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.
 Key Features and Benefits
 NEW 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 to support code assignment.
 See the medical conditions that are indicated for diagnostic and therapeutic purposes.
 Get valuable code intelligence that helps confirm correct code assignment.
 Know about billing and payment issues that affect procedure types.
 Conduct internal audits that will ensure proper reimbursement.

Auditors' Desk Reference 2015

Medical Books

Optumlnsight, Inc.

Administration & Medicine Economics

Optum360º

2015 Coding Companion® for General Surgery/ Gastroenterology Consolidate the coding process with the one-stop resource developed exclusively for those who code for general surgery and gastroenterology. This comprehensive guide includes 2015 CPT® and ICD-9-CM code sets specific to general surgery and gastroenterology 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 general surgery and gastroenterology 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 General Surgery/Gastroenterology 2015: A Comprehensive Illustrated Guide to Coding and Reimbursement

The Coding and Payment Guide for Behavioral Health Services is your one-stop coding, billing, and documentation guide to submitting claims with greater precision and efficiency. This guide has the latest 2015 specialty-specific ICD-9-CM, HCPCS Level II, and CPT code sets along with Medicare payer information, CCI edits, helpful code descriptions, and clinical definitions.
 Key Features:
 Increase coding efficiency. All CPT code information is included on one page for quick and easy look-up. 
 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 tailored to behavioral health services, to prepare cleaner claims before submission.
 Avoid confusion with easy-to-understand descriptions. Includes clear explanations of procedures represented by CPT codes, along with clinical definitions and ICD-9-CM code explanations specific to behavioral health services. 
 Improve the precision of ICD-9-CM code selection. Prevent claim denials often caused by incorrect code selection with icons that help identify the most appropriate ICD-9-CM code. 
 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 and Payment Guide for Behavioral Health Services 2015

The Coding Guide for OMS is your one-stop coding, billing, and documentation guide to submitting claims with greater precision and efficiency. Co-produced with the American Association of Oral and Maxillofacial Surgeons (AAOMS), this guide has the latest 2015 OMS specific ICD-9-CM, HCPCS Level II, CDT and CPT code sets along with Medicare payer information, CCI edits, helpful code descriptions, and clinical definitions.
 Key Features: Increase coding efficiency. Essential OMS specific CPT and CDT code information is included on one page for quick and easy look-up. 
 Prevent claim denials and stay up-to-date with Medicare payer information. Review Medicare Pub. 100 references containing information linked to CDT and CPT codes tailored to OMS services, to prepare cleaner claims before submission.
 Avoid confusion with easy-to-understand descriptions. Includes clear explanations of procedures represented by CPT and CDT codes, along with clinical definitions specific to OMS services.
 Improve the precision of ICD-9-CM code selection. Prevent claim denials often caused by incorrect code selection with inclusion of the most commonly used ICD-9-CM codes for OMS providers.
 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.
 Current Dental Terminology, © 2014 American Dental Association. All rights reserved.

Coding Guide for OMS 2015

New 2016 editions will be available mid-September 2015.
 The DRG Expert has been a trusted and comprehensive reference to the DRG classification system for over 25 years. Organized by major diagnostic category (MDC), the convenient and innovative book layout follows the logical MS-DRG decision process. This is a must-have reference for those who need to verify DRG information and accurately assign MS-DRGs concurrently or retrospectively based on ICD-10-CM methodology, which goes into effect October 1, 2015.
 Key Features and Benefits
 Optum 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.
 Optum Edge Medicare CMS rate structure. Updated to provide current relative weight (RW), geometric mean length-of-stay (GMLOS), and arithmetic mean length-of-stay (AMLOS) for each MS-DRG under IPPS.
 Optum Edge MS-DRG structure. Every diagnosis and procedure code that defines each DRG is listed.
 Optum Edge LTC-DRG crosswalk and current rate structure. Know what the RW and length-of-stay data are for each MS-DRG under the LTCH prospective payment system.
 Optum Edge MDC diagnosis list. Complete list of mutually exclusive diagnoses defining each MDC.
 Optum Edge Transfer DRG symbol. Indicates a DRG selected as a qualified discharge that may be paid at the per diem rate.
 Optum Edge Average national payment. Listed for every MS-DRG as a quick benchmark comparison.
 Easily locate the correct DRG. Use the numeric or alphabetic index to quickly identify a DRG based on its diagnosis or procedure code.
 Surgical hierarchy table. Quickly find the DRG hierarchy for multiple procedure cases to help you assign the code that reflects the greatest resource utilization. Alphabetic and numeric indexes. Search for DRGs by the numeric codes or by code titles for fast look-up.
 Icons indicate which CC subclass the DRG belongs to based upon the presence or absence of CCs or major CCs (MCCs).
 Complete list of diagnoses considered CCs and MCCs.
 List of those Principal Diagnoses that are their own CC and their own MCC
 Full titles for each MS-DRG. Selection of the correct DRG begins with knowing its accurate and complete description.
 Inpatient Medicare MedPAR benchmarking data designed to provide a high-level benchmark of discharges, length of stay, age, total charges, and total reimbursement on a DRG basis at a national level for hospitals.

DRG Expert 2015

Optuminsight Inc

Interventional radiology and cardiology coding can baffle even the most experienced coders. 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. Includes diagrams and colored images.
 Key Features and Benefits:
 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.
 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.
 Medicare Correct Coding Initiative (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.
 For facilities:
 Benchmarking information. Optimize revenue for your facility with detailed data on often-overlooked codes while capturing all charges possible and allowable.
 Facility coding tips. Provides information on how codes should be used, as well as when not to use a code, plus other codes frequently associated with the procedure, HCPCS codes reported instead of or in addition to the procedure, and modifier assignment.
 For physicians:
 Overview of Physician Quality Reporting Initiative (PQRI). Includes quality measures and coding tips for physicians.
 Physician payment methodology. Get all the details on how payment is established/determined. Detailed information regarding radiology services. Learn the difference in modifier reporting for radiology procedures where the physician provides the supervision and interpretation versus the procedure itself.
 Summaries of anti-kickback laws and Stark legislation. Review Stark legislation history and regulations to help understand patient referrals and services provided.
 Physician coding tips. Provides information on how the code should be used, provides related CPT® codes, and offers help concerning common billing errors and modifier usage.
 CPT® is a registered trademark of the American Medical Association.

Complete Guide for Interventional Radiology 2015

New 2016 editions will be available mid-September 2015. 
 The 2015 (Draft) ICD-10-PCS Expert with our hallmark features and format including the Medicare Code Edits (MCE) for the new ICD-10 MS-DRG reimbursement system contains the latest official government version of the ICD-10-PCS code set, plus the familiar Optum coding and reimbursement alerts you have come to rely upon in your ICD-9-CM code books.
 Set the standard for coding accuracy, the cornerstone of healthcare analytics and revenue cycle management, with the confidence only an Optum product can deliver.
 Key Features and Benefits
 The 2015 (Draft)ICD-10-PCS Expert edition includes:
 NEW Optum 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 ICD10 MS-DRG MCEs for procedures including;
 o Noncovered procedures
 o Limited coverage procedures
 o Combination only procedures
 o Non-operating room procedures affecting MS-DRG assignment
 o Non-operating room procedures NOT affecting MS-DRG assignment
 o HAC related procedures
 NEW Optum Edge Illustrations featuring anatomy and terminology included in the ICD-10-PCS classification system
 Optum Edge Intuitive features and format. Ease into the new classification system using these handy code tables to build the code through character value selections that reflect the procedure performed.
 Detailed information on structure and conventions of ICD-10-PCS. Learn the new coding system with its unique structure of specific definition and functions for each character.
 Complete set of ICD-10-PCS codes. View all 16 sections of tables by general procedure type from medical/surgical to substance abuse 30 tables in the medical surgical section alone covering procedures on all body systems.
 Valuable resources. Receive additional resources to help guide the user, including tables that list root operation with definitions, anatomical listing, character meaning, and coding exercises.
 Official coding guidelines. Learn how to use the code set appropriately following the guidelines specific for each section.
 Basic tutorial with coding scenarios. Find step-by-step instructions in a well-organized format for developing basic coding proficiency of the new code set and implementing it in your facility.
 Coding exercises. Facilitate training by completing sample exercises using the ICD-10-PCS code set.
 HIPAA compliance. Comply with HIPAA transaction and code set requirements to avoid delayed or denied claims and costly fines for violations.

ICD-10-PCS: The Complete Official Draft Code Set

New 2016 editions will be available mid-September 2015.
 The 2015 (Draft) ICD-10-CM Expert for Hospitals featuring our hallmark color-coding and symbols reflecting the new ICD-10 MS-DRG reimbursement edits, makes facing the challenges of the new code set and reimbursement system easier. Use the code book that contains the latest official government version of the ICD-10-CM code set, plus the familiar Optum coding and reimbursement alerts you have come to rely upon in your ICD-9-CM code books.
 Set the standard for coding accuracy, the cornerstone of healthcare analytics and revenue cycle management, with the confidence only an Optum product can deliver.
 The 2015 (Draft) ICD-10-CM Expert for Hospitals edition includes:
 Optum Edge Exclusive PDx acting as CC and MCC Alert Symbols. This symbol (designed and used exclusively by Optum) alerts the coder to a new key factor in the DRG10 system that some diagnoses act as both PDx and CC or MCC.
 Optum 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 MCEs for diagnoses
 o Age o Sex o Manifestation codes o Unacceptable PDx o Hospital Acquired Condition o CC and MCC with Exclusion List o New Edit CC as PDx and MCC as PDx o HIV Optum Edge Key Word. Green font is used to differentiate key words that appear in similar code descriptions in a given category.
 Optum Edge Exclusive Following references in the indexes The Following references help coders locate those alphanumeric codes that are out of sequence in the tabular
 Optum Edge Additional character required symbols. Know when an additional character is required for code specificity and validity to avoid invalid code submissions (provided in Index and Tabular Section).
 Optum Edge Illustrations featuring anatomy and terminology included in the ICD-10-CM classification system
 Optum Edge Intuitive features and format. Ease into the new classification system using intuitive visual alerts to highlight code groupings as well as the distinctions between code choices plus, added features that make finding specific sections easier.
 Complete 2015 ICD-10-CM code set. View all 21 chapters, from infectious and parasitic diseases to injuries, including external causes and reasons for visit.
 ICD-10-CM official conventions. This new coding system comes with new conventions that are concisely outlined for quick reference
 ICD-10-CM official coding guidelines. Build a solid coding practice foundation and understanding and get the new coding system right the first time.
 Optum Edge Official index. Navigate through the official index to the tabular section and external causes using our exclusive shade guides to easily identify subterm levels under main terms.
 Table of Drugs and Chemicals and Neoplasm Table Updated tables within ICD-10-CM

ICD-10-CM Expert for Hospitals 2015: The Complete Official Draft Code Set

The greater number of ICD-10-CM diagnostic codes means an even bigger need for detailed clinical documentation. Making the right codes selection requires having adequate clinical detail, and under ICD-10, clinician's documentation will--more than ever--translate into reimbursement gained or lost.
 The quality of clinical documentation is a longstanding challenge. This manual provides the resources you need to gain physician cooperation and to enhance coding through clinical documentation improvement for ICD-10-CM.
 Important Note: Clinical documentation improvement (CDI) is not about how to code in ICD-10. CDI is knowing what to look for in medical records, as well as how to ask for clarification and get ongoing changes to the notes and comments provided by physicians. 
 Key Features and Benefits:
 Includes the unique "ICD-10 Translator" that maps clinical terms. An exclusive documentation resource that maps ICD-9-CM clinical terminology to the associated ICD-10-CM terms to speed finding the correct code.
 See key terms. Confirm accurate code selection for every chapter of ICD-10-CM.
 Know when ICD-10-CM differs dramatically from ICD-9-CM. Alerts and warnings in the text of this book call your attention to situations where ICD-10-CM coding protocols are different from ICD-9-CM and significantly affect code choices. 
 Streamline the query process. Show physicians which medical terms are essential to assigning codes in ICD-10-CM. Includes best practice query forms that get results without unduly influencing clinicians.
 Know when the coding system rules affect how documentation is interpreted.

ICD-10-CM Clinical Documentation Improvement Desk Reference 2015

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