helpful advice designed for difficult
E/M coding situations.
DESIGNED FOR PHYSICIANS, PAYERS
$95.95
• Includes actual medical records.
Use to outline in detail how to
document services and apply the
correct modifiers.
• Covers modifier compliance. Better
understand OIG compliance and
Medicare audits.
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ESSENTIAL CODING |
21
HCPCS LEVEL II
2017 HCPCS Level II
Professional (Softbound)
2017 HCPCS Level II Expert (Spiral)
HCPCS Level II Expert (Updateable)
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
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2017 HCPCS Level II
Accurately report supplies and services with a comprehensive, user-friendly reference for the HCPCS code set that
focuses on management of reimbursement. Coders are guided through current modifiers, code changes, additions and
deletions with information as dictated by the CMS.
FEATURES
Professional
Expert
Updateable
Comprehensive code updates
3
3
3
APC status indicators and ASC designation symbols
3
3
3
DMEPOS icons with modifiers noted at the code level
3
3
3
In-depth illustrations
3
3
3
AHA Coding Clinic® for HCPCS references
3
3
3
Color-coded bars and icons
3
3
3
Table of Drugs & NOC Table of Drugs
3
3
3
Modifiers
3
3
3
Abbreviations & acronyms
3
3
3
Medicare Internet-only Manuals (IOMs) Pub. 100 references
3
3
3
New, revised, deleted & reinstated HCPCS codes
3
3
3
Type of service & place of service tables
3
3
3
PQRS icons
3
3
3
PQRS appendix
3
3
Medicare National Average Payment — access available online
3
3
MUEs table — access available online
3
3
Deleted Code Crosswalk
3
3
Glossary of terms
3
3
Quarterly updates
3
Code changes tracked throughout the year
3
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HCPCS LEVEL II
A
OPPS status indicators
B
Color-coded
bars and icons
C
Special coverage
instruction
| ESSENTIAL CODING
22
A
C
B
Partial sample page from HCPCS Level II Expert
Companion resource: HCPCS Level II coding
2017 Coders’ Desk Reference for HCPCS Level II
2017 HCPCS Fast Finder® for Home Health
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
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ONLINE DIGITAL CODING SOLUTIONS |
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EncoderPro.com for Payers
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EncoderPro.com
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Local Coverage Determinations (LCDs) and Medicare’s Pub. 100 access
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ONLINE DIGITAL CODING SOLUTIONS |
CODING REFERENCE
ADD-ON
Total
CPT
Customize your online digital
coding solutions with add-ons
®
CPT
Total
®
See how much more you can do and get the most out of your online digital product
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I-10 Map Manager
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CPT is a registered trademark of the American Medical Association.
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• Stedman’s Medical Dictionary
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ONLINE DIGITAL CODING SOLUTIONS |
DATA
Data files
Updates and compliance
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• HCPCS Level II
• DRG
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CODING REFERENCE
| ONLINE DIGITAL CODING SOLUTIONS
28
Find the digital coding solution
that meets your needs at
optum360coding.com/transition
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ONLINE DIGITAL CODING SOLUTIONS |
CODING REFERENCE
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CPT is a registered trademark of the American Medical Association.
Multi-user licenses available.
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CODING REFERENCE
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30
MedicalReferenceEngine.com
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Product Manager spotlight
Julie Orton Van
CPC, CPC-P, CEMC
Employed with Optum360
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Julie Orton Van, CPC, CPC-P, CEMC, works at Optum360 as a manager of coding software. She
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ONLINE DIGITAL CODING SOLUTIONS |
REVENUE CYCLE
Billing management solutions
Audit Management
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Revenue cycle
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SPECIALTY REFERENCE |
CODING & REIMBURSEMENT
Co-published
with AAO-HNS.
Discount for
members.
2017 Coding Companion® Specialty Guides
These valuable resources offer the most up-to-date CPT®, HCPCS procedure
and ICD-10-CM code sets, specific to your specialty, in a quick-search format.
Includes descriptions, illustrations and other relevant references listed
for procedures.
• Quickly find information. All the information you need is provided, including
illustrations, lay descriptions, coding tips, terms, cross-coding, Medicare RVUs and
Pub. 100 references.
2017 Coding Companion®
Specialty Guides
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Available: Dec 2016
$199.95
• Prevent claim denials and stay up-to-date with Medicare payer
information. Medicare payer information provides the references to Pub. 100
guidelines, follow-up days, MUEs, modifier and assistant-at-surgery indicators.
• Organized by CPT® and HCPCS procedure code. Essential, specialty-specific
procedures are listed by CPT® and HCPCS procedure code and cross-walked to
ICD-10-CM codes.
• CCI edits by CPT® and HCPCS procedure code. CPT® and HCPCS procedure
codes with associated CCI edits in a special section and quarterly updates
available online.
2017 Coding Companion® Specialty Guides
SPECIALTY
Item No.
SPECIALTY
Item No.
Cardiology/Cardiothoracic/Vascular Surgery
ATCR17
Orthopaedics: Hips & Below
ATLE17
ENT/Allergy/Pulmonology
AENT17
Orthopaedics: Spine & Above
ATUE17
General Surgery/Gastroenterology
AGEN17
Plastics/Dermatology
ATPR17
Neurosurgery/Neurology
ATNN17
Podiatry
ASPOD17
Obstetrics/Gynecology
ATOB17
Primary Care/Pediatrics/Emergency Medicine
ASPC17
Oncology/Hematology
ATHO17
Radiology
ASRA17
Ophthalmology
ATEY17
Urology/Nephrology
ATUN17
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CODING & REIMBURSEMENT
45338 [45346]
45338 Sigmoidoscopy, flexible; with removal of tumor(s),
polyp(s), or other lesion(s) by snare technique
45346
with ablation of tumor(s), polyp(s), or other lesion(s)
(includes pre- and post-dilation and guide wire
passage, when performed)
C19
C20
C21.2
C21.8
C7A.025
C7A.026
C7A.029
D01.0
D01.1
D01.2
D12.5
D12.6
D12.7
D12.8
D12.9
D37.5
D3A.025
D3A.026
D3A.029
Explanation
The physician performs flexible sigmoidoscopy and removes
tumors, polyps, or other lesions. The physician inserts the
sigmoidoscope into the anus and advances the scope into the
sigmoid colon. The lumen of the sigmoid colon and rectum are
visualized. The tumor, polyp, or other lesions are identified and
removed by snare technique in 45338 or by ablation in 45346.
The sigmoidoscope is withdrawn at the completion of the
procedure. Code 45346 includes dilation before and after with
utilization of guidewire, if employed.
Digestive
Coding Tips
B
34
Easy-to-read, two-column format
NEW!
A
| SPECIALTY REFERENCE
Code 45346 is a resequenced code and will not display in
numeric order. Moderate (conscious) sedation performed with
45338 and 45346 is considered to be an integral part of the
procedure and is not reported separately. However, anesthesia
services (00100–01999) may be billed separately when
performed by a physician (or other qualified provider) other than
the physician performing the procedure. Report the appropriate
endoscopy for each anatomic site examined. For
proctosigmoidoscopy with ablation of tumors, polyps, or other
lesions not amenable to removal by hot biopsy forceps, bipolar
cautery, or snare technique (e.g., laser), see 45320. For mucosal
resection, performed endoscopically, see 45349. For
colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other
lesion(s), see 45388 or HCPCS G6024. For anoscopy, with ablation
of tumors, polyps, or other lesions not amenable to removal by
hot biopsy forceps, bipolar cautery, or snare technique, see
46615. When code 45338 is performed, do not report with 45349
if both procedures are performed on the same lesion.Likewise,
when code 45346 is performed, do not report with 45340 if both
procedures are performed on the same lesion.These codes
should not be reported with code 45330.
ICD-10-CM Diagnostic
C18.7
C18.8
Malignant neoplasm of sigmoid colon
Malignant neoplasm of overlapping sites of colon
© 2016 Optum360,
OptumInsight,
Inc.
LLC.
318 — Digestive
K62.1
K63.5
C18.9
C21.0
C21.1
C78.5
D01.3
D37.4
D49.0
K62.0
Malignant neoplasm of rectosigmoid junction
Malignant neoplasm of rectum
Malignant neoplasm of cloacogenic zone
Malignant neoplasm of overlapping sites of rectum,
anus and anal canal
Malignant carcinoid tumor of the sigmoid colon
Malignant carcinoid tumor of the rectum
Malignant carcinoid tumor of the large intestine,
unspecified portion
Carcinoma in situ of colon
A Easy-to-understand
Carcinoma in situ of rectosigmoid junction
explanations of codes
Carcinoma in situ of rectum
Benign neoplasm of sigmoid colon
Benign neoplasm of colon, unspecified
Benign neoplasm of rectosigmoid junction
B ICD-10-CM
Benign neoplasm of rectum
Benign neoplasm of anus and anal canal
Neoplasm of uncertain behavior of rectum
Benign carcinoid tumor of the sigmoid colonMedicare edits
Benign carcinoid tumor of the rectumC
at your fingertips
Benign carcinoid tumor of the large intestine,
unspecified portion
Rectal polyp
Polyp of colon
Malignant neoplasm of colon, unspecified
Malignant neoplasm of anus, unspecified
Malignant neoplasm of anal canal
Secondary malignant neoplasm of large intestine and
rectum
Carcinoma in situ of anus and anal canal
Neoplasm of uncertain behavior of colon
Neoplasm of unspecified behavior of digestive system
Anal polyp
HCPCS Equivalent Codes
G6022 Sigmoidoscopy, flexible; with ablation of tumor(s),
polyp(s), or other lesions(s) not amenable to removal by
hot biopsy forceps, bipolar cautery or snare technique
Terms To Know
polyp. Small growth on a stalk-like attachment projecting from a
mucous membrane.
snare. Wire used as a loop to excise a polyp or lesion.
tumor. Pathological swelling or enlargement; a neoplastic growth
of uncontrolled, abnormal multiplication of cells.
Medicare Edits
Fac RVU Non-Fac RVU
45338
45346
4.04
0.00
45338
45346
51
N/A
9.02
0.00
FUD
Status
MUE
0
N/A
A
I
1(2)
Modifiers
N/A
N/A
N/A
N/A
C
Medicare Reference
N/A
N/A
None
* with documentation
CPT © 2016 American Medical Association. All Rights Reserved.
Coding Companion for Primary Care
Sample page from Coding Companion® for Primary Care
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35
SPECIALTY REFERENCE |
CROSS CODING
2017 Cross Coders (eBooks)
Simplify and speed coding with the one-stop, cross-coding resources
developed for those who work for physicians, hospitals or payers.
These easy-to-use manuals provide essential links from CPT® codes
to the appropriate ICD-10-CM and HCPCS Level II codes.
• Numerical organization by CPT® code. Provides an all-in-one guide
for coders who need diagnosis and procedure code information.
• Ideal for quick reference. Appendix offers a complete listing of
add-on and unlisted codes, as well as CPT® and HCPCS modifiers.
• Recognize when primary/secondary codes are required.
ICD-10-CM code icons indicate when additional codes are needed
and if the code selected is appropriate for the sex of the patient.
2017 Cross Coders (eBooks)
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Available: Dec 2016
$174.95
CROSS CODERS (eBOOKS)
Item No.
Anesthesia
eACC17
Laboratory
eLCC17
Medical
eMCC17
Radiology
eRCC17
Surgical
eSCC17
2017 Procedural Cross Coder (eBook)
Designed for coding both inpatient and outpatient procedures, this resource
crosswalks ICD-10-PCS codes for procedures to CPT® and HCPCS Level II
codes, enabling you to analyze data across coding systems.
• Search quickly and easily. Links ICD-10-PCS codes for procedures with
corresponding CPT® and HCPCS Level II codes.
• Increase coding efficiency using just one resource. Complete claims
requiring ICD-10-PCS procedure codes, CPT® and HCPCS Level II codes using the
same resource.
• Find answers quickly. The glossary supplies definitions for common clinical,
billing and reimbursement terminology.
2017 Procedural Cross Coder
(eBook)
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: ePCC17
Available: Dec 2016
CPT is a registered trademark of the
American Medical Association.
$174.95
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CODING & PAYMENT
| SPECIALTY REFERENCE
36
Co-published
with APTA.
Discount for
members.
2017 Coding and Payment Guides
These resources provide valuable coding, billing and documentation resources in one handy location.
You’ll get the latest specialty-specific ICD-10-CM, HCPCS Level II and CPT® code sets along with Medicare
payer information, CCI edits, helpful code descriptions and clinical definitions.
• Increase coding efficiency. Includes clear explanations of
procedures represented by CPT® and HCPCS procedure codes,
along with clinical definitions, documentation and reimbursement
tips and ICD-10-CM diagnostic codes.
• Prevent claim denials and stay up to date with Medicare
payer information. Review Medicare Pub. 100 references
containing information linked to HCPCS Level II and CPT® codes
to prepare cleaner claims before submission.
• CCI edits by CPT and HCPCS procedure code. CPT and HCPCS
procedure codes with associated CCI edits in a special section and
quarterly updates available online.
®
®
2017 Coding and Payment Guides
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Available: Dec 2016
$179.95
2017 Coding and Payment Guides
CODING AND PAYMENT GUIDES
Item No.
Anesthesia Services
SAP17
Behavioral Health Services
SYCH17
Dental Services
CGDS17
Laboratory Services
SLAB17
Physical Therapist
SPT17
2017 Coding Guide for OMS
Co-produced with the American Association of Oral and Maxillofacial
Surgeons, the Coding Guide for OMS is your one-stop coding, billing and
documentation guide to submitting claims with greater precision and
efficiency. The guide provides the latest 2017 OMS-specific ICD-10-CM,
HCPCS Level II, CDT and CPT® code sets along with documentation and
reimbursement tips, Medicare payer information, CCI edits, helpful code
descriptions and clinical definitions.
Co-published
with AAOMS.
Discount for
members.
2017 Coding Guide for OMS
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: SOMS17
Available: Dec 2016
$199.95
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DESK REFERENCE |
37
CODING & BILLING
2017 Coders’ Dictionary
Unlike other medical dictionaries, the Coders’ Dictionary helps you
understand medical terminology from a coder’s perspective with
diagnosis, procedure and HCPCS codes included.
• Get essential clinical terms with code assignments.
With easy-to-understand explanations, plus CPT®, HCPCS and
ICD code assignments.
• More than 1,200 new terms added for ICD-10. The ICD-10
icon marks key new ICD-10 terms, such as root operations and
body part keys.
• Includes more than 9,500 alphabetic entries and 250 illustrations
for terminology key to code selection. Find definitions for medical
nomenclature, eponyms, new technology and acronyms.
2017 Coders’ Dictionary
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: TCD17
Available: Dec 2016
$99.95
• Clear, concise definitions for clinical, coding, billing and
reimbursement terms. No need to use multiple print or electronic
references to access medical definitions.
• Illustrations. Detailed illustrations accompany medical terminology to
enhance understanding of the definition.
• New and updated terms for ICD-10, CPT® and HCPCS code sets.
Plus, terms for CMS programs and regulations (ACOs, PQRS, EHR/
prescribing), and includes many new lab and path terms that appear
the 2017 CPT® code set.
Also available as an eBook.
Clinical Technical Editor (CTE) spotlight
Leanne Patterson
CPC
Employed with Optum360 for 2 years
Leanne has more than 10 years’ experience in the health
care industry. Having worked her way up from a coder
to practice manager and now a CTE for Optum360
required many different hats along the way, including
coding auditor, privacy officer, HIPAA compliance trainer
and physician educator. This combined experience and
knowledge has helped Leanne fulfill her role as a CTE
for Optum360, working on such varied products as
comprehensive guides such as the HIPAA Toolkit,
E/M Coding Advisor, our large library of specialty coding
books, and our Clinical Documentation Improvement
Desk Reference for ICD-10-CM.
According to Leanne, “After being someone who used
Optum360 (back when it was Ingenix) products on a
daily basis in my previous positions and now being on
the inside looking out, it is easy to see why our products
are the best in the industry. Each person involved in
our product development takes pride in providing our
customers with innovative solutions and quality products
that contain meaningful content at a great value. It is
truly an honor to work with people who are passionate
about what we do and strive to provide information
that not only helps make our customers’ lives better and
hopefully easier, but also indirectly helps every patient
that our customers take care of every day. I truly love
health care and am proud to be someone who strives to
make this sometimes complicated industry a little easier
for everyone.”
CPT is a registered trademark of the American Medical Association.
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CODING & BILLING
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2017 Auditors’ Desk Reference
This unique manual shows what the medical record must contain for
correct coding and billing of specific medical and diagnostic services
and procedures.
• Completely updated for code set and regulatory changes.
• Provides coders with an auditor’s perspective. Know the clinical
detail, regulatory instructions and coding protocol needed for code
assignment, by individual code and code groupings.
• Includes a library of time-saving audit forms. Protect your
revenue-critical services and procedures with these reproducible
auditing forms and checklists, available in print and online.
• Differentiate between similar procedures. Helps coders and auditors
compare and contrast seemingly similar, but different, procedures.
2017 Auditors’ Desk Reference
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: AUDR17
Available: Nov 2016
$199.95
• Know the key terms that need to be mentioned in the medical
record. Support code assignment.
• See the medical conditions that are indicated for diagnostic and
therapeutic purposes.
• Get valuable code intelligence. Confirm correct code assignment.
• Conduct skilled internal audits. Ensure proper reimbursement.
Featured article:
Tips to improve your ICD-10 documentation
improvement education
A M O N T H LY
eNEWSLET TER FOR
A L L T H I N G S I CD -10 .
With all the trials and tribulations that came with the ICD-10 transition, the work
is far from over. A continual flow of new codes and more complex systems require
organizations keep the gas pedal down on education and training.
Cue sighs of dismay from staff who’ve already sat through hours of instruction to
prepare for the dive into ICD-10’s depth. “Training fatigue” is a real problem, as
ICD-10 requires ongoing clinical documentation improvement (CDI) education. The
challenge now is how to keep the attention of clinicians, as well as CDI specialists, in
ongoing training.
Read the rest of this article at optum360coding.com/icd10articles
To learn more about product updates, webinars and training opportunities,
subscribe to Inside Track and get all the latest coding news delivered to your inbox.
Visit optum360coding.com/insidetrack
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39
PRICE & COST |
FEES
2017 Customized Fee Analyzers
Under-priced fees can cost a practice thousands of dollars
each year. To set the most appropriate fees, you need specific
information for your geographic locality, as fees vary widely
across the country. Relying on national averages can result in
reimbursement that is too low or billable charges that are too
high. The Customized Fee Analyzer provides physicians with a
custom report for their geographic area and the CPT® codes most
frequently used in their specialty.
• Detailed custom fee reports. By specialty and ZIP code.
• Seven reference points of charge data from FAIR Health, Inc.
(50th, 60th, 75th, 80th, 85th, 90th and 95th). Perform competitive
analyses with confidence and help make more accurate adjustments
of charges.
• Medicare fees by locality. Provides an additional benchmark for fee
development and analysis.
• Professional (PC) and technical (TC) component splits of global
services for all CPT® codes. Estimate allocation and reimbursement for
the physician and technical portion of a specific service.
2017 Customized
Fee Analyzer
(1 Specialty)*
2017 Customized
Fee Analyzer
(2 Specialties)*
2017 Customized
Fee Analyzer (All
CPT® Codes)*
DESIGNED FOR PHYSICIANS
DESIGNED FOR PHYSICIANS
DESIGNED FOR PHYSICIANS
Item No: 2433
Available: Dec 2016
Item No: 2434
Available: Dec 2016
Item No: 2432
Available: Dec 2016
$299.95
$399.95
$499.95
Also available as data files. Call for details.
*Available for purchase by physicians; also available for dental codes. Please visit
optum360coding.com or call for more information.
Get customized fee data online.
FeeAnalyzer.com
FeeAnalyzer.com
DESIGNED FOR PHYSICIANS
Item No: 1576
Available: Now
$1,250.00 Single-user
Use FAIR Health, Inc. data and current Medicare fees to create
your own custom fee schedules. Get online access to percentiles of
relative and actual physician charge data for a specific geographic
area and specialty. This powerful data source makes it easier for
physicians to set defensible fees while maximizing revenues, and
allows users to import their own fee schedules and analyze up to
three fee schedules side by side.
CPT is a registered trademark of the American Medical Association.
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FEES
| PRICING & COST
40
2017 Relative Values for Dentists
Relative Values for Dentists is a relative value system established by national
surveys of physicians and dentists conducted by Relative Value Studies,
Inc. With this tool, you can establish, defend and negotiate fees for dental
procedures billed with CDT or CPT® codes.
• Relative values are based on the actual clinical work performed. Feel
confident and assured of a neutral relative value scale.
• Conversion factor benchmarks for CPT® codes. An additional tool to help you
start or update a relative value-based fee schedule.
2017 Relative Values for Dentists
DESIGNED FOR DENTISTS
• Relative value scale is based on physician and dentist survey data. Rely on
a resource free from government budgetary influence.
Item No: RVD17
Available: Dec 2016
$259.95
Also available as a data file
and an eBook. Call for details.
Also available:
Now with
three percentiles
of charge data
2017 National Fee Analyzer
DESIGNED FOR PHYSICIANS
DESIGNED FOR PHYSICIANS, PAYERS
Item No: NFA17
Available: Dec 2016
Item No: RVP17
Available: Dec 2016
$199.95
$329.95
Also available as a data file.
2017 HCPCS Fee Analyzer
The HCPCS Fee Analyzer provides
a customized report that includes
percentiles of national charge data
as well as locality-specific Medicare
allowables for HCPCS codes. Includes
four reference points of charge data:
25th, 50th, 75th and 85th percentiles.
2017 Relative Values for
Physicians
Includes gap
values for many
CPT® and HCPCS
codes not valued
in the Medicare
RBRVS
Essential RBRVS
(Updateable)
DESIGNED FOR PHYSICIANS, PAYERS
Item No: 1761
Available: Now
$279.95
Also available as a data file.
2017 HCPCS Fee Analyzer
DESIGNED FOR PHYSICIANS
Item No: 2435
Available: Feb 2017
$299.95
Also available as a data file.
Call for details.
2017 Essential RBRVS
(Annual)
DESIGNED FOR PHYSICIANS, PAYERS
Item No: RBRC17
Available: Dec 2016
$229.95
Also available as a data file.
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CODING, BILLING & REIMBURSEMENT
41
2017 Physician Quality Reporting Guide
PQRS is not just an optional CMS bonus plan anymore. While some may
ignore the 0.5 percent incentive payment that they could have received in
earlier years, physician practices will suffer a very substantial loss of Medicare
revenue in 2016. A practice that bills $20,000 a week to Medicare could lose
$20,400 in Medicare reimbursement in 2016 by not successfully reporting
quality measures.
• For 2017, there are over 300 individual quality reporting measures that
affect all specialties. In addition to the 20 new measures, there are new quality
data codes, revised measure guidelines and reporting options, and more stringent
reporting thresholds. Use our easy-to-follow guide and online data files to avoid
non-participation penalties.
2016 Physician Quality
Reporting Guide
DESIGNED FOR PHYSICIANS, PAYERS
Item No: PQRS17
Available: Feb 2017
$179.95
Also available as an eBook.
• Simplifies quality reporting methodologies to help you avoid losses for
inappropriate submissions. Includes “flow sheets” that simplify data capture
for more accurate reporting.
• Brings together hard-to-find but essential data points. For each of the
2016 quality measures, we assemble vital information that is spread over many
official sources. Saves time and ensures the best selection of quality measures.
• Includes information for other Medicare quality reporting initiatives.
Covers e-prescribing, value-based purchasing and EHR bonus payments.
2017 Complete Guide for Interventional Radiology
Developed to simplify coding for imaging-assisted surgical services, the
Complete Guide for Interventional Radiology is a resource that provides
specific direction for coding complex interventional procedures with
guidelines and references for both physicians and facility-based institutions.
• ICD-10-CM, CPT® and HCPCS Level II information specific to
interventional radiology and cardiology. Save time by reviewing only the
code sets related to interventional procedures.
• Current coding and billing regulations. Make the most appropriate code
selection for interventional procedures with the most up-to-date information,
codes, reimbursement guidance and tips.
2017 Complete Guide for
Interventional Radiology
DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: FIR17
Available: Dec 2016
$229.95
• Additional anatomical diagrams added. Provides a better understanding of
the medical procedures referenced by the codes and data. The graphics offer
coders a visual link between the technical language of the operative report and
the cryptic descriptions accompanying the codes.
• CCI edits. Reduce the risk of audits and spend less time correcting claims by
identifying which coding combinations cannot be billed together.
• Case examples. Learn through real-world scenarios of interventional
procedures based on common methods of practice. Reportable codes
are indicated to provide an understanding of code selection based on
documentation for both the physician and the facility.
CPT is a registered trademark of the American Medical Association.
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CODING, BILLING & REIMBURSEMENT
Uniform Billing Editor
Outpatient Billing Expert
DESIGNED FOR HOSPITALS, PAYERS
DESIGNED FOR HOSPITALS, PAYERS
Item No: 4787
Available: Now
Item No: 4709
Available: Now
$319.95
$199.95
Also available as an eBook.
Also available as an eBook.
Uniform Billing Editor
Outpatient Billing Expert
Facilities can use this reference tool daily to manage
the constant changes to Medicare billing and
reimbursement processes. The Uniform Billing Editor
provides detailed, accurate and timely information
about Medicare and UB-04 billing rules and assists the
user with 5010 data, UB-04 and 837i requirements.
Outpatient Billing Expert provides detailed
references with payment information and guidance
to improve reimbursement and reduce claim denials.
This all-in-one resource also provides APC and
ASC groups, reimbursement amounts, coverage
issues and information on what is not covered.
• Includes 5010 standards and provides detailed,
accurate and timely information about Medicare
billing and reimbursement. Avoid payment delays
and CMS rejections by submitting clean, 5010-compliant
electronic claims.
• Includes fees, formulas and tables in Microsoft
Excel. Determine appropriate APC or ASC
reimbursement prior to submitting your claim.
• Quickly locate topics based on field locators,
revenue codes or coding structures. This easy-to-use
format is fully indexed and tabbed with icons for quick
reference.
• Quickly link HCPCS and CPT® codes to applicable
revenue codes. This crosswalk helps you to prevent
the most common reasons for rejections — mismatched
revenue codes and CPT® or HCPCS Level II codes.
• Crosswalk to 837 institutional claims. Provides links
to 837i 4010 and 5010 data elements and any applicable
billing rules — facilitating easier transition to the 837i.
42
• Comprehensive coverage of both ASC and APC
payment systems. Establish the right payment and
audit reimbursement processes for your facility.
• Includes the most recent code sets and information
from CMS and other industry sources. Keep all billing
current and accurate using up-to-date rates and groups
for the APC and ASC payment systems.
• Contains information used on a daily basis by
hospital outpatient departments (HOPD) and ASC
facilities. Resolve billing and denial issues and establish
payment and audit reimbursement processes.
• Non-OPPS payment fee schedule. Provides the name
of the fee schedule that applies to non-OPPS payments.
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43
CODING, BILLING & REIMBURSEMENT
2017 HIPAA Customizable Compliance Plan
Because of new rules affecting the privacy and security of health care
information, a detailed HIPAA compliance plan is a must.
• Scores of ready-to-deploy policies and procedures included. Easily update
your HIPAA plan; includes both print and customizable electronic formats.
• Provides expert guidance on policy selection and modification. Plus, model
policies accommodate newest requirements of the HIPAA Omnibus law.
• Includes the HIPAA Tool Kit. This 800-page manual covering privacy,
security and transactions provides the information you need to comply
with HIPAA regulations.
2017 HIPAA Customizable
Compliance Plan
DESIGNED FOR PHYSICIANS, HOSPITALS
Item No: HCCP17
Available: Sept 2016
$299.95
2017 HIPAA Tool Kit
Designed to help providers implement HIPAA rules and regulations,
the HIPAA Tool Kit is an ideal resource for creating a new compliance
program or conducting a compliance assessment.
• Policy and procedure development guidance templates. More than
200+ templates and forms for privacy, security and transactions.
• Comprehensive breach management, risk assessment and HIPAA auditing
policies and procedures. Get customizable reports and forms that the Office
for Civil Rights expects you to have in your records.
• Customizable training materials. Get ready-to-use presentation
content plus talking points designed to make complex HIPAA topics
understandable to all.
• Get our 100-page HIPAA Customizable Compliance Plan free when
you purchase the HIPAA Tool Kit. Policies and procedures are ready to be
customized and available in an easy-to-use Microsoft Word format.
2017 HIPAA Tool Kit
2017 HIPAA Tool Kit (eBook)
DESIGNED FOR PHYSICIANS, HOSPITALS
DESIGNED FOR PHYSICIANS, HOSPITALS
Item No: HTKT17
Available: Sept 2016
Item No: eHTKT17
Available: Sept 2016
$299.95
$299.95
CPT is a registered trademark of the American Medical Association.
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WORKERS’ COMPENSATION
| BOOKSTORE
44
Workers’ Compensation Fee Schedules
Optum360 is the exclusive publisher of the official Workers’ Compensation Fee Schedule for several states. Health care
professionals and payers need to reference this information to determine correct reimbursements. Although specific
data varies state by state, these comprehensive references generally include state-specific rules and guidelines, fees or
RVUs, CPT® codes and applicable state-specific codes for services rendered. Call 1-800-464-3649, option 1, or visit
optum360coding.com for more information.
AVAILABLE TITLES
Item No.
2016 South Carolina Workers’ Compensation Medical Services Provider Manual
Call for information
2016 Official Connecticut Practitioner Fee Schedule
2441
2016 Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers eBook
E2300
2015 Official Connecticut Fee Schedule for Hospitals and Ambulatory Surgical Centers eBook
E2360
2015 South Carolina Workers’ Compensation Medical Services Provider Manual
2333
2015 Official Connecticut Practitioner Fee Schedule
2374
2016 Official Mississippi Workers’ Compensation Medical Fee Schedule*
5779
2012 Official New York Workers’ Compensation Medical Fee Schedule
2171
Also available as data files.
*Also available as a web version with updates.
State Fee Schedule Plus
The State Fee Schedule Plus module is a database of current state fee schedule data arrayed in a consistent format.
Optum gathers and maintains fee schedules and rules for 45 state-mandated workers’ compensation fee schedules,
seven state-mandated automobile fee schedules and the federal workers’ compensation fee schedule, and converts
them into a standardized format to be incorporated into a client’s system. Optum also reviews ground rules and
guidelines and adds various supporting fields and data to the standardized formats. In addition, documentation is
provided for each state. Call 1-800-765-6807 or email empower@optum.com for more information.
WORKERS’ COMPENSATION FEE SCHEDULES
We offer state fee schedules for the District of Columbia
and all 45 states that mandate workers’ compensation.
AUTO FEE SCHEDULES
• Florida
• New York
• Pennsylvania
• Hawaii
• Oregon
• Utah
• New Jersey
AMA Impairment Guides
AMA Guides to the Evaluation of Permanent Impairment is used in workers’ compensation systems, federal systems
and automobile casualty and personal injury cases to rate impairment, not disability.
Call 1-800-464-3649, option 1, for more information.
AVAILABLE TITLES
Item No.
AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition
J005PD
AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition
J01113
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45
MEDICARE
Medicare Correct Coding Guide
DESIGNED FOR PHYSICIANS, PAYERS
Item No: 3024
Available: Now
$299.95
Medicare Desk Reference
for Hospitals
DESIGNED FOR HOSPITALS, PAYERS
Item No: 2446
Available: Now
$299.95
Medicare Correct Coding
Guide (eBook)
DESIGNED FOR PHYSICIANS, PAYERS
Item No: 3676
Available: Now
$299.95
Medicare Desk Reference for
Hospitals (eBook)
DESIGNED FOR HOSPITALS, PAYERS
Item No: 1085
Available: Now
$299.95
Medicare Correct Coding Guide
Medicare Desk Reference for Hospitals
Up-to-date and easy to use, Medicare Correct Coding
Guide is a comprehensive manual that provides medical
practices with correct coding policies, CCI edits and the
Medicare physician fee schedule — all in one resource.
This all-in-one reference provides hospitals and hospital
systems with quick access to information that will improve
management of Medicare coverage, billing and payment
policies for Medicare Part A and Part B services.
• CCI edits, Medicare RVUs, Medicare payment
indicators and MUEs. Access it all in one
easy-to-use listing.
• Optum360 Edge — Information concerning Medicare
Part A and Part B services for hospitals. Medicare rules
and regulations are consolidated into this robust reference.
• Unique Medicare edit icons are included. Instantly
know why a code combination will not be paid separately.
• Icons identify risk areas. Easily identify services that fall under
medical review policies or fraud alerts, as well as common
claims processing issues.
• Summary of Changes table helps you identify
changes to your most frequently used codes.
Quickly identify changes.
• Quarterly updates for one full year. Stay current
as CMS implements changes.
• OPPS information. Provides narrative explanations for
OPPS regulatory requirements, direct links to the original
CMS source documents and operational strategy for
management, auditing and consulting.
• Updated twice per year. Stay current with the
complex and frequent changes to Medicare and the
regulatory changes that may affect your Medicare
program participation.
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