This unique manual shows what the medical record must contain for correct coding and billing of specific medical and diagnostic services and procedures.
 It provides coders and anyone concerned about coding with an auditor's perspective on the clinical detail, regulatory instructions, and coding protocol needed for code assignment.
 Avoid the devastating effects of outside audits and reviews with this detailed coding tool. 
 The 2016 Auditor s Desk Reference includes: 
 Key Features and Benefits
 New Optum360 Edge Exclusive. More auditing tools to protect your revenue critical services and procedures. 
 New Optum360 Edge Exclusive. Completely updated for code set and regulatory changes. 
 Contains library of time-saving Audit Forms. In easy-to-customize electronic format. 
 Provides coders with an auditor's perceptive. Know the clinical detail, regulatory instructions, coding protocol needed for code assignment, by individual code and code groupings. 
 Know what information needs to be in the medical record. And on the claim form to capture appropriate reimbursement. 
 Differentiate between similar procedures. Helps coders and auditors compare and contrast seemingly similar, but different procedures. 
 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. 
 CPT® is a registered trademark of the American Medical Association

Auditors Desk Reference 2016

Medical Books

OPTUM360

Administration & Medicine Economics

Optum360º

Coding from the Operative Report for ICD-10-CM and PCS is an ideal resource for your inpatient coders to test their ICD-10-CM and PCS coding skills with detailed, inpatient cases. Your coding staff will be able to practice with these real-life operative report-based coding challenges.Key Features and Benefits
 Part of the Optum Learning Coding &amp; Reimbursement Educational series. Includes answer rationale that explains in detail the reasons for code choices. Includes 90 case studies demonstrating correct ICD-10 coding. Provides inpatient coders a real-life coding challenge. Excellent for individual or group study.

Coding from the Operative Report for ICD-10-CM and PCS-2015 (Coding & Reimbursement Educational)

Ingenix

Evaluation and Management (E/M) coding is notoriously difficult, mainly because coders have trouble accurately selecting a code from among a range of seemingly appropriate choices. Consequently, providers make more mistakes with E/M coding than coding for any other item or service. This new resource offers detailed and advanced guidance on selecting the appropriate E/M codes, with helpful resources designed for difficult E/M coding situations. Now, with ICD-10-CM implementation approaching, your E/M coding takes on even greater importance and we've devoted an entire new chapter to this vital E/M and ICD-10-CM relationship.

Evaluation and Management Coding Advisor

Business & Money

Insurance

Delmar/Cengage Learning

Evaluation and Management Coding Advisor 2016 Evaluation and Management (E/M) coding is notoriously difficult. Consequently, providers make more mistakes with E/M coding than coding for any other item or service. This new resource offers detailed and advanced guidance on selecting the appropriate E/M codes, with helpful resources designed for difficult E/M coding situations. 
 Now, with ICD-10-CM implementation approaching, your E/M coding takes on even greater importance and we've have provided extensive coverage to this vital E/M and ICD-10-CM relationship. The 2016 Evaluation and Management Coding Advisor includes: Key Features and Benefits ICD-10-CM code assignment hinges on the quality and detail of E/M encounter data. Get appropriate ICD-10-CM coding assignments with improved E/M coding process. Minimize physician queries, and prevent delays in claims processing pending information and stop outright claims denials. 
 Includes clinical case studies. Train coders and clinicians using real-life scenarios. 
 Covers every E/M service. Review of the E/M rules and protocols for all E/M care. 
 Helpful advice designed for difficult E/M coding situations. Well-patient exams, H1N1 flu, and other common, but problematic coding scenarios are explained. 
 E/M template examples for EMRs. Ensure accurate code selection and avoid over-coding with guidelines for using templates. 
 Includes Knowledge Assessments. With answers and rationale. Instant feedback on knowledge retention. 
 Targeted areas. Review what auditors are targeting, such as critical care. 
 Documentation guidance. Review key factors for proper E/M code selection, plus advice to help clinicians make an objective review of subjective information. 
 CPT® is a registered trademark of the American Medical Association

Evaluation and Management Coding Advisor - 2016

A successful transition from ICD-9-CM, Volume 3, to the ICD-10-PCS coding system will require focused training for individuals and organizations. The first step is to understand that procedure codes are built from a range of variables including root operation, body system, body part, approach and more not selected from a list. Multiple codes may even be needed in some instances.  Beginning and advanced coders will benefit from Detailed Instruction for Appropriate ICD-10-PCS Coding, which goes beyond the official guidelines by anticipating questions and points of confusion. This resource will help with mastery of ICD-10-PCS coding, an essential skill since reimbursements for Medicare inpatient services make up a significant portion of hospital revenues.  Key Features and Benefits Part of the Optum360 Learning Coding & Reimbursement Educational series.   Easy-to-follow guide to ICD-10-PCS. Master the very different organizational principles and completely new classification system that are the foundation of ICD-10-PCS.  Map ICD-9-CM procedure terminology to ICD-10-PCS root operation terminology.  The umbrella procedures in ICD-9-CM map to several alternative root operations, and, some PCS root operations may map backwards to many commonly used procedural terms in ICD-9-CM. Know the key factors that will determine your code selection.  Exclusive Optum360 Root Operation Conversion Table.  Translate commonly used ICD-9-CM procedural terms to ICD-10-PCS root operations.  Shows how to quickly solve the foremost ICD-10-PCS coding challenges. Users are guided through the process with expert guidance on selecting the correct root operation from among the 31 root operations found in the Medical and Surgical section. Plus, get essential guidance for CMS body part and device keys that are crucial to appropriate code assignment.  Real-life coding scenarios.  Test your skills or your coders' with real-life coding scenarios that include not just answers but answer rationale that explain why the correct answer is the most appropriate.  Distills official guidelines into essential steps in the code building process.

Detailed Instruction for Appropriate ICD-10-PCS Coding 2016

The Physician's Compliance Guide brings physicians and practice managers up-to-speed quickly on federal investigative efforts that affect their organizations. With a focus on the top compliance risks for physician practices stemming from OIG, RAC, CERT, and other contractor reviews, this resource identifies the range of investigative actions that can result in monetary recoveries or other penalties. Most importantly, it names key practice management issues that pose the greatest compliance threats and demonstrates how to efficiently comply with Medicare s rules. An analysis of each issue includes discussion of the root cause of the problem, and how to restructure work processes to boost compliance.
 Key Features and Benefits:
 NEW. Sample compliance policies. Your copy of this manual includes ready to use, customizable compliance policies covering key compliance issues such as E/M, screening services, surgeries, and preventive services. Integrate easily into your practice workflow and your practice compliance manual. Plus, get additional compliance policies via the customer-only website.
 NEW. Get the updated RAC Issues Table. This feature brings together the most current data on RAC audit targets, available on the customers-only website for the Physicians' Compliance Guide.
 Understand what the investigators (RACs, OIG, MACs) are looking for. Provides case studies and easy-to-understand examples of errors and non-compliance.
 Identifies the agency or contractor conducting the investigation or review initiative. Know the reasons why the agency has an interest in this compliance area.
 Area of investigation as outlined by the agency performing the review. Explains the official purpose of the review and how it fits with other current or earlier investigations.
 Explanation of the infractions or errors. Shows which billing or coding practices are contributing to the error. Includes a discussion of what the agency is expecting to find, such as coding errors, inappropriate business relations, Stark violations, and balance billing violations.
 Strategies for assessing risk. Gives physician practices the techniques, formulas, and benchmarks to determine their risk and estimate potential liability.
 Get guidance on identifying the workflow processes that are contributing to compliance errors and omissions. Identifying faulty processes is the first step in protecting your practice.
 Implement corrective actions to mitigate risk. Learn how to reduce or eliminate problems by establishing coding policies, educating staff, reviewing billing policies, or seeking legal assistance in renegotiating contracts and other business relationships.

Physician's Compliance Guide 2015

Coders Dictionary 2016 Unlike other medical dictionaries, the 2016 Coders Dictionary helps you understand medical terminology from a coder s perspective. This unique dictionary was developed to meet the specific needs of medical coders, admitting clerks, billers, and adjudicators. Key Features and Benefits 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. 
 In total, includes more than 9,500 alphabetic entries and 250 illustrations for terminology key to code selection so you can find definitions for medical nomenclature, eponyms, new technology, and acronyms. 
 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 including many new lab and path terms that appear in 2015 CPT® code set. 
 CPT® is a registered trademark of the American Medical Association

Coders' Dictionary - 2016

Consolidate the coding process with the one-stop resource developed exclusively for those who code for podiatry. 
 This comprehensive and easy-to-use guide includes 2016 CPT®, HCPCS, and ICD-10-CM code sets specific to podiatry. 
 Each specialty-specific procedure code includes its official description and lay description, coding tips, terminology, cross-coding, and national Medicare relative value units. 
 Getting to the code information you need has never been so easy. 
 Key Features and Benefits
 Optum360 Edge HCPCS Procedure Codes. Only Optum360 offers HCPCS procedure codes specific to your specialty with the same information as we provide for CPT codes. 
 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. 
 Organized by CPT® and HCPCS code. Essential procedures for podiatry are listed by CPT® or HCPCS code, along with crosswalks to ICD-10-CM diagnosis codes. 
 Easily determine fees for your practice and reinforce consistency in the charges. National Medicare relative value units for surgery codes and most diagnostic procedures are included. 
 Avoid claim denials and/or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery. 
 CCI Edits by CPT® and HCPCS code. CPT® codes with associated CCI edits in a special section and quarterly updates available online. 
 CPT® is a registered trademark of the American Medical Association.

Coding Companion® for Podiatry 2016

Consolidate the coding process with the one-stop resource developed exclusively for those who code for radiology. 
 This comprehensive and easy-to-use guide includes 2016 CPT®, HCPCS, and ICD-10-CM code sets specific to radiology. 
 Each specialty-specific procedure code includes its official description and lay description, coding tips, terminology, cross-coding, and national Medicare relative value units. 
 Getting to the code information you need has never been so easy. 
 Key Features and Benefits
 Optum360 Edge HCPCS Procedure Codes. Only Optum360 offers HCPCS procedure codes specific to your specialty with the same information as we provide for CPT codes. 
 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. 
 Organized by CPT® and HCPCS code.v Essential procedures for radiology are listed by CPT® or HCPCS code, along with crosswalks to ICD-10-CM diagnosis codes. 
 Easily determine fees for your practice and reinforce consistency in the charges. National Medicare relative value units for surgery codes and most diagnostic procedures are included. 
 Avoid claim denials and/or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery. 
 CCI Edits by CPT® and HCPCS code. CPT® codes with associated CCI edits in a special section and quarterly updates available online. 
 CPT® is a registered trademark of the American Medical Association

Coding Companion® for Radiology 2016

2015 Coding Companion® for Cardiology/Cardiothoracic Surgery/Vascular Surgery Consolidate the coding process with the one-stop resource developed exclusively for those who code for cardiology, cardiothoracic surgery and vascular surgery. This comprehensive guide includes 2015 CPT® and ICD-9-CM code sets specific to cardiology, cardiothoracic surgery, and vascular surgery in an easy-to-use, one-page format. Each page has the CPT® code with its official description and a detailed illustration, as well as lay descriptions, coding tips, terminology, cross coding, and national Medicare relative value units. Getting to the code information you need has never been so easy.
 Key Features and Benefits
 Illustrated one-page format. All the information you need is on one illustrated page, including lay descriptions, coding tips, terms, cross-coding, and Medicare RVUs and Pub. 100 references.
 Organized by CPT® code. Essential procedures for cardiology, cardiothoracic surgery and vascular surgery are listed by CPT® code, along with crosswalks to ICD-9-CM diagnosis, procedure, and anesthesia codes.
 Easily determine fees for your practice and reinforce consistency in the charges. National Medicare relative value units for surgery codes and most diagnostic procedures are included.
 Avoid claim denials and/or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery.
 CCI Edits by CPT® code. CPT® codes with associated CCI edits in a special section and quarterly updates available online.
 CPT® is a registered trademark of the American Medical Association.

Coding Companion for Cardiology/Cardiothoracic Surgery/Vascular Surgery -- 2015

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