This course explains the function of the Outpatient Code Editor (OCE), including the National Correct Coding Initiative (NCCI) edits, in the processing of Outpatient Prospective Payment System (OPPS) claims. The course will cover Procedure to Procedure (PTP), Medically Unlikely Edits (MUEs), and Add-on Edits within the NCCI edits.
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Section 1: Introduction
About This Course
Section 2: Integrated Code Editor
Integrated Outpatient Code Editor Background
Integrated Outpatient Code Editor Software
Section 3: OCE Edits
Current OCE Edits
Current OCE Dispositions
Sample RTP Edits
OCE Edit 17 Associated with the Bilateral Modifier
OCE Edit 74 Associated with the Bilateral Modifier
OCE Edit 21
OCE Edits Associated with Observation Services
Section 4: PTP Edits
OCE Edits and NCCI Edits
Procedure to Procedure (PTP) Edits
Allowable Modifier Designation
Non-modifiable NCCI Edits: OCE Edit 20
Modifiable NCCI Edits: OCE Edit 40
NCCI Coding Policy Manual for Medicare Services
Section 5: Medically Unlikely Edits
Medically Unlikely Edits, Part 1
Medically Unlikely Edits, Part 2
Adjudication of Medically Unlikely Edits
Examples of Medically Unlikely Edits
Examples of Laboratory Medically Unlikely Edits
Add-on Code Edits
Section 6: Conclusion
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Access to over 1,450 courses! Access to 1,450+ courses for one low price.