Coding,billing
& Reimbursement
Summer 2015 catalog
Fe aturing
2016 Edition
Resources
ICD-10 ICD-10 ICD-10 IS ISNOW NOW NOW. ICD-10IS IS NOW CHANGE WITHCHANGE CONFIDENCE. OWN OWN OWN THE THE THE CHANGE CHANGE NAVIGATE PIONEER EXPLORENAVIGATE PIONEER NAVIGATE NAVIGATE EXPLORE EXPLORE EXPLORE PIONEER PIONEER Uncharted Territory
The changing coding landscape.
the new frontier of coding.
Explore uncharted territory with Optum360 by your side. Browse our full line of I-10 products inside.
pages
14-25
WHEN YOU MIX IT UP BY GOING DIGITAL
ICD-10 is set for October 1, 2015, and soon you’ll be faced with more codes and complexity in your job than ever before. Make your life a little easier with Optum360™ digital coding solutions. Our online digital coding solutions are always up to date with the proper code sets and updates, which means you spend less time searching for an elusive code, researching compliance rules and codes or digging for referential information. MIX
IT UP
Amp it up with faster and always up-to-date online digital coding tools from Optum360.
See pages 4-13 and page 22.
OPTPRJ7876 | SPRJ2231 | June 2015
Table of Contents
SUMMER
2015 catalog
New Solutions 3
New solutions
ONLINE DIGITAL CODING SOLUTIONS 4
Online digital coding solutions | Pg. 4
Coding reference
11 Data 12 Revenue cycle
ICD-10 Transition
Comprehensive ICD-10 training and resources | Pg. 14
14 ICD-10 transition
20 Reference
15 Physician 16 Hospital
22 Online digital coding solutions
18 Post acute
23 Education
19 Mapping & documentation improvement
25 Training
Essential Coding
Essential coding | Pg. 26
26 CPT® coding 28 HCPCS Level II 30 DRG
Specialty Reference 32 Coding & reimbursement 34 Cross coding 35 Coding & payment
Desk ReferenceS 36 Coding & billing
Pricing & Cost
Optum360 Edge Optum360 Edge identifies hallmark product features that are uniquely designed by or are exclusive to Optum360.
38 Fees
Coding, Billing & Reimbursement 31, 40 Coding, billing & reimbursement
Bookstore
eBooks available Look for the download icon throughout the catalog for books and resources available as an eBook.
42 Workers’ compensation 43 Companion products
Medicare
Products contained in this catalog are made in the USA. CPT is a registered trademark of the American Medical Association.
44 Medicare
optumcoding.com
1
TAKE THE
QUIZ!
What type of coding
rockstar are you?
RIFF
Three Part
MA
HARMONY
STER
PERFECT CH
OR
PIT
Remix
Classic
B IG BEAT
How do you roll with your band of coders? Between compliance changes, continuing education and preparing for ICD-10, we know you’re swamped trying to master the codes. But it’s good to know how you sync with other coders and what strengths you bring to the group. We know everyone rocks the code a little differently. Before you take center stage, learn more about your style of play and how you get the crowd cheering. Take this quiz and find out what style of coder you are. It’s fast, fun and informative.
Find out how you rock today! Take the quiz. Visit optumcoding.com/codersrock
2
1-800-464-3649, option 1 Mention your promo code for discounts
Online Reference
| New Solutions
Also available as an eBook.
I nn o vati v e NEW
s o l uti o n s
2016 Coders’ Desk Reference for Diagnoses (ICD-10-CM) >> DESIGNED FOR PHYSICIANS, HOSPITALS, POST ACUTE, PAYERS
Item No: ITDRD16 Available: Sep 2015 $139.95
2016 Comprehensive Coding Guide
ICDExpert.com for Post Acute Care
>> Designed for Physicians, Hospitals,
>> DESIGNED FOR POST ACUTE
Post Acute, Payers
Item No: CCG16 Available: Nov 2015 $95.95
Item No: 9076 Available: Oct 2015 $199.95 See page 6 for more details.
Also available as an eBook. See page 20 for more details.
Customize your online coding solutions with these new add-ons Dr. Z’s Medical Coding Series: Interventional Radiology*
DRG Grouper Calculator*
>> Designed for Physicians, Hospitals,
Item No: WA33
Post Acute, Payers, Consultants
Item No: WA30 (Hospitals/Physicians); WA31 (Consultants)
>> Designed for Hospitals, Payers
Available: Now Call for pricing
Available: Now Call for pricing
*May be purchased with a new or existing subscription to an Optum360 online digital coding solution.
optumcoding.com
3
ONLINE DIGITAL CODING SOLUTIONS |
coding Reference
Encoder Pro.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
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
Multi-user licenses available. CPT is a registered trademark of the American Medical Association.
4
1-800-464-3649, option 1 Mention your promo code for discounts
coding Reference
| Online digital coding solutions
Encoder Pro.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 optumcoding.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.
I-10 Map manager This add-on to all EncoderPro.com versions, as well as RevenueCyclePro.com, is the perfect way to get forward and backward mappings between ICD-9-CM and ICD-10-CM/PCS.
I-10 Map Manager >> Designed for Physicians, Hospitals, Payers
Item No: WA26 Available: Now Call for pricing
Code sets mapped easily. Simply add or import lists of ICD-9 or ICD-10 codes to create custom mappings using general equivalence mappings (GEMs) and Optum360 MapSelects. Optimal mapping. By including Optum360 MapSelects, the most appropriate mapping based on code descriptions, coding guidelines and clinical expertise, is identified. Intuitive. A simple-to-understand interface makes I-10 Map Manager easy to implement and use.
optumcoding.com
5
ONLINE DIGITAL CODING SOLUTIONS |
coding Reference
Optum360 Medical Code Experts Gain access 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. Online, however, information is always current and faster to search than a traditional code book. Use to prep your coders for an eventual transition to electronic solutions in order to boost productivity, first-pass payment and your bottom line. CurrentProceduralCodingExpert.com
ICDExpert.com for Physicians
>> Designed for Physicians, Hospitals, payers
>> Designed for Physicians, hospitals, payers, consultants
Item No: 1400 Available: Now $99.95 Single-user
Item No: 1402 Available: Now $109.95 Single-user
HCPCSExpert.com
ICDExpert.com for Hospitals
>> Designed for Physicians, hospitals, payers
>> Designed for hospitals, payers, consultants
Item No: 1401 Available: Now $99.95 Single-user
Item No: 1403 Available: Now $119.95 Single-user
NEW!
ICDExpert.com 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 latest official version of 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.com for Post Acute Care is always current and helps with HIPAA compliance. 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. Optum360 Edge — Detailed clinical descriptions. Access comprehensive clinical information at the chapter, code block, category, subcategory and code level. Optum360 Edge — Key word highlights. Green font is used to differentiate key words that appear in similar code descriptions in a given category.
ICDExpert.com for Post Acute Care >> DESIGNED FOR POST ACUTE
Item No: 9076 Available: Oct 2015 $199.95 Single-user
Optum360 Edge — Optum360 Post Acute Library. Included documents specifically address home health and hospice reimbursement and coverage issues, including: –– Home Health PPS –– Clinical Dimension Case Mix Groups –– Selection and Assignment of OASIS Diagnoses –– Valid Diagnosis/Etiology Pairing List –– Non-routine Supplies Case-Mix Adjustment Model, Variables and Scores –– Medicare Coverage of Home Health and Hospice Services
Multi-user licenses available. CPT is a registered trademark of the American Medical Association.
6
1-800-464-3649, option 1 Mention your promo code for discounts
coding Reference
| Online digital coding solutions
Customize your online digital coding solutions with add-ons 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: CPT® Assistant
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.
Get ready for the new code set and map 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 with just a click of your mouse as you perform specific code searches.
NEW! Dr. Z’s Medical Coding Series: Interventional Radiology Coding Reference Without leaving your workflow, access the go-to manual that simplifies the complexity inherent in interventional radiology coding.
DRG Grouper Calculator Quickly group diagnosis and procedure codes to their applicable DRG and exact provider’s reimbursement for both ICD-9 and ICD-10 codes.
Learn more about all the available add-on modules at optumcoding.com/addons
AHA Coding Clinic® for ICD
Coders’ Dictionary
DrugReimbursement.com
AHA Coding Clinic® for HCPCS
CPT® Assistant
FeeAnalyzer.com Professional
ASA Crosswalk®
CPT® Changes: An Insider’s View
Historical Application Content
Claims Batch Editor
Dental Codes
I-10 Map Manager
Repair Toolkit for Claims Batch Editor
NEW! DRG Grouper Calculator
MedicalReferenceEngine.com
NEW! Dr. Z’s Medical Coding Series: Interventional Radiology
Stedman’s Medical Dictionary
Coders’ Essential 3-Pack
optumcoding.com
7
ONLINE DIGITAL CODING SOLUTIONS |
coding Reference
Find the electronic coding solution that meets your needs at optumcoding.com/ transition FacilityCoder.com Expert >> Designed for hospitals
Item No: 1152 Available: Now $899.95 Single-user ASCExpert.com >> Designed for ASCs
Item No: 1373 Available: Now $1,099.95
For facility coders
For freestanding ASCs
Facility Coder.com Expert
ASC Expert.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 the 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 check the work you do so that errors are caught before submittal.
CPT is a registered trademark of the American Medical Association.
8
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 check 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.
1-800-464-3649, option 1 Mention your promo code for discounts
coding Reference
| Online digital coding solutions
Medical Reference Engine.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, and get easier 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 $899.95
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.
NEW! DRG Decision Trees for ICD-9 and ICD-10. Access Optum360 exclusive DRG Decision Trees for proper billing decision making. Reference links. Create, store, edit and delete third-party reference links. CC/MCC code lists. Look up the CC/MCC designated code information for proper billing decision making. Enhanced policy search functionality. Navigate with ease. *Add-ons can be purchased at an additional cost; Medicaid information is available for select single or multiple states.
Clinical Documentation Guidelines (CDG). Guide your coders to better and more compliant code assignment. More add-on* choices to customize your subscription:
–– Dr. Z’s Medical Coding Series: Interventional Radiology –– CPT® Assistant –– AHA Coding Clinic® for ICD –– AHA Coding Clinic® for HCPCS –– Additional states to choose from for Medicaid information
Over 38 essential Optum360 references plus regulatory content: Medicare
Hospital
ICD-10
CMS Transmittals Office of Inspector General (OIG) Workplan Advisory Opinions Fraud Alerts MLN Matters Proposed and Final Rules Recovery Audit Contractor (RAC) Audit Code of Federal Regulations Fee Schedules LCD/NCD Policies Internet Only Manuals CMS Press Releases PQRS ICD-10
Complete Guide to Medicare Coverage Issues Hospital Chargemaster Guide Medicare Desk Reference for Hospitals Outpatient Billing Expert Uniform Billing Editor DRG Expert DRG Desk Reference
Coding from Operative Report Coding Readiness Assessment Comprehensive Anatomy & Physiology ICD-10-CM Clinical Doc. Improvement Detailed Instructions ICD-10-CM Coding Detailed Instructions ICD-10-PCS Coding
optumcoding.com
Physician HIPAA Tool Kit Physicians’ Compliance Guide Auditors’ Desk Reference Physician Quality Reporting Guide
View the complete list and watch an auto demo at: optumcoding.com/mre 9
ONLINE DIGITAL CODING SOLUTIONS |
coding Reference
Make a smooth transition to ICD-10-CM on the go.
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 that identify gender or age edits, if a code is new, deleted or revised, if a code requires extra digits, and much more.
10
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. Apply a note to a code that is unique to you in order to identify unique coding scenarios or apply specific specialty guidelines unique to your organization or payer. Favorites. Quickly mark and reference codes that are most applicable to your specialty or common use. 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.
1-800-464-3649, option 1 Mention your promo code for discounts
Data
| Online digital coding solutions
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.
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. optumcoding.com
For a complete list of data available, visit optumcoding.com/ dataservices ICD-9-CM ICD-10-CM ICD-10-PCS ICD-9-CM to ICD-10-CM Mapping Procedure Codes with RVUs HCPCS Level II DRG CCI Edits Cross Coding Medicare and Fee Data UB-04 Revenue Codes Insurance Directory
11
ONLINE DIGITAL CODING SOLUTIONS |
Revenue cycle
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 $2,275.95
Item No: 1798 Available: Now Call for pricing
Revenue Cycle Pro.com
Chargemaster Expert.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 industryleading CDM consulting and 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 patient signature, this valuable tool helps hospitals avoid denials.
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 — APC calculator. Estimate expected payment and validate payments received. Optum360 Edge — Essential DRG calculator. Obtain a more accurate DRG-level payment rate.
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.
Ease your transition to ICD-10 with RevenueCyclePro.com ICD-10-CM • Code search • Code definitions and instructional notes
12
ICD-10-PCS — Code builder tool • L earn the complexities of the new coding system while you identify codes • S earchable index • Mapping tool
Quickly map from ICD-9-CM to ICD-10-CM/PCS codes and back • Identifies bill-together codes, GEM and Optum360-recommended mappings
1-800-464-3649, option 1 Mention your promo code for discounts
REVENUE CYCLE
| Online digital coding solutions
Billing Management Solutions
Audit Management
Medicare RT® 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. Understand exposure areas, determine audit outcomes and generate email alerts.
Improve first-time acceptance rates.
Track and manage workflow processes through the lifecycle of an audit.
Reduce return-to-provider (RTP) claims.
Be aware of scheduled RAC recoupment. Leverage comprehensive and configurable technology. Streamline and automate manual tasks. Accelerate audit resolution with the esMD module. Electronically submit requested records to audit contractors, eliminating delays associated with the paper process.
Automate Medicare claim submission. Automate status inquiry and secondary claim processing. Reduce reimbursement turnaround time.
To learn more about Billing Management Solutions, call us at 866-223-4730, email us at
[email protected] or visit optum360.com/rcm
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:
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:
Improve billing efficiency. Resolve and accelerate receivables collection. Eliminate unnecessary work. Reduce claim rejections. Accelerate secondary claims transmission. Decrease/eliminate paper claim volume. Analyze performance and productivity.
Improve collection efforts. Enhance patient satisfaction. Reduce bad debt, denials and unnecessary write-offs. Use consistent and accurate documentation for claim submission. Automate and store ABNs with real-time policy updates. Decrease A/R days while achieving maximum reimbursement. Enhance productivity and verify medical necessity.
optumcoding.com
13
ICD-10 Transition
ICD-10 IS NOW. CHANGE WITH CONFIDENCE.
EXPLORE. NAVIGATE. PIONEER.
The new frontier of coding awaits. With no more anticipated governmental delays to ICD-10, momentum is building toward the Oct 1, 2015 implementation date. No matter how ready you are, Optum360 will be by your side every step of the way. Explore our full suite of resources designed to help you navigate the transition and be a pioneer in the new frontier of coding. Optum360 can help you get to where you need to be by Oct. 1 and keep you up-to-date and on top of your game well after the transition.
pages
15-18
page
19
pages
20-21
pages
23-25
ICD-10-CM and -PCS Code Sets Designed for physicians, hospitals and post acute care facilities. ICD-10 Mapping and Documentation Improvement Code with confidence! Know how to map your frequently used ICD-9-CM codes to the corresponding ICD-10-CM/PCS codes and get help with physician documentation training. ICD-10 References and Specialty Resources Complete your coding collection with our reference tools designed to compliment your official code set and make code selection easier. ICD-10 Training and Education Prepare for the transition with our coder education books, flexible and omprehensive ICD-10 training courses and our annual Essentials Coding Conference, complete with ICD-10 boot camps. Get all your ICD-10 questions answered.
Inside Track to ICD-10 Stay in the know with our free monthly newsletter covering current events, industry news and all things ICD-10. Subscribe today at optumcoding.com/insidetrack ICD-10 is now. Change with confidence. Pioneer the new frontier of coding with expert resources from Optum360.
14
1-800-464-3649, option 1 Mention your promo code for discounts
Physician
| ICD-10 Transition
2016 ICD-10-CM FOR PHYSICIANS The 2016 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 the familiar Optum360 coding and reimbursement alerts you have come to rely upon. NEW Optum360 Edge — Coding guideline explanations and examples. Includes detailed explanations and examples related to application of the ICD-10-CM coding guidelines. 2016 ICD-10-CM Expert for Physicians (Spiral)
NEW Optum360 Edge — Intuitive features and format. Intuitive visual alerts highlight code groupings as well as the distinctions between code choices—plus, added features that make finding specific sections easier.
>> Designed for Physicians
Item No: ITPS16 Available: Sep 2015 $109.95
Optum360 Edge —
Alerts the coder to a new ICD-10-CM convention, the use of a “placeholder X.”
Optum360 Edge — Color-coding and symbols for the Medicare Diseases of the Musculoskeletal System and Connective Tissue
code edits. Hallmark color-coding and symbols for the most comprehensive M79.3–M80.039 Diseases of the Musculoskeletal System and Connective Tissue ICD-10-CM 2015 coverage ofM79.3 MCEs for diagnoses. Panniculitis, unspecified M79.A19 Nontraumatic compartment syndrome of 1
lupus panniculitis (L93.2) neck and back panniculitis (M54.0-)
unspecified upper extremity
d M79.A2 Nontraumatic compartment syndrome of lower
relapsing [Weber-Christian] panniculitis (M35.6) extremity Optum360M79.4 Edge — Exclusive Following references in the indexes. Nontraumatic compartment syndrome of hip, buttock, Hypertrophy of (infrapatellar) fat pad thigh, leg, foot, and toes
M79.5 Residual foreign body in soft tissue
Nontraumatic compartment syndrome of 1 foreign body granuloma of skin and subcutaneous locate those M79.A21 The Following references help coders alphanumeric codes that right lower extremity tissue (L92.3) M79.A22 Nontraumatic compartment syndrome of foreign body granuloma of soft tissue (M60.2-) left lower extremity M79.6 Pain in limb, hand, foot, fingers and toes are out ofcsequence in the tabular. M79.A29 Nontraumatic compartment syndrome of 2 pain in joint (M25.5-) unspecified lower extremity M79.A3 Nontraumatic compartment syndrome of abdomen
d M79.60 Pain in limb, unspecified
Pain in right arm M79.A9 Nontraumatic compartment syndrome of other sites when an Optum360 EdgeM79.601 — Additional symbols. Know Pain in right upper limb NOS character required c M79.8 Other specified soft tissue disorders M79.602 Pain in left arm M79.81 Nontraumatic hematoma of soft tissue Pain in left upper limb NOS Nontraumatic hematoma of muscle additional character isPainrequired validity to avoid invalid M79.603 in arm, unspecified for code specificity and Nontraumatic seroma of muscle and soft tissue Pain in upper limb NOS M79.89 Other specified soft tissue disorders Pain in right leg Polyalgia code submissions M79.604 (provided inlimbIndex and Tabular Section). Pain in right lower NOS M79.9 Soft tissue disorder, unspecified
>> Designed for Physicians
Item No: ITPB16 Available: Sep 2015 $104.95
2016 ICD-10-CM Professional for Physicians (eBook)
d
Exclusive Code Titled Highlighted Key Word(s) in d green font M79.3–M80.039
2016 ICD-10-CM Professional for Physicians (Softbound)
d
d
d
>> Designed for physicians
Item No: eITPB16 Available: Sep 2015 $104.95
M79.7
c M79.A
d
Excludes 1 and Excludes 2 definition/use reminder note
M79.605 Pain in left leg Pain in left lower limb NOS M79.606 Pain in leg, unspecified Pain in lower limb NOS M79.609 Pain in unspecified limb Pain in limb NOS M79.62 Pain in upper arm Pain in axillary region M79.621 Pain in right upper arm M79.622 Pain in left upper arm M79.629 Pain in unspecified upper arm M79.63 Pain in forearm M79.631 Pain in right forearm M79.632 Pain in left forearm M79.639 Pain in unspecified forearm M79.64 Pain in hand and fingers M79.641 Pain in right hand M79.642 Pain in left hand M79.643 Pain in unspecified hand M79.644 Pain in right finger(s) M79.645 Pain in left finger(s) M79.646 Pain in unspecified finger(s) M79.65 Pain in thigh M79.651 Pain in right thigh M79.652 Pain in left thigh M79.659 Pain in unspecified thigh M79.66 Pain in lower leg M79.661 Pain in right lower leg M79.662 Pain in left lower leg M79.669 Pain in unspecified lower leg M79.67 Pain in foot and toes M79.671 Pain in right foot M79.672 Pain in left foot M79.673 Pain in unspecified foot M79.674 Pain in right toe(s) M79.675 Pain in left toe(s) M79.676 Pain in unspecified toe(s) Fibromyalgia Fibromyositis Myofibrositis Fibrositis Nontraumatic compartment syndrome Code first, if applicable, associated postprocedural complication 1 compartment syndrome NOS (T79.A-) fibromyalgia (M79.7) nontraumatic ischemic infarction of muscle (M62.2-) traumatic compartment syndrome (T79.A-) M79.A1 Nontraumatic compartment syndrome of upper extremity Nontraumatic compartment syndrome of shoulder, arm, forearm, wrist, hand, and fingers M79.A11 Nontraumatic compartment syndrome of right upper extremity M79.A12 Nontraumatic compartment syndrome of left upper extremity
1 Not coded here 700
2 Not included here
8 Newborn Age: 0
OSTEOPATHIES AND CHONDROPATHIES (M80-M94) Disorders of bone density and structure (M80-M85) b M80 Osteoporosis with current pathological fracture
1 osteoporosis with current fragility fracture Use additional code to identify major osseous defect, if applicable (M89.7-) 1 collapsed vertebra NOS (M48.5) pathological fracture NOS (M84.4) wedging of vertebra NOS (M48.5) 2 personal history of (healed) osteoporosis fracture (Z87.310) The appropriate 7th character is to be added to each code from category M80. A initial encounter for fracture D subsequent encounter for fracture with routine healing G subsequent encounter for fracture with delayed healing K subsequent encounter for fracture with nonunion P subsequent encounter for fracture with malunion S sequela
c M80.0 Age-related osteoporosis with current pathological fracture
g d
d
d
Involutional osteoporosis with current pathological fracture Osteoporosis NOS with current pathological fracture Postmenopausal osteoporosis with current pathological fracture Senile osteoporosis with current pathological fracture M80.00 Age-related osteoporosis with current y pathological fracture, unspecified site M80.01 Age-related osteoporosis with current pathological fracture, shoulder e M80.011 Age-related osteoporosis with current y pathological fracture, right shoulder e M80.012 Age-related osteoporosis with current y pathological fracture, left shoulder e M80.019 Age-related osteoporosis with current y pathological fracture, unspecified shoulder M80.02 Age-related osteoporosis with current pathological fracture, humerus e M80.021 Age-related osteoporosis with current y pathological fracture, right humerus e M80.022 Age-related osteoporosis with current y pathological fracture, left humerus e M80.029 Age-related osteoporosis with current y pathological fracture, unspecified humerus M80.03 Age-related osteoporosis with current pathological fracture, forearm Age-related osteoporosis with current pathological fracture of wrist e M80.031 Age-related osteoporosis with current y pathological fracture, right forearm e M80.032 Age-related osteoporosis with current y pathological fracture, left forearm e M80.039 Age-related osteoporosis with current y pathological fracture, unspecified forearm
9 Pediatric Age: 0-17
Optum360 Edge Xtension Alert Symbol, our exclusive feature
x Maternity Age: 12-55
y Adult Age: 15-124 ICD-10-CM 2015
Partial sample page from ICD-10-CM Professional for Physicians
optumcoding.com
15
ICD-10 Transition |
Hospital
2016 ICD-10-CM FOR HOSPITALS With our 2016 ICD-10-CM resources for hospitals, set the standard for coding accuracy — the cornerstone of healthcare analytics and revenue cycle management — with the confidence only an Optum360 product can deliver. Now reflecting the new ICD-10 MS-DRG reimbursement edits. All the great features found in our 2016 ICD-10-CM for Physicians resources, plus:
2016 ICD-10-CM Expert for Hospitals (Spiral) >> Designed for Hospitals, payers
Item No: ITHS16 Available: Sep 2015 $109.95
NEW Optum360 Edge — Supplementary appendixes (exclusive to the Optum360 Expert edition). Several appendixes have been added that provide supplementary information, including: –– 10 steps to correct coding with –– Major complication and comorbidity coding examples (MCC) code list –– Valid 3-character ICD-10-CM codes –– Pharmacological listings by chapter –– Complication and comorbidity (CC) –– Present on admission (POA) tutorial code list NEW Optum360 Edge — Color-coding and symbols for the Medicare code edits. –– Manifestation code alert –– CC/MCC –– Age and sex –– PDx Exclusion for CC and MCC –– Hospital acquired condition (HAC) –– PDC CC and PDx MCC alerts Optum360 Edge — Exclusive PDx acting as CC and MCC alert symbols. Alerts the coder to a new key factor in the DRG10 system that some diagnoses 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.
2016 ICD-10-CM Professional for Hospitals (Softbound) >> Designed for Hospitals, Payers
CC Excludes-list of PDx for which the SDx code does not act as a CC or MCC
Item No: ITHB16 Available: Sep 2015 $104.95 2016 ICD-10-CM Professional for Hospitals (eBook)
Unacceptable/ Questionable Admission codes highlight
>> Designed for physicians, Payers
Item No: eITHB16 Available: Sep 2015 $104.95
PDx acting as CC and MCC alert
Highlighted Hospital Acquired Condition alert Partial sample page from ICD-10-CM Professional for Hospitals
16
1-800-464-3649, option 1 Mention your promo code for discounts
| ICD-10 Transition
hospital
2016 ICD-10-PCS New Optum360 Edge — New productivity tools. Body part definitions table and root operation conversion table. New Optum360 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. New 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-covered procedures
2016 ICD-10-PCS
affecting MS-DRG assignment
–– Combination-only procedures
–– Non-operating room procedures NOT affecting MS-DRG assignment
–– HAC-related procedures
>> Designed for Hospitals, Payers
Item No: ITPC16 Available: Sep 2015 $104.95
–– Non-operating room procedures
–– Limited coverage procedures
Optum360 Edge — Procedure combination tables. Identify ICD-10-PCS code combination requirements needed to satisfy certain MS-DRG requirements. Illustrations. Featuring anatomy and terminology included in the ICD-10-PCS classification system.
2016 ICD-10-PCS (eBook)
Item No: eITP16 Available: Sep 2015 $104.95
Color coding indicates codes that do not affect DRG assignment
Heart and Great Vessels
>> Designed for Hospitals, Payers 02F–02H 0 2 F
Heart and Great Vessels
Body Part Character 4
4
3 Percutaneous 4 Percutaneous Endoscopic X External
Device Character 6 Z No Device
Qualifier Character 7 Z No Qualifier
02FNXZZ
Non-OR 02FNXZZ
0 2 H
Medical and Surgical Heart and Great Vessels 02H Insertion 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 Approach Character 5
? 0 Open ? 3 Percutaneous ? 4 Percutaneous Endoscopic ? ?
Device Character 6
A Heart
3 0 Open
A Heart
? 0 Open
R External Heart Assist System
S Biventricular Z No Qualifier
0 2 J K M 0 2 3 D
Z No Qualifier
Coronary Vein Atrium, Right Atrium, Left Ventricle, Right Ventricle, Left
3 Percutaneous 4 Percutaneous Endoscopic
?
N Pericardium
P Q R S T V W
3 4 0 3 4
Percutaneous Percutaneous Endoscopic Open Percutaneous Percutaneous Endoscopic
0 Open 3 Percutaneous 4 Percutaneous Endoscopic
Pulmonary Trunk Pulmonary Artery, Right Pulmonary Artery, Left Pulmonary Vein, Right Pulmonary Vein, Left Superior Vena Cava Thoracic Aorta
Monitoring Device, Pressure Sensor Monitoring Device Infusion Device Intraluminal Device Cardiac Lead, Pacemaker Cardiac Lead, Defibrillator Cardiac Lead Implantable Heart Assist System
Monitoring Device, Pressure Sensor Monitoring Device Cardiac Lead, Pacemaker Cardiac Lead, Defibrillator Cardiac Lead Monitoring Device, Pressure Sensor Monitoring Device Infusion Device Intraluminal Device
DVC
Qualifier Character 7
0 2 3 D J K M Q
4 6 7 K L
02F–02H
02F
Approach Character 5
4 0 Open
N Pericardium
Body Part Character 4
List of Procedure Combinations that affect DRG assignment
ICD-10-PCS 2015
Medical and Surgical Heart and Great Vessels Fragmentation Breaking solid matter in a body part into pieces
Z No Qualifier
DVC Symbol alerts coders that the root operation involves a device
Z No Qualifier
Z No Qualifier
Procedure Combinations Implant of Heart Assist System DRG 001-002 Insertion of Heart Assist System One of 02HA[0,3,4]R[S,Z] and one of 02PA[0,3,4]RZ Cardiac Defibrillator Implant DRG 222-227 Defibrillator One of 02H[6,7,K,L][0,3,4]KZ with one of 0JH[6,8][0,3]8Z Cardiac Resynchronization Defibrillator Pulse Generator One of 02H[K,L][0,3,4]KZ with one of 0JH[6,8][0,3]9Z Contractile Modulation Device One of 02HL[3,4]MZ with one of 0JH[6,8][0,3]AZ Permanent Cardiac Pacemaker Implant DRG 242-244 Implantation of Permanent Cardiac Pacemaker Cardiac Resynchronization Pacemaker Pulse Generator One of 0JH[6,8][0,3]7Z and one of 02H4[0,3,4]JZ and one of 02H6[0,3,4]JZ and one of 02HK[0,3,4]JZ Pacemaker One of 0JH[6,8][0,3][4, 5,6,7]Z and one of 02H[4,6,7,K,L,N][0,3,4][J,M]Z Cardiac Rhythm Related Device One of 0JH[6,8][0,3]PZ and one of 02H[4,6,7,K,L,N][0,4][J,M]Z Or One of 0JH[6,8][0,3]PZ and one of 02H[6,7,K,L,N]3JZ Replacement of Cardiac Pacemaker One of 0JH[6,8][0,3][4,5,6,7,P]Z and one of 0JPT[0,3]PZ and one of 02H[6,7,K,L]3JZ and one of 02PA[0,3,4,X]MZ Or One of 0JH[6,8][0,3][4,5,6,7,P]Z and one of 0JPT[0,3]PZ and one of 02H[6,7]3MZ Or One of 0JH[6,8][0,3][4,5,6,7,P]Z and one of 0JPT[0,3]PZ and one of 02H[4,N][0,4][J,M]Z
Cardiac Pacemaker Revision, Except Device Replacement DRG 260-262 One of 02H[6,7,K,L]3JZ and one of 02PA[0,3,4,X]MZ Other Circulatory Procedures DRG 264 One of 02HK[0,3,4][0,2]Z and one of 0JH[6,8][0,3]0Z
3 Non-OR Non-OR Non-OR DRG Non-OR DRG Non-OR DRG Non-OR
? ?
Notation Box with code ranges for which the edits apply
02HA[0,3,4]0Z 02H[P,Q,R][0,3,4][0,2,3]Z 02H[S,T,V][0,3,4]3Z 02HW[0,3,4][0,3]Z 02H[4,6,7][0,4][J,M]Z 02H[6,7]3JZ 02H[K,L][0,3,4][J,M]Z 02H[4,6,7,K,L][0,3,4][J,M]Z 02H[K,L]3MZ
Partial sample page from ICD-10-PCS
See page 20 for details about our ICD-10-PCS Quick Reference Cards. 3 Limited Coverage 148
optumcoding.com
4 Noncovered
HAC associated procedure
Combination Only
DRG Non-OR
Non-OR
Revised Text in GREEN
ICD-10-PCS 2014 (Draft)
17
ICD-10 Transition |
post acute
2016 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.
2016 ICD-10-CM Expert for Home Health and Hospice >> Designed for Post acute, Payers
Item No: ITHA16 Available: Sep 2015 $159.95
NEW Optum360 Edge — Appendixes added. Supplemental appendixes have been added that address home health and hospice reimbursement and coverage issues, including: –– Home health prospective –– Valid diagnosis/etiology pairing list payment system –– Non-routine supplies case-mix
–– Clinical dimension case mix groups –– Selection and assignment of OASIS diagnoses
adjustment model, variables, and scores
–– Medicare coverage of home health and hospice services
2016 ICD-10-CM Expert for Home Health and Hospice (eBook) >> Designed for Post acute, Payers
Item No: eITHA16 Available: Sep 2015 $159.95
NEW 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. NEW 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.
2016 ICD-10-CM Expert for Skilled Nursing Facilities, Inpatient Rehabilitation Services, and Hospice 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. 2016 ICD-10-CM Expert for Skilled Nursing Facilities, Inpatient Rehabilitation Services, and Hospice >> Designed for Post acute, Payers
Item No: ITSN16 Available: Sep 2015 $159.95 2016 ICD-10-CM Expert for Skilled Nursing Facilities, Inpatient Rehabilitation Services, and Hospice (eBook)
Optum360 Edge — Hallmark page design and features. Intuitive visual alerts highlight code groupings as well as the distinctions between 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.
>> Designed for Post acute, Payers
Item No: eITSN16 Available: Sep 2015 $159.95
18
1-800-464-3649, option 1 Mention your promo code for discounts
Mapping & Documentation Improvement
| ICD-10 Transition
2016 ICD-10-CM Mappings
2016 ICD-10-PCS Mappings
>> Designed for Physicians, Hospitals,
>> Designed for Hospitals, payers
post acute, Payers
Item No: ITPM16 Available: Sep 2015 $129.95
Item No: ITCM16 Available: Sep 2015 $129.95
2016 ICD-10-CM Mappings (eBook)
>> Designed for Physicians, Hospitals, post acute, Payers
2016 ICD-10-PCS Mappings (eBook)
>> Designed for Hospitals, payers
Item No: eITPM16 Available: Sep 2015 $129.95
Item No: eITCM16 Available: Sep 2015 $129.95
2016 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 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.
2016 ICD-10-CM Clinical Documentation Improvement Desk Reference NEW Optum360 Edge — Includes the unique ICD-9 to ICD-10 mapping tables. 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. Make copies of this handy tri-fold, pocket-sized card for every clinician. Provides powerful documentation tips for the five most important chronic and acute conditions. 2016 ICD-10-CM Clinical Documentation Improvement Desk Reference >> Designed for Physicians, Hospitals, Payers
Item No: CDI16 Available: Dec 2015 $139.95
optumcoding.com
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. 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. Don’t teach your clinicians to code ICD-10-CM. Instead, show them what is needed for optimal code assignment.
19
ICD-10 Transition |
NEW!
Reference
2016 Coders’ Desk Reference for Diagnoses (ICD-10-CM) When the official ICD-10-CM code description needs further explanation, the 2016 Coders’ Desk Reference for Diagnoses (ICD-10-CM) 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. 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:
2016 Coders’ Desk Reference for Diagnoses (ICD-10-CM) >> Designed for Physicians, Hospitals, Post Acute, Payers
Item No: ITDRD16 Available: Sep 2015 $139.95 2016 Coders’ Desk Reference for Diagnoses (ICD-10-CM) (eBook) >> Designed for Physicians, hospitals, Post acute, Payers
–– 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. Numerical organization by ICD-10-CM code. Locate codes quickly with a resource developed to work hand-in-hand with your Optum360 ICD-10-CM code book.
Item No: eITDRD16 Available: Sep 2015 $139.95
2016 ICD-10-PCS Quick Reference Cards This convenient set of 13 cards is the perfect tool to guide the coder through the code-building process that includes essential definitions and conversion tables. An exclusive Optum360 resource. Get ICD-10-PCS coding assistance at your fingertips. Important coding reference information is consolidated
2016 ICD-10-PCS Quick Reference Cards >> Designed for Hospitals
into one place. – Body-part key – Root operation conversion table – Device key and aggregation table – Anatomical region definitions – Basic -PCS character definitions
Item No: ITQR16 Available: Sep 2015 $49.95
20
1-800-464-3649, option 1 Mention your promo code for discounts
Reference
| ICD-10 Transition
2016 ICD-10-CM SPECIALTY CODING WORKBOOKS 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. 2016 ICD-10-CM Coding Workbook for OB/GYN
2016 ICD-10-CM Coding Workbook for Cardiology
>> Designed for Physicians, Consultants
>> Designed for Physicians, Consultants
Item No: PWO16 Available: Sep 2015 $89.95
Item No: PWC16 Available: Sep 2015 $89.95
Also available as an eBook.
Also available as an eBook.
2016 ICD-10-CM Coding Workbook for Orthopaedics
2016 ICD-10-CM Coding Workbook for General Surgery
>> Designed for Physicians, Consultants
>> Designed for Physicians , Consultants
Item No: PWR16 Available: Sep 2015 $89.95
Item No: PWG16 Available: Sep 2015 $89.95
Also available as an eBook.
Also available as an eBook.
2016 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. 2016 ICD-10-CM Fast Finders >> Designed for Physicians
Valid codes with important coding instruction. Code directly from the tables with confidence.
Available: Sep 2015 $34.95 Downloadable format available.
optumcoding.com
Hundreds of the most commonly used codes for each specialty at your fingertips.
21
ICD-10 Transition |
Online Digital coding Solutions
Code with more speed and accuracy while easing the transition to ICD-10. Online digital coding solutions can help you experience a smooth, successful transition 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 $999.95 Single-user
Item No: 4790 Available: Now $2,275.95 Single-user
Item No: WA26 Available: Now Call for pricing
encoder pro.com expert
REVENUE CYCLE PRO.COM
Consider powerful lookup software that includes the content of 37 code books in one easy-to-use electronic resource — so it saves time and money while helping smooth the transition to ICD-10.
Help address many of the issues that result in claim rejections, denials and underpayments while preparing for ICD-10 with new mapping tools and an ICD-10-PCS code builder.
22
I-10 Map manager 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.
1-800-464-3649, option 1 Mention your promo code for discounts
Education
| ICD-10 Transition
2016 Detailed Instruction for Appropriate ICD-10-CM Coding
2016 Detailed Instruction for Appropriate ICD-10-PCS Coding
>> Designed for Physicians, Hospitals
>> Designed for Hospitals
2016 Comprehensive Anatomy and Physiology for ICD-10-CM and -PCS Coding
Item No: ITCE16
Item No: ITPE16
>> Designed for Physicians, Hospitals
Available: Nov 2015 $99.95
Available: Nov 2015 $129.95
Item No: TAP16 Available: Nov 2015 $129.95
Also available as an eBook.
Also available as an eBook.
Create a solid foundation for all levels of ICD-10-CM coding. Loaded with real-life examples and case studies to explain key coding concepts. Suitable for all specialties.
Easy-to-follow guide to ICD-10-PCS. Master the different organizational principles and new classification system that are the foundation of ICD-10-PCS.
Also available as an eBook.
Real-life coding scenarios. Test coders’ skills with answers and rationales to explain appropriate coding.
Targeted ICD-10 training. Focus on the detail
of conditions, terminology and anatomy needed to code accurately in ICD-10, since coders need to understand the anatomical differences between codes. Includes extensive knowledge assessments. Plus, rationale answers incorporated within each chapter.
2016 ICD-10-CM and -PCS Coding Readiness Assessment
2016 Coding from the Operative Report for ICD-10-CM and -PCS
>> Designed for Physicians, Hospitals, Payers
>> DEsigned for Hospitals, Payers
Item No: RASS16 Available: Oct 2015 $79.95
Item No: CHOP16 Available: Oct 2015 $169.95
Also available as an eBook.
Measure staff’s readiness for the transition to ICD-10. Includes basic and intermediate skill level questions (answers and rationale provided). Exam strategy for upcoming ICD-10 certification tests. Know in advance what to expect from the major coding associations so you can adequately prepare.
optumcoding.com
Also available as an eBook.
Detailed inpatient cases. Test inpatient coders’ ICD-10-CM/PCS coding skills. Includes answer rationale. Plus, includes 90 case studies that explain the reasons for code choices and demonstrates correct coding.
23
ICD-10 Transition |
Education
Optum360™
FIFTEENTH ANNUAL
Navigating the new frontier Destination: Coding, billing and compliance excellence Mark your calendars now for the 15th annual Optum360™ Essentials Conference. Whether you’re looking to focus on your continuing education, network with experts in your field, or ensure your skills stay current and relevant in this ever-changing world of coding, billing and compliance, Optum360 Essentials is truly, well, essential.
Nov. 30–Dec. 3, 2015 The Cosmopolitan™ Hotel Las Vegas
É
Register
NOW
Optum360 Essentials Coding, Billing & Compliance Conference Earn up to 16 CEUs and learn from nationally recognized experts to help you navigate the new frontier of coding, billing and compliance.
Conference registration: $725
Why should you go? • Attend 40+ educational sessions. • Participate in ICD-10 boot camps. • Network with industry experts. • Explore strategies, techniques and best practices for hospitals and physician practices.
• Stay current with updates on 2016 ICD-10-CM/PCS, CPT®, HCPCS and DRG codes, IPPS and OPPS.
• Learn from nationally recognized experts on medical coding, billing and compliance.
• Attend vetted presentations that are reviewed and approved by clinical experts.
• Gain valuable insight during expert panel sessions and ask them your most difficult questions.
• We’re back in Vegas, baby!
To learn more and register, visit optumcoding.com/essentials CPT is a registered trademark of the American Medical Association.
24
1-800-464-3649, option 1 Mention your promo code for discounts
Training
| ICD-10 Transition
OPTUM360 ICD-10 eLEARNING and ON-SITE TRAINING COURSES We offer comprehensive and flexible ICD-10 training designed to meet the needs of any professional in your organization. You can take courses online at your desk, invite a specialist to your office for on-the-job training, or even have our consulting professionals create a tailor-made program specific to your organization’s needs. With Optum360 by your side, you’ll be well-equipped for Oct. 1, 2015. The transition to ICD-10 offers a chance to improve your systems and processes — let’s explore the opportunities change can bring. Learn more about how to get our expert training at optumcoding.com/ICD10training.
AHIMA ICD-10 Fundamentals eLearning Optum360 is now reselling the AHIMA ICD-10 Fundamentals eLearning curriculum with a personal touch and in comprehensive package combinations that cover a variety of ICD-10 transition topics. AHIMA is a nationally recognized leader in the HIM industry, and Optum360 is a globally recognized leader in health care solutions. By combining our strengths, we offer convenient, web-based curriculum at an affordable price. Learn what you need to know for the ICD-10 transition (and earn CEUs) with AHIMA eLearning at optumcoding/ICD10eLearning.
AAPC ICD-10 Training Optum360 has also teamed up with AAPC to bring you ICD-10 training. Choose from general ICD-10 code set training for coders, specialty learning, physician education and general staff preparation. Ensure your organization is fully prepared for the transition — let us find the perfect combination to get you to ICD-10 on time. For more courses and information, go to optumcoding.com/AAPCICD10training.
optumcoding.com
25
Essential Coding |
CPT® coding
2016 Current Procedural Coding Expert
2016 Current Procedural Coding Expert with Tab Dividers
>> Designed for Physicians, Hospitals, Payers
>> Designed for Physicians, Hospitals, Payers
Item No: CE16 Available: Dec 2015 $99.95
Item No: CET16 Available: Dec 2015 $104.95
2016 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. Optum360 Edge — Code-specific definitions, rules and references. Reference comprehensive information compiled from the AMA, CMS, Optum360 and other sources to assist with accurate coding and speed reimbursement. Helpful illustrations. Anatomical color illustrations help detect different structures with ease.
Facility and non-facility relative value units (RVUs) and global follow-up days. Ensure more accurate reimbursement with attachment to the corresponding code. Modifier icons. Apply modifiers correctly with quick icon identification with the CPT® code.
Also Available: from the American Medical Association
2016 CPT® Professional Edition
2016 CPT® Standard Edition
2016 CPT® Changes: An Insider’s View
>> Designed for Physicians, Hospitals, Payers
>> Designed for Physicians, Hospitals, Payers
>> Designed for Physicians, Hospitals, Payers
Item No: CS16 Available: Sep 2015 $114.95
Item No: CB16 Available: Oct 2015 $89.95
Item No: CI16 Available: Nov 2015 $77.95
CPT is a registered trademark of the American Medical Association.
26
1-800-464-3649, option 1 Mention your promo code for discounts
CPT® coding
Optum360 instructions included at the code level for ease of use
Did you know the American Medical Association’s CPT® code books don’t include reimbursement Reimbursement information? Optum360 CPT® resources have you covered.
| Essential Coding
and Coding icons Facility and non-facility RVUs and global follow-up days Partial sample page from Current Procedural Coding Expert
Companion resources: CPT coding ®
2016 Coders’ Desk Reference for Procedures
2016 Evaluation and Management Coding Advisor
2016 Understanding Modifiers
>> Designed for Physicians, Hospitals, Payers
>> Designed for Physicians
Item No: CDR16 Available: Dec 2015 $139.95
Item No: EMCA16 Available: Feb 2016 $129.95
Item No: MDFR16 Available: Dec 2015 $95.95
Comprehensive CPT® code listing with easy to understand 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. optumcoding.com
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
Includes actual medical records. Use to outline in detail how to document services and apply the correct modifiers.
27
Essential Coding |
HCPCS Level II
2016 HCPCS Level II Professional (Softbound)
2016 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: HB16 Available: Dec 2015 $79.95
Item No: HS16 Available: Dec 2015 $99.95
Item No: 4524 Available: Now $154.95
2016 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 Pub 100 references
3
3
3
New, revised, deleted & reinstated HCPCS
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 Table
3
3
Medically Unlikely Edits (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
28
1-800-464-3649, option 1 Mention your promo code for discounts
HCPCS Level II
| Essential Coding
OPPS Status Indicators
Special Coverage Instruction
Color-coded bars and icons Partial sample page from HCPCS Level II Expert
Companion resources: HCPCS Level II 2016 Coders’ Desk Reference for HCPCS Level II >> Designed for Physicians, Hospitals, Payers
Item No: CDRH16 Available: Dec 2015 $139.95
optumcoding.com
29
Essential Coding |
DRG
2016 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-ofstay (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. 2016 DRG Expert (ICD-10-CM) >> Designed for hospitals, Payers
Item No: DRG16 Available: Sep 2015 $129.95
2016 DRG Desk Reference for ICD-10-CM 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.
2016 DRG Expert (ICD-10-CM) (eBook)
>> Designed for hospitals, Payers
Item No: 6279 Available: Sep 2015 $129.95
2016 Guide to Clinical Validation, Documentation & Coding 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
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
2016 DRG Desk Reference for ICD-10-CM >> Designed for hospitals, Payers
documentation requirements. Code assignment justifications are thoroughly outlined. distinctions in a patient’s medical condition and ensure appropriate reimbursement. 2016 Guide to Clinical Validation, Documentation & Coding >> Designed for hospitals, Payers
Item No: DDR16 Available: Oct 2015 $219.95 Also available as an eBook.
Item No: CDCG16 Available: Nov 2015 $199.95 Also available as an eBook.
30
1-800-464-3649, option 1 Mention your promo code for discounts
CODING, billing & reimbursement
2016 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. 2016 HIPAA Customizable Compliance Plan >> Designed for Physicians, Hospitals
Item No: HCCP16 Available: Aug 2015 $299.95
2016 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 incident management policies and procedures. Get customizable reports and forms for the risk assessment 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 easy-to-use Microsoft Word format.
optumcoding.com
2016 HIPAA Tool Kit
>> DESIGNED FOR PHYSICIANS, HOSPITALS
>> Designed for Hospitals, Payers
2016 HIPAA Tool Kit (eBook)
Item No: HTKT16 Available: Aug 2015 $299.95
Item No: eHTKT16 Available: Aug 2015 $299.95
31
Specialty Reference |
COding & reimbursement
Co-published with AAO-HNS. Discount for members
2016 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 each code. 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. 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 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® code. CPT® codes with associated CCI edits in a special section and quarterly updates available online. 2016 Coding Companion® Specialty Guides >> Designed for Physicians, Hospitals, Payers
Available: Dec 2015 $199.95
2016 Coding Companion® Specialty Guides Specialty
Item No.
Specialty
Item No.
Cardiology/Cardiothoracic/Vascular Surgery
ATCR16
Orthopaedics: Hips & Below
ATLE16
ENT/Allergy/Pulmonology
AENT16
Orthopaedics: Spine & Above
ATUE16
General Surgery/Gastroenterology
AGEN16
Plastics/Dermatology
ATPR16
Neurosurgery/Neurology
ATNN16
Podiatry
ASPOD16
Obstetrics/Gynecology
ATOB16
Primary Care/Pediatrics/Emergency Medicine
ASPC16
Oncology/Hematology
ATHO16
Radiology
ASRA16
Ophthalmology
ATEY16
Urology/Nephrology
ATUN16
CPT is a registered trademark of the American Medical Association.
32
1-800-464-3649, option 1 Mention your promo code for discounts
COding & reimbursement
New easy-to-read, two-column format
NEW!
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)
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
ICD-10-CM diagnostics
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
Detailed illustrations
Easy-tounderstand explanations of codes
| 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
© 2015 OptumInsight, Inc.
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 Carcinoma in situ of rectosigmoid junction Carcinoma in situ of rectum Benign neoplasm of sigmoid colon Benign neoplasm of colon, unspecified Benign neoplasm of rectosigmoid junction Benign neoplasm of rectum Benign neoplasm of anus and anal canal Neoplasm of uncertain behavior of rectum Benign carcinoid tumor of the sigmoid colon Benign carcinoid tumor of the rectum 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
Medicare edits at your fingertips
Medicare Reference N/A N/A
None
* with documentation CPT © 2015 American Medical Association. All Rights Reserved.
Coding Companion for Primary Care
Sample page from Coding Companion® for ENT/Allergy/Pulmonology
optumcoding.com
33
Specialty Reference |
cross coding
2016 Cross Coders 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.
2016 Cross Coders >> Designed for Physicians, Hospitals, Payers
Available: Dec 2015 $174.95
2016 Cross Coders Cross coders
Item No.
Anesthesia Cross Coder
ACC16
Ideal for quick reference. Appendix offers a complete listing of add-on and unlisted codes, as well as CPT® and HCPCS modifiers.
Anesthesia Cross Coder (eBook) eACC16 Surgical Cross Coder
SCC16
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.
Surgical Cross Coder (eBook)
eSCC16
2016 Procedural Cross Coder 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. 2016 Procedural Cross Coder >> Designed for Physicians, Hospitals, Payers
CPT is a registered trademark of the American Medical Association.
34
Item No: PCC16 Available: Dec 2015 $174.95
2016 Procedural Cross Coder (eBook)
>> Designed for Physicians, Hospitals, Payers
Item No: ePCC16 Available: Dec 2015 $174.95
1-800-464-3649, option 1 Mention your promo code for discounts
COding & payment
| Specialty Reference
Co-published with APTA. Discount for members
2016 Coding & 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 and ICD-10-CM diagnostic code explanations. 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. Avoid confusion with easy-to-understand descriptions. Includes clear explanations of procedures represented by CPT® codes, along with clinical definitions and ICD-10-CM code explanations.
2016 Coding & Payment Guides >> Designed for Physicians, Hospitals, Payers
Available: Dec 2015 $179.95
2016 Coding & Payment Guides Coding & Payment Guides
Item No.
Anesthesia Services
SAP16
Behavioral Health Services
SYCH16
Dental Services
CGDS16
Laboratory Services
SLAB16
Physical Therapist
SPT16
Improve the precision of ICD-10-CM code selection. Icons to help identify the most appropriate ICD-10-CM code.
2016 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. 2016 Coding Guide for OMS
Co-published with AAOMS. Discount for members
optumcoding.com
>> Designed for Physicians, Hospitals, Payers
Item No: SOMS16 Available: Dec 2015 $199.95
35
Desk References |
Coding & Billing
2016 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-tounderstand explanations, plus CPT®, HCPCS and ICD code assignments. 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. 2016 Coders’ Dictionary >> Designed for Physicians, Hospitals, Payers
Item No: TCD16 Available: Dec 2015 $99.95
2016 Auditors’ Desk Reference 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. Contains a library of time-saving audit forms. Available online with purchase, simply download in an easy-to-customize electronic format. 2016 Auditors’ Desk Reference >> Designed for Physicians, Hospitals, Payers
Item No: AUDR16 Available: Nov 2015 $199.95
2016 Insurance Directory The 2016 Insurance Directory includes our online Health Plan Directory of more than 400 insurers, which provides direct links to specific claim, medical policy, credentialing and pharmacy information. Save time. Quickly locate hard-to-find addresses for claims, payer ID, phone and web addresses. Know who to contact. Provides a complete listing of state insurance commissioners and workers’ compensation boards. Claim completion guidance. Provides step-by-step instructions for the CMS-1500 form. 2016 Insurance Directory >> Designed for Physicians, Hospitals, Payers
CPT is a registered trademark of the American Medical Association.
36
Item No: ID16 Available: Sep 2015 $79.95
1-800-464-3649, option 1 Mention your promo code for discounts
COding & Billing
| Desk References
2016 Regulatory Audits Desk Reference Be prepared for regulatory auditors’ automated and complex claim reviews and learn how to prepare an appeal of incorrect overpayment determinations. Medicare and Medicaid RACs. Includes content relevant to DRGs and medical necessity. Understand audit threats. Complete listing and description of all the regulatory agencies and their auditing functions. Appeal letter templates. Includes customizable response letters for overpayment demands with recommended language.
2016 Regulatory Audits Desk Reference >> Designed for Hospitals
Item No: DRRA16 Available: Oct 2015 $199.95
Laboratory and diagnostic tests. Includes those commonly associated with MCC and CC diagnoses. Documentation requirements. Find out what documentation is needed for each targeted DRG and for targeted inpatient medical necessity reviews.
2016 Physician’s Compliance Guide This latest edition of the Physician’s Compliance Guide includes 50 new, ready-to-use customizable compliance policies covering key issues such as E/M, screening services, surgeries and preventive services. This resource also includes foundation compliance policies that meet OIG standards for monitoring, training, communications, disciplinary actions and more. New Optum360 Edge — Customizable compliance policies. Includes ready-to-use, customizable compliance policies covering key compliance issues such as E/M, screening services, surgeries and preventive services. 2016 Physician’s Compliance Guide >> Designed for Physicians
Item No: PCG16 Available: Feb 2016 $169.95
Know what the investigators (RACs, OIG, MACs) are looking for. Provides case studies and easy-to-understand examples of errors and non-compliance. Updated RAC Issues Table. This feature brings together the most current data on RAC audit targets, available on the customer-only website for the Physician’s Compliance Guide. Understand the infractions or errors. Shows which billing or coding practices are contributing to the error.
optumcoding.com
37
Pricing & Cost |
Fees
2016 Customized Fee Analyzers >> A vailable for purchase by physicians; also available for dental codes. Please visit optumcoding.com or call for more information. Detailed custom fee reports. By specialty and ZIP code. Seven reference points of charge data (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. 2016 Customized Fee Analyzer (1 Specialty) >> Designed for Physicians
Item No: 2189 Available: Dec 2015 $299.95
2016 Customized Fee Analyzer (2 Specialties)
2016 Customized Fee Analyzer (All CPT® Codes)
>> Designed for
>> Designed for
Physicians
Physicians
Item No: 2190 Available: Dec 2015 $399.95
Item No: 2191 Available: Dec 2015 $449.95
Also available as data files. Call for details.
Fee Analyzer.com Build your own custom fee data at the click of a mouse. Get online access to percentiles of relative and actual physician charge data for a specific geographic area and specialty. Updated quarterly, this powerful data source makes it easier for physicians to set defensible fees while maximizing revenues, and allows users to import their own fee schedule, as well as analyze up to three fee schedules side by side. FeeAnalyzer.com Professional
Get customized fee data online.
>> Designed for Physicians
Item No: 1576 Available: Now $1,250.00 Single-user
CPT is a registered trademark of the American Medical Association.
38
1-800-464-3649, option 1 Mention your promo code for discounts
fees
| Pricing & Cost
2016 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. Relative value scale is based on physician and dentist survey data. Rely on a resource free from government budgetary influence. 2016 Relative Values for Dentists (eBook)
2016 Relative Values for Dentists >> Designed for Dentists
Item No: RVD16 Available: Jan 2016 $259.95 Also available as a data file. Call for details
>> Designed for Dentists
Item No: eRVD16 Available: Jan 2016 $259.95
2016 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. 2016 HCPCS Fee Analyzer
2016 HCPCS Fee Analyzer (Data File)
>> Designed for Physicians
Item No: 2182 Available: Feb 2016 $299.95
Also Available:
>> Designed for Physicians
Item No: 2358 Available: Feb 2016 Call for pricing
Includes gap values for many CPT® and HCPCS codes not valued in the Medicare RBRVS.
Now with three percentiles of charge data.
2016 National Fee Analyzer
2016 Relative Values for Physicians
Essential RBRVS (Updateable)
>> Designed for Physicians
>> Designed for Physicians, payers
>> Designed for Physicians, payers
Item No: NFA16 Available: Dec 2015 $199.95
Item No: RVP16 Available: Dec 2015 $329.95
Item No: 1761 Available: Now $279.95
Also available as a data file.
2016 Essential RBRVS (Annual) Item No: RBRC16 Available: Dec 2015 $229.95 Also available as data files. Call for details.
optumcoding.com
39
Coding, billing & reimbursement
2016 Complete Guide for Interventional Radiology Developed to simplify coding for imaging-assisted surgical services, this guide provides current CPT® coding and Medicare reporting guidelines, along with specific direction for coding complex interventional procedures. 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.
2016 Complete Guide for Interventional Radiology >> DESIGNED FOR PHYSICIANS, HOSPITALS, PAYERS
Item No: FIR16 Available: Dec 2015 $229.95
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. Medicare CCI edits. Reduce the risk of audits and spend less time correcting claims by identifying which coding combinations cannot be billed together.
2016 Physician QUALITY REPORTING GUIDE PQRS is not just an optional CMS bonus plan anymore. While some may have ignored 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.
2016 Physician Quality Reporting Guide >> Designed for Physicians, payers
Item No: PQRS16 Available: Feb 2016 $179.95 2016 Physician Quality Reporting Guide (eBook) >> Designed for Physicians, payers
Simplifies quality reporting methodologies to help you avoid losses for inappropriate submissions. Includes “Flow Sheets” that simplify data capture for more accurate reporting. Includes information for other Medicare quality reporting initiatives. Covers ePrescribing, value-based purchasing and EHR bonus payments. Easy and fast to use. See what quality measures are new, updated and deleted each year. 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.
Item No: ePQRS16 Available: Feb 2016 $179.95 CPT is a registered trademark of the American Medical Association.
40
1-800-464-3649, option 1 Mention your promo code for discounts
Coding, BIlling & reimbursement
Uniform Billing Editor
Outpatient Billing Expert
>> Designed for Hospitals, payers
>> Designed for Hospitals, payers
Item No: 4787 Available: Now $319.95
Item No: 4709 Available: Now $199.95
Also available as an eBook.
Also available as an eBook.
Uniform Claim Editor for Professional Services >> Designed for physicians
Item No: 4909 Available: Now $159.95 Also available as an eBook.
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. 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.
optumcoding.com
Includes fees, formulas and tables in Microsoft Excel. Determine appropriate APC or ASC reimbursement prior to submitting your claim.
Expert guidance. Learn how to implement new rules and requirements from multiple industry sources such as Medicare, NUCC and the AMA.
Comprehensive coverage of both ASC and APC payment systems. Establish the right payment and audit reimbursement processes for your facility.
Quickly locate topics. Fully indexed and tabbed with icons for quick reference, based on item numbers, key words and original source documents.
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.
Crosswalk to 837 professional claims. Links 837P 5010 data elements and any applicable billing rules to facilitate easier transition to the 837P.
Contains information used on a daily basis by 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.
Includes 5010 standards. Provides detailed, accurate and timely information about Medicare billing and reimbursement. Addresses difficult billing issues. Quickly find solutions for challenging revenue cycle questions.
41
bookstore |
workers’ compensation
WORKERS’ COMPENSATION FEE SCHEDULES Optum360 is the exclusive publisher of the official Workers’ Compensation Fee Schedule for several states. Healthcare 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 optumcoding.com for more information. available titles
Item No.
2015 Official Connecticut Fee Schedule for Hospitals & Ambulatory Surgical Centers
E2360
2015 Official Connecticut Practitioner Fee Schedule
2374
2015 Unofficial Colorado Workers’ Compensation Fee Schedule
E2359
2013 Official Mississippi Workers’ Compensation Medical Fee Schedule*
5627
2012 Official New York Workers’ Compensation Medical Fee Schedule
2171
2010 Official Alaska Workers’ Compensation Medical Fee Schedule
5299
Also available as data files.
*Also available as a web version with annual 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
[email protected] for more information. Workers’ Compensation fee schedules
Auto fee schedules
We offer state fee schedules for the District of Columbia and all 45 states that mandate workers’ compensation.
• 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
CPT is a registered trademark of the American Medical Association.
42
1-800-464-3649, option 1 Mention your promo code for discounts
Companion products
| Bookstore
Companion products Optum360 is the leader in providing coding and referential materials, including coding books, software, electronic resources and almost any kind of medical publication you may need. We not only provide a full suite of solutions, but resell referential titles, making it very simple to order all your publications through Optum360. If you do not see the resource you need listed below, please call our Customer Service line at 1-800-464-3649, option 1, and we can track it down for you.
Jablonski’s Dictionary of Medical Acronyms and Abbreviations (Book plus CD), 6th Edition
Nettler’s Atlas of Human Anatomy for CPT® Coding, 2nd Edition
Stedman’s Medical Dictionary, 28th Edition
>> DESIGNED FOR PHYSICIANS, Hospitals
>> DESIGNED FOR PHYSICIANS
>> DESIGNED FOR PHYSICIANS, hospitals
Item No: 1447 Available: Now $47.95
Item No: 3815 Available: Now $50.95
Item No: J005VZ Available: Now $39.95
Other available titles
Item No.
Dorland’s Illustrated Medical Dictionary, 32nd Edition
2027
Diagnostic and Statistical Manual (DSM-5) Hardcover, 5th Edition
2036
Merck Manual of Diagnosis & Therapy, 19th Edition
2038
Diagnostic and Statistical Manual (DSM-5) Paperback, 5th Edition
2296
2014 PDR® for Nonprescriptive Drugs
2309
2015 Lippincott’s Nursing Drug Guide
2314
2015 Faye Brown’s ICD-9-CM Coding Handbook with Answers (revised)
2357
2015 Faye Brown’s ICD-9-CM Coding Handbook without Answers (revised)
2370
Taber’s Cyclopedic Medical Dictionary
3450
Nursing2016 Drug Handbook, 36th Edition
3820
2015 Coding for Pediatrics, 20th Edition
7115
CDT 2015: Dental Procedure Codes
J015
CDT 2015 Companion: Help Guide and Training Manual
J445
optumcoding.com
43
Medicare
Medicare Correct Coding Guide
Medicare Desk Reference for Hospitals
>> Designed for Physicians, Payers
>> Designed for Hospitals, payers
Item No: 3024 Available: Now $279.95
Item No: 2446 Available: Now $299.95 Medicare Desk Reference for Hospitals (eBook)
Medicare Correct Coding Guide (eBook) >> Designed for Physicians, Payers
>> Designed for Hospitals, Payers
Item No: 3676 Available: Now $279.95
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, Mediare 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.
44
1-800-464-3649, option 1 Mention your promo code for discounts
/ Simplify your ordering / Magnify your savings /
SAVE
15% on your next order when you register at optumcoding.com
1
Click.
optumcoding.com gives you the power to: • Access all things ICD-10. Visit Coding Central for expert resources including articles, Inside Track to ICD-10, and coding scenarios to test your knowledge. Plus, shop our full suite of ICD-10 products, training tools and eLearning courses.
• Find the products you need quickly and easily.
• View all available formats and edition years on the same page.
• Chat live with a customer service representative.
• View this catalog online! Plus, utilize our interactive online catalog features to view product information quickly and easily.
2
Register.
By registering, you’ll be able to: • Earn rewards for shopping online. When you register you’re automatically enrolled in our eRewards program.
• Enjoy special promotions and discounts.
3
Save.
Get 15% off your next order Register for an account and receive a coupon via email for 15% off your next order.
Plus, earn cash with our no-cost eRewards program.
• Get recommendations based on your order history.
• Check on shipment status and tracking.
• View order and payment history. • Pay invoices. • Manage your address book and ship orders to multiple locations.
• Renew your order with a single click.
• Compile a wish list of the products you want and purchase when you’re ready.
*Offer valid only for customers who are NOT part of our Medallion or Partner Account programs. You must be registered at optumcoding.com to have your online purchases tracked for rewards purposes. Shipping charges and taxes still apply and cannot be used for rewards. Optum Coding eReward offers valid online only.
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 optumcoding.com, the eRewards meter keeps track of purchases toward your next reward.
2525 Lake Park Blvd., Salt Lake City, UT 84120
Customer Number
Contact Number
Promo Code
000009XM
Click When you place your order on optumcoding.com, save 50% on 2015 edition and 25% on 2016 edition coding resources. You’ll also save 35% on 2015 edition and 15% on 2016 edition American Medical Association products.* Go green.
optumcoding.com Enter your promo code to save an extra 10%.
CALL 1-800-464-3649, option 1 Mention your promo code to secure your discount.
You can browse and shop this catalog online at https://www.optumcoding.com/catalog/.
*Discounts above reflect an additional 10% for ordering on optumcoding.com; additional 10% discount does not apply when ordering via phone. Discount excludes workers’ compensation and custom fee products, online digital coding solutions and bookstore items. Become an Optum360 Coding Reseller/Partner and enjoy special benefits and discounts. For more information call 1-800-765-6095 or email
[email protected]. 100% Money Back Guarantee. Here at Optum360 we believe in long-term relationships and want you to be happy with your purchase. If you are unsatisfied with your purchase, please return it within 60 days of receipt. Merchandise must be in saleable condition. Please visit optumcoding.com before submitting a return for our full policy terms and conditions. © 2015 Optum360. All rights reserved. OPTPRJ8229
