CODING, BILLING & REIMBURSEMENT CATALOG n ew TO 2017 editi on codi n g tools Save % 50 up to * See back cover for details Summer 2016 1 DISCOVER THE PERFECT MIX OF OPTUM360® DIGITAL CODING TOOLS TO CREATE YOUR ULTIMATE DIGITAL CODING PLAYLIST. optum360coding.com/transition Amp up your coding capabilities with the perfect mix of digital coding tools. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 2 2 016 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 hallmark product features that are uniquely designed by or are exclusive to Optum360. eBooks available Look for the download icon throughout the catalog for books and resources available as an eBook. Products contained in this catalog are made in the USA. CPT is a registered trademark of the American Medical Association. 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT NEW SOLUTIONS 3 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 Item No: ITDRP17 Available: Dec 2016 $139.95 Also available as an eBook. See page 10 for more details. Item No: ITDRD17 Available: Dec 2016 $139.95 $139.95 Also available as an eBook. See page 10 for more details. 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 Item No: ITEP17 Available: Dec 2016 See page 12 for more details. 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). CPT is a registered trademark of the American Medical Association. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM NEW SOLUTIONS ADD-ON ADD-ON AMA CPT Content Module Total CPT ® The American Medical Association (AMA) CPT® Content Module* DESIGNED FOR ALL MARKETS Item No: WA34 Available: Now ® Total CPT®* DESIGNED FOR ALL MARKETS Clinical Documentation Improvement* Item No: WA37 Available: Now DESIGNED FOR PHYSICIANS, HOSPITALS, CONSULTANTS $339.95 Single-user Item No: WA35 Available: Now See page 25 for more details. $399.95 Single-user $249.95 Single-user See page pages 23, 25 for more details. See page 25 for more details. *May be purchased with a new or existing subscription to an Optum360 online digital coding solution; multi-user licenses available. Seven new online coding courses Optum360® is here to support you by offering the same training leadership the industry has come to expect over the past 30 years. Through our new online training, you and your organization can stay ahead of the evolving coding world. Our self-paced courses provide indispensable knowledge about coding, ICD-10 and other valuable aspects important to the day-to-day workflow. Now is the time to take advantage of our online coding courses and ensure that you, along with others in your organization, stay current on the coding essentials. On your schedule From your computer Earn your CEUs View the growing course list at optum360coding.com/onlinecourses CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 4 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 Still need training on ICD-10 code details to ensure accurate and timely reimbursements? Optum360 has you covered with ICD-10 training books, online courses and our annual coding conference. ICD-10 IS NOW. CHANGE WITH CONFIDENCE. PIONEER THE NEW FRONTIER OF CODING WITH INDUSTRY-LEADING RESOURCES FROM OPTUM360. Still need an I-9 code book for references and audits? Our 2015 edition ICD-9-CM resources are still available for order on optum360coding.com. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM | ICD-10 TRANSITION PHYSICIAN 6 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 Available: Sept 2016 $114.95 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 Professional for Physicians (Softbound) Item No: ITPB17 Available: Sept 2016 $109.95 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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 WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 Item No: ITPC17 Available: Sept 2016 $109.95 2017 ICD-10-PCS (eBook) DESIGNED FOR HOSPITALS, PAYERS Item No: eITPC17 Available: Sept 2016 $109.95 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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 DESIGNED FOR POST-ACUTE, PAYERS Item No: ITSN17 Available: Sept 2016 $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 specific to SNF, IRF and hospice for improved coding accuracy and work efficiency. See page 29 for details about ICDExpert for Post-acute Care. $179.95 WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM ONLINE DIGITAL CODING SOLUTIONS | ICD-10 TRANSITION 14 Code with more speed and accuracy in ICD-10. Online digital coding solutions can help you code more accurately with fast access to ICD-10 codes, data and mapping tools, and can easily be used in conjunction with our ICD-10 code set and training books. EncoderPro.com Expert RevenueCyclePro.com I-10 Map Manager DESIGNED FOR PHYSICIANS DESIGNED FOR HOSPITALS DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS Item No: 1127 Available: Now Item No: 4790 Available: Now Item No: WA26 Available: Now $999.95 Single-user $2,275.95 Single-user Call for pricing EncoderPro.com Expert RevenueCyclePro.com I-10 Map Manager Consider powerful look-up software that includes the content of 37 code books in one easy-to-use electronic resource — saving time and money while helping coders use ICD-10. Help address many of the issues that result in claim rejections, denials and underpayments while working in ICD-10 with mapping tools and an ICD-10-PCS code builder. Import or create a file of ICD-9-CM or ICD-10-CM codes, map them to all clinically equivalent codes in the other code set and then export for your applications. KNOWLEDGE IS POWER Learn more about our digital coding tools by registering for a complimentary webinar. To explore topics and register, visit optum360coding.com/webinars WHILE YOU’RE ONLINE, ORDER YOUR NEW 2017 RESOURCES AND SAVE 25%.* *Save 15% on 2017 edition American Medical Association products, Customized Fee Analyzers and SOMS. Discount excludes workers’ compensation, online digital coding solutions and bookstore items. While supplies last. Use your promo code on the back cover of this catalog at checkout to redeem your discount. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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 NOV. 28–DEC. 1, 2016 THE COSMOPOLITAN HOTEL TM Las Vegas CONFIDENCE IN CODING, BILLING AND COMPLIANCE Join us for the 16th annual Optum360® Essentials Conference. We’ve got continuing education credits, networking opportunities, and all the latest and greatest coding, billing and compliance information you need to elevate your precision, accuracy and confidence. Why attend Optum360 Essentials? 2 DAY CONFERENCE REGISTRATION PRICING • Get an overview of the industry changes and challenges. • 40+ educational sessions — 16 CEUs. Early-Bird Discount: $700 Now through July 31, 2016 • Learn from nationally recognized • Stay current with updates on ICD-10-CM/PCS, CPT®, HCPCS, DRG codes, IPPS and OPPS. • Join breakout sessions for the Optum360 Online Digital Coding Tools User Optimization Track. experts on medical coding, billing and compliance. • Gain valuable insights during • Explore strategies, techniques and expert panel sessions, and ask your most difficult questions. best practices for hospitals and Advanced Planner: $745 August 1 – October 14, 2016 physician practices. Last Chance! Don’t Miss Out! $795 October 15 – November 14, 2016 • Join us in Vegas! See registration website for Full Conference (2 day conference, plus 1/2 day Add-on Bundle) or 1/2 Day Add-on (upgrade only) pricing. Register early and save! To learn more visit optum360coding.com/essentials 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM EXPLORE. NAVIGATE PIONEER. 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 $139.95 $129.95 • Comprehensive CPT® code listing with procedure lay descriptions. Eliminate the need for multiple resources with a one-stop resource 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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 DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS Item No: HS17 Available: Dec 2016 Item No: 4524 Available: Now $104.95 $154.95 Item No: HB17 Available: Dec 2016 $79.95 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 WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 DESIGNED FOR POST-ACUTE, PAYERS Item No: CDRH17 Available: Dec 2016 Item No: 7363 Available: Dec 2016 $139.95 $24.95 • Over 3,000 HCPCS Level II codes and 2,000 lay descriptions. Gain a clear understanding of the clinical definitions for thousands of alphanumeric codes for supplies and services to improve coding accuracy. • Easy to use by coders and clinicians. Contains more than 300 HCPCS Level II codes with shortened descriptions based on actual frequencies for home health. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 23 ONLINE DIGITAL CODING SOLUTIONS | CODING REFERENCE EncoderPro.com for Payers Designed specifically for payer organizations to search for CPT® procedures, HCPCS supplies and services, ICD-9-CM diagnosis and procedures, and ICD-10-CM and -PCS codes, this tool also includes a library of facility coding and billing information such as DRGs, revenue code crosswalks and more. EncoderPro.com for Payers DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS Item No: 1145 Available: Now $1,495.95 Single-user Sign up for a free product demo at optum360coding.com/transition Stay focused on your work, instead of struggling to update resources one-by-one on your own every time the industry changes. Online digital coding solutions from Optum360 help you to be ready no matter what delays or new rules occur, and to gain access to updates and new code sets as they become available. See how you can put them to work for you with a free trial or customized one-on-one demo. Clinical Documentation Improvement Gain access to essential information to interpret and create thorough documentation for proper code identification, as well as complete and accurate coding. • Identify and clarify documentation. Any confusing, incomplete, conflicting or missing information in the physician-documentation portion of the health record that is related to diagnoses or procedures can be easily corrected. Clinical Documentation Improvement* DESIGNED FOR PHYSICIANS, HOSPITALS, CONSULTANTS Item No: WA35 Available: Now $249.95 Single-user • Search clinical terms, codes and keywords. Print and/or email documentation for any clinician, coder or other health care individual needing information for accurate code identification and a more robust and precise depiction of patient severity. • Ensure clinical quality. This content is provided by code and improves clinical quality, substantiates medical necessity and aids in justification for the appropriate reimbursement. *May be purchased with a new or existing subscription to an Optum360 online digital coding solution; multi-user licenses available. CPT is a registered trademark of the American Medical Association. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM CODING REFERENCE | ONLINE DIGITAL CODING SOLUTIONS 24 EncoderPro.com Stay current with your code sets, guidelines and updates, no matter what happens in the industry. Always up to date, EncoderPro.com can help you save time and money by searching medical coding referential information faster. From ICD-10 mapping tools and supplemental modules to three different levels of content and functionality, Optum360 offers a wide range of tools to help your coding stay current, compliant and competitive. Standard Professional Expert DESIGNED FOR PHYSICIANS DESIGNED FOR PHYSICIANS DESIGNED FOR PHYSICIANS Item No: 1137 Available: Now Item No: 1221 Available: Now Item No: 1127 Available: Now $299.95 Single-user $549.95 Single-user $999.95 Single-user To learn more about EncoderPro.com products, visit optum360coding.com/transition FEATURES Standard Professional Expert ICD-10-CM code content and search. Easily search and learn ICD-10-CM codes. 3 3 3 ICD-10 mapping tool. Crosswalk from ICD-9-CM codes to the appropriate ICD-10 codes quickly and easily. 3 3 3 CodeLogicTM Search Engine. Search across all code sets simultaneously. 3 3 3 Color Code Edits 3 3 3 Coders’ Desk Reference lay descriptions 3 3 3 Deleted code crosswalk 3 3 3 Automatic monthly updates 3 3 3 Local Coverage Determinations (LCDs) and Medicare’s Pub. 100 access 3 3 Modifier crosswalk 3 3 Medicare National Correct Coding Initiative (CCI) edits 3 3 Cross-coder relationships from coding and billing specialty reference books 3 3 Enhanced compliance editor. Check your work by running selected codes through an edit check prior to submittal to a clearinghouse/vendor/payer. Includes an 18-month historical content database. 3 Fee calculator. Calculate the adjusted Medicare reimbursement rate for your area. 3 Enhanced LCD/NCD policy searching. Search local and national coverage policies by any code type, keyword or geographic location. 3 Claims scrubbing and repair available 3 See what EncoderPro.com can do for you. Watch an auto demo at optum360coding.com/encoderprodemo Multi-user licenses available. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 25 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 subscription with add-on modules designed for specific needs. Our most popular are: ADD-ON NEW! Total CPT® I-10 Map Manager Coders’ Essential 3-Pack Gain online access to every relevant article found in the American Medical Association’s CPT® Assistant coding newsletters and CPT® Changes: An Insider’s View in their entirety. Make using the new code set easier by mapping your most-used codes between ICD-9 and ICD-10-CM/PCS. See all the relevant code-related referential information provided in the Pink Sheet Specialty Newsletters, Part B News and Answer Book as you perform specific code searches. NEW! Clinical Documentation Improvement The AMA CPT® Content Module Ensure clinical quality, substantiate medical necessity and determine justifications for appropriate reimbursement — all by code — for clinicians and coders. Especially helpful with the increased specificity required with ICD-10-CM/PCS. Gain unparalleled access to content from the AMA that helps provide clarity and accuracy in CPT® code reporting: CPT® Assistant newsletters, CPT® Changes: An Insider’s View and thousands of CPT® questions and answers from the CPT® Knowledge Base. Learn more about all the available add-on modules at optum360coding.com/addons • AHA Coding Clinic® for HCPCS • CPT® Assistant • I-10 Map Manager • AHA Coding Clinic® for ICD • CPT® Changes: An Insider’s View • MedicalReferenceEngine.com •NEW! The AMA CPT® Content Module • Dental Codes • ASA Crosswalk • DRG Grouper Calculator • Repair Toolkit for Claims Batch Editor • Claims Batch Editor • DrugReimbursement.com •NEW! Clinical Documentation Improvement • Dr. Z’s Medical Coding Series: • Coders’ Dictionary • FeeAnalyzer.com Professional • Coders’ Essential 3-Pack • Historical Application Content ® Interventional Radiology CPT is a registered trademark of the American Medical Association. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM • Stedman’s Medical Dictionary •NEW! Total CPT® CODING REFERENCE | ONLINE DIGITAL CODING SOLUTIONS 26 Optum360 Mobile Diagnosis DESIGNED FOR PHYSICIANS, HOSPITALS Item No: 2295 Available: Now $99.95 Single-user Optum360 Mobile Diagnosis Optum360 Mobile Diagnosis is the clinician’s and coder’s essential ICD-9-CM and ICD-10-CM code look-up application designed for Apple® iPad and iPhone. This easy-to-use, content-rich application offers fast, detailed search capabilities simultaneously across both ICD-9-CM and ICD-10-CM code sets. With complimentary code updates, powerful search capabilities, mapping content unique to Optum360 and clear guidelines providing documentation support for those ICD-10-CM codes that require specific documentation criteria to be considered, this mobile application allows for accurate coding right at the point of care. • Optum360 Edge — Powerful CodeLogic™ search engine technology. Find the most clinically accurate diagnosis codes using keyword searches across both ICD-9-CM and ICD-10-CM code sets, simultaneously or independently using up to four terms, acronyms or abbreviations. • Optum360 Edge — Physician documentation guidelines. Quickly identify guidelines for ICD-10-CM codes that require specific clinical documentation considerations for accurate coding. • Optum360 Edge — Automatic monthly updates. A real-time application update service delivers code changes monthly and updates Medicare information regularly for coding confidence. • Color-coded edits. Reduce research time and improve coding accuracy with at-a-glance icon indicators for gender or age edits, new, deleted or revised codes, required extra digits and more. • CMS GEM and Optum360 MapSelects mapping content. Includes mapping content for ICD-9-CM to ICD-10-CM (as well as backward mapping) using the GEM and Optum360 MapSelects clinical mapping content. Also includes ICD-10-CM Optum360 tabular content (ICD-10-CM book content such as chapter notes, tabular notes, section notes, “code first” or “use additional” scenarios, as well as includes and excludes). • User notes and favorites. Apply a note to a code or guideline that is unique to you or pertinent to your organization or payer. Quickly mark commonly used codes or those applicable to your specialty. • Great value. Includes the content from more than four code and reference books in one powerful mobile solution, allowing for increased coding accuracy at the point of care. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 27 ONLINE DIGITAL CODING SOLUTIONS | DATA Data files Updates and compliance made easier Trust Optum360 to bring you the most accurate and complete data files at the industry’s best prices. We offer an array of data file solutions, including ICD-10 code and mapping data. You can choose solutions that bring you updated codes throughout the year, or simply select one of our standard data file solutions for one-time delivery. And we now offer new add-on data elements to enhance your coding systems. • Accurate data. Gain confidence in correct code selection the first time. • Real-time, quarterly updates. Have more time to implement code updates in your systems with notification of and access to updated data on our website when it becomes available. • Valuable add-on files. Access additional, value-added information to enhance coding precision, including code change details and age/gender indicator edits. Data content is also available through Optum360® Real-Time eContent web services. Stop spending time and money building and maintaining large, complex medical coding repositories, managing data files and dealing with time-consuming data update processes. The information you or your clients need is delivered to your application in real time, when you need it, and customized to how you want it displayed, with powerful searching capabilities. For a complete list of data available, visit optum360coding.com/dataservices • ICD-10-CM • ICD-10-PCS • ICD-9-CM • ICD-9-CM to ICD-10-CM mapping • Procedure codes with RVUs Need to embed data into your applications? Call us at 1-800-464-3649, option 1, to find out how we can help improve your current systems. CPT is a registered trademark of the American Medical Association. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM • HCPCS Level II • DRG • CCI edits • Cross coding • Medicare fee data • Relative value data • UB-04 • Revenue codes CODING REFERENCE | ONLINE DIGITAL CODING SOLUTIONS 28 Find the digital coding solution that meets your needs at optum360coding.com/transition FacilityCoder.com Expert ASCExpert.com DESIGNED FOR HOSPITALS DESIGNED FOR ASCs Item No: 1152 Available: Now Item No: 1373 Available: Now $899.95 Single-user $1,099.95 Single-user For facility coders For freestanding ASCs FacilityCoder.com Expert ASCExpert.com Save time with online code searches and exclusive code crosswalks, up-to-date coding content, reference data, edits and optimization tips for health information management (HIM) coders. Access information from our top-selling DRG code books. Achieve more accurate reimbursement under the Medicare ambulatory surgical center (ASC) payment system by bringing together the billing, coding and payment resources of freestanding ASCs. • ICD-9-CM to ICD-10-CM/PCS mapping. Identifies GEM and Optum360-recommended mappings. • ICD-10-PCS Code Builder. Understand the relationships between root operation, body system and section. • Easy and intuitive search. Find the latest CPT®, HCPCS Level II, ICD-9-CM, ICD-10-CM/PCS, revenue codes, modifiers and code-specific reference data using acronyms, abbreviations or medical terms. • Fewer denials. The compliance checker and ABN generator review the work you do so that errors are caught before submittal. • ICD-9-CM to ICD-10-CM/PCS mapping. Identifies GEM and Optum360-recommended mappings. • Easily crosswalk from codes to NCCI, modifiers, revenue codes, coverage policies and related procedures. Exclusive code crosswalks and coding tips provide quick links from clinical codes to Centers for Medicare and Medicaid Services (CMS) source documentation, billing and reimbursement information. • Fewer denials. Robust ASC medical necessity checker and ABN generation tool examine the work you do so that errors are caught before submittal. • Physician compliance editor (with Claims Manager rules). Check your work by running your selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses and more, prior to submittal. Multi-user licenses available. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 29 ONLINE DIGITAL CODING SOLUTIONS | CODING REFERENCE NEW! ICDExpert for Post-acute Care DESIGNED FOR POST-ACUTE Item No: 9076 Available: Now $199.95 Single-user ICDExpert for Post-acute Care Tackle the challenges of home health, hospice, skilled nursing and rehabilitation services head-on with this online, digital code look-up tool. Gain immediate access to the ICD-10-CM code set, descriptions, instructions and guidelines, as well as the Optum360 coding and reimbursement alerts that make coding easier. Updated monthly, ICDExpert for Post-acute Care is always current and helps with HIPAA compliance. Optum360 Medical Code Experts Gain faster access online to the individual code sets you need (CPT®, HCPCS Level II, ICD-9-CM, ICD-10-CM and -PCS) with all the descriptions, guidelines and instruction found in your Expert code books. Use to prep your coders for an eventual transition to electronic solutions in order to boost productivity, first-pass payment and your bottom line. • Optum360 Edge — Color-coding and symbols specific to the home health Prospective Payment System (PPS) edits. Quickly identify coding and reimbursement issues specific to home health for improved coding accuracy and work efficiency. CurrentProceduralCodingExpert DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS • Optum360 Edge — Detailed clinical descriptions. Access comprehensive clinical information at the chapter, code block, category, subcategory and code level. Item No: 1400 Available: Now $99.95 Single-user • Optum360 Edge — Key word highlights. Green font is used to differentiate key words that appear in similar code descriptions in a given category. HCPCSExpert DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS Item No: 1401 Available: Now • NOW AVAILABLE Optum360 Edge — Optum360 Post-acute Library. Included documents specifically address home health and hospice reimbursement and coverage issues, including: $99.95 Single-user ICDExpert for Physicians – Overview of Home Health PPS – Qualifications for Medicare Coverage of Home Health – Oasis Diagnosis Guidance – Case-mix Variables and Scores – Clinical Dimension Case-mix Groups – NRS Case-mix Adjustment Variables and Scores – Diagnosis Categories for NRS Case-mix Adjustments – Valid Diagnosis/Etiology Pairings – Hospice Criteria for Medicare Coverage of Non-cancer Hospice Care – Hospice Guidance and Quality Reporting Guidance DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS, CONSULTANTS Item No: 1402 Available: Now $109.95 Single-user ICDExpert for Hospitals DESIGNED FOR HOSPITALS, PAYERS, CONSULTANTS Item No: 1403 Available: Now $119.95 Single-user CPT is a registered trademark of the American Medical Association. Multi-user licenses available. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM CODING REFERENCE | ONLINE DIGITAL CODING SOLUTIONS 30 MedicalReferenceEngine.com Access dozens of Optum360 reference books, thousands of Medicare and Medicaid documents, and local and national Medicare policy information in one easily searchable database, to get fast answers to your coding reference questions. • Flexible customization options. Reduce research time with saved searches and bookmarks. • Quick and easy to use. Conduct searches across multiple sources from a single location. MedicalReferenceEngine.com DESIGNED FOR PHYSICIANS, HOSPITALS, POST-ACUTE, PAYERS Item No: 1917 Available: Now • Customized email alerts. Maintain compliance with access to up-to-date rules and regulations. • Access to forms and fee schedules. Easily find Medicare fee schedules and frequently used forms. • Search state Medicaid content. Reference select state-specific Medicaid guidelines and policies. $899.95 Single-user • Reference links. Create, store, edit and delete. Multi-user licenses available. • CC/MCC code lists. Look up the CC/MCC designated code information for proper billing decision-making. • Enhanced policy search functionality. Navigate with ease. • Clinical Documentation Guidelines (CDG). Guide your coders to better and more compliant code assignment. View the complete list of reference content and watch an auto demo at optum360coding.com/mre • More add-on* choices to customize your subscription: – AHA Coding Clinic® for ICD – CPT® Assistant – AHA Coding Clinic® for HCPCS – Dr. Z’s Medical Coding Series: Interventional Radiology – The AMA CPT­® Content Module – Clinical Documentation Improvement – Medicaid information from additional states *Add-ons can be purchased at an additional cost; Medicaid information is available for select single or multiple states. Product Manager spotlight Julie Orton Van CPC, CPC-P, CEMC Employed with Optum360 for 11 years Julie Orton Van, CPC, CPC-P, CEMC, works at Optum360 as a manager of coding software. She has over 30 years’ experience in the health care industry, including medical coding and billing, physician office management, home health and hospice, managed care, and contract and benefits administration from a payer perspective. Most recently, she provided technical support and clinical content for a fully-integrated ambulatory electronic health record for a large teaching university. Ms. Van recently worked with business analysts, software developers, quality assurance specialists and customers to create a coding application specific to post-acute care. She says, “The reporting and reimbursement requirements from CMS make it extremely difficult to get the full payment for which you are entitled. Add to this the fact that there are differing payment methodologies for the different types of post-acute care, so confusion — and underpayment — are certainly guaranteed. The post-acute care market is grossly underserved in terms of affordable, efficient and useful tools to help organizations get paid properly and to meet regulatory requirements, while improving patient outcomes. Optum360 has useful and cost-effective products to help meet these needs.” CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 31 ONLINE DIGITAL CODING SOLUTIONS | REVENUE CYCLE Billing management solutions Audit Management MedicareRT® Claims System Audit Management helps with oversight of RAC, CMS and other payer audits to minimize future recoveries. With it, you can: Claims processed through the MedicareRT® Claims System are accepted through Medicare’s online system more than 95 percent of the time, reducing adjudication rates as well as Medicare and secondary A/R days. • Analyze claims data to prevent RAC audits and determine financial risk. • Improve first-time acceptance rates. • Understand exposure areas, determine audit outcomes and generate email alerts. • Automate Medicare claim submission. • Track and manage workflow processes through the lifecycle of an audit. • Automate status inquiry and secondary claim processing. • Be aware of scheduled RAC recoupment. • Reduce return-to-provider (RTP) claims. • Reduce reimbursement turnaround time. • Leverage comprehensive and configurable technology. • Streamline and automate manual tasks. To learn more about billing management solutions, call us at 866-223-4730, email us at optum360@optum.com or visit optum360.com/rcm • Accelerate audit resolution with the esMD module. Electronically submit requested records to audit contractors, eliminating delays associated with the paper process. Claims Administrator Compliance Checking Claims Administrator provides robust reporting and workflow tools that allow users to create unique or project-oriented work lists and track claims through the entire submission cycle. It can help you: • Improve billing efficiency. Compliance Checking helps you demonstrate your intent to fully comply with all guidelines from the CMS and OIG, and your commitment to achieving accurate and proper documentation for full and appropriate reimbursement. Compliance Checking can help your organization: • Resolve and accelerate receivables collection. • Improve collection efforts. • Eliminate unnecessary work. • Enhance patient satisfaction. • Reduce claim rejections. • Reduce bad debt, denials and unnecessary write-offs. • Accelerate secondary claims transmission. • Use consistent and accurate documentation for claim submission. • Decrease/eliminate paper claim volume. • Analyze performance and productivity. • Automate and store ABNs with real-time policy updates. • Decrease A/R days while achieving maximum reimbursement. • Enhance productivity and verify medical necessity. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM REVENUE CYCLE | ONLINE DIGITAL CODING SOLUTIONS 32 Revenue cycle management Optum360 revenue cycle management offerings provide hospitals and health systems with unprecedented control over their coding, compliance and reimbursement data and processes. Coding, compliance and clinical documentation RevenueCyclePro.com ChargemasterExpert.com DESIGNED FOR HOSPITALS DESIGNED FOR HOSPITALS Item No: 4790 Available: Now Item No: 1798 Available: Now $2,275.95 Single-user Call for pricing RevenueCyclePro.com ChargemasterExpert.com Help address many of the issues that result in claim rejections, denials and underpayments while improving revenue cycle performance. This comprehensive, problem-solving tool includes access to exclusive code crosswalks, updated Medicare LCD and NCD policies, revenue codes and UB-04 billing tips you need to improve your revenue cycle. ChargemasterExpert.com combines industry-leading CDM consulting, coding and compliance knowledge into one powerful tool that automates more than 80 percent of the CDM review work necessary for accurate reimbursement under the outpatient prospective payment system (OPPS)/APCs. • Optum360 Edge — Robust medical necessity checker and ABN generation tool. Used to screen physician orders and generate an advance beneficiary notice (ABN) to get a patient’s signature, this valuable tool helps hospitals avoid denials. • Optum360 Edge — APC calculator. Estimate expected payment and validate payments received. • Optum360 Edge — Essential DRG calculator. Obtain a more accurate DRG-level payment rate. • Optum360 Edge — Current code information. Updated monthly, this solution boosts data quality by ensuring access to the most current regulatory and coding changes that affect the CDM. • Optum360 Edge — Sophisticated analytics. Once your data is imported and mapped, the auto-analysis function thoroughly scans and identifies more than 12 CDM coding and billing compliance problems, and offers solutions on a line-by-line basis to increase accuracy. • Optum360 Edge — Mapping and integration tool. Simplify the importing of CDM data. See what RevenueCyclePro.com can do for you. Watch an auto demo at optum360coding.com/revenuecycleprodemo Multi-user licenses available. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 33 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 CPT is a registered trademark of the American Medical Association. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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 WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM CODING & BILLING | DESK REFERENCE 38 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 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 CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 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. WE HAVE A NEW WEB ADDRESS — OPTUM360CODING.COM 46 SIMPLIFY YOUR ORDERING / MAGNIFY YOUR SAVINGS www.optum360coding.com 15 SAVE % ON YOUR NEXT ORDER WHEN YOU REGISTER AT OPTUM360CODING.COM 1 2 3 CLICK REG I ST E R SAV E Visit optum360coding.com: By registering, you’ll be able to: Get 15% off your next order • Find the products you need quickly and easily. • Enjoy special promotions, discounts and automatic rewards. • View all available formats and edition years on the same page. • Get recommendations based on your order history. 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Register for an account and you’re automatically enrolled in our eRewards program, where you’ll get a $50 coupon for every $500 you spend.* When logged in at optum360coding.com, the eRewards meter keeps track of purchases toward your next reward. *Offer valid only for customers who are NOT part of our Medallion or Partner Account programs. You must be registered at optum360coding.com to have your online purchases tracked for rewards purposes. Shipping charges and taxes still apply and cannot be used for rewards. Optum360 Coding eReward offers valid online only. CALL 1-800 -464-3649, OPTION 1 | MENTION PROMO CODE FOR DISCOUNT 2525 Lake Park Blvd., Salt Lake City, UT 84120 Customer Number Contact Number Promo Code 00000E2A Save 50 up to %* WHEN YOU ORDER ON OPTUM360CODING.COM: Save 50% on most 2016 edition coding resources Save 25% on most 2017 edition coding resources Discounts above reflect an additional 5% for ordering online. 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