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1. M H rr 124 Punt OUER mm T IP E bamaeeucees 124 meme o on Abeadedss 124 E M Assistant Ctrl E EXPT and PRO only sss 124 Administration Administrator Login All Multi User Versions eeeeeeeeeeseeeeeee 124 Administration Administrator Logout All Multi User Versions eeeeeeeesse 124 Administration Change Admin Password All Multi User Versions 124 Administration Change Password All Multi User Versions esses 125 Administration User Maintenance All Multi User Versions eeeeeeeesssreeeees 125 xii CTE od cM MU M REC MM eM MEME 125 gj e 125 Ge OTITO rr 125 A bod e Ma did eT ear EE ee nee ee 125 ETE y el OPERA TET 125 Select Carrier Locality EXPT and PRO only ccooooocnccnnncccccccconccnnncnonononanccnnnonononannnnnnnnonononanennnns 125 View i O PA PP 126 IQEC GISING ee C iia 126 BOOKINGS P M 126 eed aem RT 126 NOODI m T PUR 126 NEw COC UN T UTE 126 Revised DIOS C 126 Deleted COS A EMT 126 CPT GoelorGodes 4nob im CIP cu AA cdots AAA N R 126 IGD 9 Vole T4590lof COGS oid cotto sa co tan a Dian oco dr
2. 4 Unspecified Code Valid OR Procedure Once you ve narrowed your search results sufficiently select any code in the Tabular Results box to see it in the Code Detail panes Code Detail displays which section of the appropriate book the code falls under the description for the selected code and all neighboring codes and any applicable color codes Code Detail is presented in three panes Section Headers This pane displays section titles that identify where in the ICD 9 CM CPT or HCPCS code book a group of codes are located This pane defaults to the lowest level category in the book but by using the drop down list you see any of the higher levels as is applicable Code Details This pane shows you the description for the selected code and all neighboring codes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 39 Color Code Box This pane displays the color code symbols that are applicable to the selected code Add on Codes have blue hyperlinks to the Primary PX tab of the CPT Guidelines dialog and take you there if you click on them CPT and HCPCS codes that have Medicare policy references also have blue hyperlinks that take you to the corresponding dialog Previous Section Clicking this link displays the Code Detail view for the previous section of codes Next Section Clicking this link displays the Code Detail view for the next section of codes If a Sticky
3. Add To Global Sticky Notes Opens the Network Sticky Notes dialog box Note that a code must be selected in the Code Detail Add To Personal Sticky Notes Opens the View Personal Sticky Note dialog box Note that a code must be selected in the Code Detail Add To Notepad Adds the selected code to the Notepad dialog box View Carriers with LMRP EXPT and PRO only Opens the Carriers with LMRP Edits dialog box Note that a code that has an LMRP or NCD edit from any carrier must be selected in the Code Detail CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 134 Toolbar This section highlights the buttons available from the toolbar Note that not all buttons are available in all products Also an applicable code must be selected in order for some of the buttons to be available The dependencies are listed below th A E 3X M cc MRF OMS FEE DRG e3 ADD After selecting a code from the Code Detail clicking this button opens the Add Code dialog box BOOKMARKS Eb Opens the Bookmarks dialog box STICKY NOTES Opens the Sticky Notes dialog box NOTEPAD Opens the Notepad dialog box If you have Encoder Pro Expert this button opens the Compliance Notepad dialog box PRINT Opens the Print Report dialog box After selecting a code that contains a note from the Code Detail clicking this button opens one of the section notes dialog boxes depending
4. GMLOS AMLOS and RW The geometric mean length of stay GMLOS arithmetic length of stay AMLOS and relative weight RW are used for the Medicare reimbursement calculation for a particular DRG The length of stay 1s averaged for the given DRG and GMLOS and is weighted to allow for outliers and other factors that skew data and potentially change reimbursement The RW is a comparative assigned weight to CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 44 indicate relative resource consumption associated with the given DRG The higher the relative weight the greater the reimbursement The relative weight is multiplied by a facility s conversion factor to produce the dollar amount to be paid the facility Footnote The Footnote section contains information about the DRG code ICD 9 Vol 1 Color Coding Legend This information box displays a legend showing all ICD 9 CM Vol 1 Color Codes and their definitions You access it either by selecting an ICD 9 CM code and then clicking the Color Coding Legend button amp 3 from the toolbar or by selecting Color Coding Legend from the ICD 9 Vol 1 menu ICD 9 ol 1 Color Coding Legend X d Digit Cade Required ad Diagnosis ES Code Mot a E Primary Diagnosis Sth Digit Code Required M Maternity Diagnosis i ae econdary Payer i imar Diagnosis e f ew Code N f ewborn Diagnosis puse Primary Diagnosis amp Revised Code P eost Diagnosis K Code as
5. Encoder Pro User s Manual 21 LOOKING UP CODES THAT HAVE COLOR SYMBOLS The CPT ICD 9 Vol 1 and Vol 3 and HCPCS Color Codes dialog boxes found under the View menu let you see codes that are assigned a certain color code For example you can quickly reference all ICD 9 CM Vol 1 or Vol 3 codes that are new and or revised for the current year Or you can see all CPT Codes that are add on codes These dialog boxes are for reference only and do not support printing Note Not all color codes are shown in these dialog boxes For example you will not find all codes that are commonly miscoded within these boxes CPT Color Codes not in CIF I9 To open the CPT Color Code dialog box select CPT Color Codes from the View menu This dialog box allows you to look up all CPT codes assigned color codes It has tabs for New Revised Add on and 51 Exempt All six subordinate tabs contain a Find field that acts as a Go To button to maneuver within the codes in a given tab This is not a search filter and only accepts from 1 to 5 digits The data presented in these five tabs is the same no matter what code has been selected in the Code Detail or Tabular Results This dialog box contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button New The New tab shows all new CPT codes and their descriptions
6. Entering Search Terms You can enter up to four search terms or term abbreviations to allow you to narrow down the results when you first initiate a search An automatic spell check feature ensures that CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 3 you enter valid terms Search Type You can set the search preferences to limit your searches to certain code sets e g just ICD 9 CM Vol 1 and CPT and define the parameters of your search results Narrowing Search Results You can narrow the search results by clicking the Narrow button Narrow Search features let you specify the type of code by section e g surgery radiology hospital procedure etc You can use the Narrow Search as often as necessary to pare down the results to specific code sections Viewing Search Results The Tabular Results show relevant codes that match your search criteria The number of code matches found is referenced on screen Codes are displayed so that the most likely codes are listed first by rank Fourth and fifth digit ICD 9 CM codes are grouped as sublevels under each primary code CPT and HCPCS codes are grouped as sublevels under the corresponding section or subsection identified by the range of codes in that subsection Index Listing You can view matches to your search terms in the indexes of the ICD 9 CM CPT and HCPCS books The Index Listing window displays index terms and correspond
7. If you receive a Code Not Supported message box you are a Code It Fast I 9 customer and have attempted to use a feature not supported by Code It Fast I9 Ingenix recommends you consider upgrading to one of our more powerful products HARDWARE REQUIREMENTS Recommended Minimum Requirements Requirements Encoder Pro Expert and 64 MB RAM 32 MB RAM Encoder Pro Professional PII 233 MHz processor PI 166 MHz processor 800 X 600 SVGA 800 X 600 SVGA 100 MB disk space 100 MB disk space CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Recommended Minimum Requirements Requirements P 16 bit color 16 bit color Encoder Pro Standard 64 MB RAM 32 MB RAM OPERATING SYSTEM REQUIREMENTS Encoder Pro has been tested on the following operating systems Windows 95C and above Windows 98 Windows ME Windows 2000 Windows NT versions 4 x and 2000 Windows XP ABOUT THE SOFTWARE All Encoder Pro products are Windows sharable programs not client server programs They are designed with the ability to have multiple users but are not a traditional network product Encoder Pro can execute on top of a Novell environment with a Windows Operating System OS CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual ENCODER PRO WINDOW Open menus on the menu bar to select commands Determine which code sets to search Indicates which code set s are included
8. Detail For various preferences regarding this functionality refer to Copy Tab in the Preferences section of this manual CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 80 Copying Text You can also use the copy function to copy all or a portion of text from most code specific dialog boxes To copy text 1 Use your mouse to select the portion of text you want to copy 2 Click Ctrl C to copy the text to the Windows clipboard Copying to the Clipboard From the Windows clipboard you can paste codes from your program into other Windows software e g billing program electronic claim form etc Ingenix s Encoder Pro suite provides two ways for copying codes descriptions and other information to the clipboard Ctrl C or the Copy option under the Edit menu copies the selected code line or block of text directly to the clipboard Adding codes to the Notepad temporarily stores codes and descriptions before you send them to the clipboard Notepad features also let you append modifiers to CPT and HCPCS codes Note Please consult your Windows system documentation for information on using the Windows Clipboard PRINTING Encoder Pro lets you print general information such as Tabular Results Code Detail codes and descriptions the Bookmarks list and Notepad contents You can also print information in any code specific dialog box based on the code you have selected
9. Help Coding k Application Help CEri H Environment Information AMA Copyright License Agreement Data Version Abaut Coding Provides guidelines definitions and tips for coding with ICD 9 CM CPT and HCPCS codes and modifiers Program Help Ctri H Provides instructions on using Encoder Pro suite Environment Information Opens the Environment Information dialog box AMA Copyright not in CIFI9 Opens the AMA Copyright message box License Agreement Opens a printable Ingenix License Agreement message box Data Version Opens the Data Version dialog box About Opens a splash screen that lists copyright and version information for the Encoder Pro product you purchased CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 133 RIGHT CLICK ADD MENU This menu is available only when a code is selected in the Code Detail Items not available are dimmed Note that if you are using Encoder Pro Expert the Add to Notepad option reads Add to Compliance Notepad Add to Global Bookmarks Add to Personal Bookmarks Add to Global Sticky Makes Add to Personal Sticky Motes Add to Motepad View Carriers with LMRP Add To Global Bookmarks Opens the Edit Bookmark dialog box Note that a code must be selected in the Code Detail Add To Personal Bookmarks Opens the Edit Bookmark dialog box Note that a code must be selected in the Code Detail
10. The History Menu The History menu lists a trail of up to 15 previously viewed codes This makes it easy to go back to a previous code selection for the current session Bookmarks With Bookmarks you can store amend and catalog lists of frequently used codes Copying Codes You can copy codes descriptions and modifiers into the Windows clipboard to be pasted into other Windows programs The Notepad lets you send multiple codes to the clipboard at one time You can set preferences to copy the code only or the code and its description Deleted Codes The Deleted Codes dialog box appears whenever you enter a deleted code or when you access it through the View menu This dialog box lists all the deleted codes for each applicable code set and any applicable cross reference codes Color Codes Dialog Boxes You can quickly look up all codes that have a color code associated with them by viewing a sorted list in the applicable dialog box from the View menu Sticky Notes You can add edit your own comments to codes with sticky notes Each code with a sticky note attached is flagged for user reference Printing You can print the code information that appears in any dialog box E M Clinical Examples All products except Code It Fast I 9 Displays examples from Appendix D of the CPT Book for the CPT Evaluation and Management Codes Modifier Place of Setting All products except Code It Fast I 9 Indicates which CPT or HCPCS modif
11. and feet 2 5 em or less 12002 Simple repair of superficial wounds of scalp neck axillae external genitalia trunk and or extremities including hands and feet 2 5 em to 7 5 em 12004 Simple repair of superficial wounds of scalp neck axillae external genitalia Cancel Help Examples This tab is visible only for E M codes It shows clinical examples from Appendix D of the CPT Book As described in CPT clinical examples of the CPT codes for E M services are intended to be an important element of the coding system The clinical examples when used with the E M descriptors contained in the full text of the CPT Book provide a comprehensive and powerful new tool for physicians to CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 50 report the services provided to their patients CPT Section Notes 99201 1 x Initial office visit with a 9 month old female with diaper rash Pediatrics Initial office visit for a 50 year old male from out of town who needs a prescription refill for a nonsteroidal anti inflammatory drug Anesthesiology Initial office visit for the evaluation and management of a contusion of a finger Orthopaedic Surgery Initial office visit for a 22 year old male with a small area of sunburn requiring first aid Dermatology F amily Medicine Internal Medicine The clinical examples that are provided are limited to Office or Other Outpatient Servic
12. mien prede a s Er T n rn Medical Decition Making The level cl amics for nach component comma 1897 EM Gadea when counseling iral of cave labs up mora than DO percent of Her total wind time then Time should be ite debesmining actor in electa an E JM eode i Madai la High CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 93 Select Visit Option Dialog box you will be presented Emergency New or Established Patient Miren limit pendit codes ace Hiiop Examination and Hada Decinon Making The level of Domeka istis OS 153567 EA Guidelines o hen counseling and coordina percent ol Ghee total visit ima then Time add be ha determining azko in Emergency Other Emergency Services Does not have access to the Exam Calculator Physics deecton of emergency medical sese LHS lenaper Nursing Comprehensive QO tt 08 Nursing Facility Assessments ids A 7593 New or Established slaved Vik Eten Haina acy inem Newer iiaii Esmas Coder Detritions Gurdelmes The kes components hor E rie si Ier T ren amt indicar The level ol servi los nach component comiales iris C 5 15687 EM Guide her counseling and M Hed aM Eu rand uk i vl s then Time should be Ha determi facta in ieleciing an EM ende Nursing Subsequent Nursing EA Facility Care New or Established Gaav o Epi Coder Detriers Gudelees Type armes Kurangi Humba il Kap Comprar Paquet 203 he leg componenti for EM cades i
13. mini bus mou Nonemergency transportation wheelchair va Nonemergency transportation and air travel p Nonemergency transportation per mile case Transportation ancillary parking fees tolls o Nonemergency transportation ancillary lodai Nonemergency transportation ancillary meal Nonemergency transportation ancillary lodgi Nonemergency transportation ancillary meal Ambulance service neonatal transport base BLS mileage per mile BLS routine disposable supplies of b xl Cancel Heb Encoder Pro User s Manual 29 PERFORMING A CODE SEARCH This section explains how to perform a code search You learn how to determine and enter key search terms and use the spell check feature Entering Search Criteria The Search box is used to enter search terms and narrow down search results You can also type in a valid code number to bypass the search and go directly to the Code Detail 1 Type up to four key words or a code number at the Search Prompt You do not have to click into the Search box in order to populate the text box You can begin typing from anywhere in the main screen Additionally if you ve entered something into the Search box and then decide to start another search using a different term typing anywhere in the main screen replaces the older search term in place of the new term you are looking for If you want to append another word to your search you have to click into the Search box to modify or add
14. penis scrotum hydrocele hernia Female external genitalia Batholin s glands cervix uterus Musculoskeletal range of motion strength atrophy swelling tenderness tone Skin cyanosis pigmentation turgor lesions ulcers petechiae purpura Neurological Romberg tremor tic ataxia aphasia reflexes gait Psychiatric alertness orientation memory calculation abstract concepts speech cortical integration Hematologic Immunologic Lymphatic blood specimens immunoassays lymph nodes Quantifying the Examination There are four types indicated in the levels of E M codes 1997 Documentation Guidelines for Evaluation and Management Services Problem focused Perform and document examination of one to five bullet elements in one or more organ systems body areas from the general multisystem examination OR examination of one to five bullet point elements from one of the ten single organ system examinations shaded or unshaded boxes Expanded problem focused Perform and document examination of at least six bullet elements in one or more organ systems from the general multisystem examination OR perform and document examination of at least six bullet point elements from one of the ten single organ system examinations shaded or unshaded boxes Detailed Perform and document examination of at least six organ systems or body areas including at least two bullet elements for each organ system or body area from the gener
15. t BP Tc UU ERE UI MER TEUEONN 53 LMRP Medical Necessity Edits EXPT and PRO only ooocccncncccnccnoncccnnncccocononcccnnnccnnonnnccnnnnnnnnnnanos 54 Local Medical Medicare Review Policy LMRP occccccoccncccccccnccconcncocononnocononnconnnnnonononcnnonons 55 Medically Necessary and Reasonable ccccccssssccccccssseeceeceesececeeeeuceeeseeaeceeessesecesssaaeeeess 56 Documental ara AA a DUREE RA TEX a Pet ipa ua Dus 56 A CM scc LEN 56 Natonal PONCY MT E M 56 Focused Medical REVIEW 56 National Coverage Determinations Edits EXPT and PRO only ooccccccccccncnncccconccnncnononccnncnonanons 57 Medically Necessary and Reasonable ccccccssssccccccessecececaeseceeeeeeeeeeeseeaeeeeessaaeeeesessageeeees 57 Docilnerntellol zuo utens estat dla ci tva baf e ia Tod UM Ust 58 REImMbUIS SMN turrones ido ScR EID Uie ocio 58 Nationa BONC V uen 58 Medicare Physician Fee Schedule EXPT and PRO only ooooccccccccccccccnccccnnnccnnonononononnccnnnanonnnns 58 Special Coverage Instructions not in CIFI9 coonncncccccconcnnccccooncnnnononononcnnonnnnnnnononnnnnnnnnnanenonnss 61 CPT Color Coding Legend not in CIFID ccccccccccncnnccccconcnnnccconncnnnonononnnnnnnonnnnnnononnnnnnnononnnnnnnos 62 HCPCS Dialog BOXES AL lala 63 HCPCS Section Notes not in CIFI9 ooccccccccocccncccccncnnnnnoconccnnnnnnononnnonononnnnnnonannnnnnnnnnnnnnnnonononess 63 HGP CS Annotrdt
16. ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 61 Medicare Fee EXPT only This tab provides you with area specific payment information Medicare Information 24075 x RVUs Facility RVUs Nonfacility Global Information Medicare Rules MedicareFee Payment Information Select Medicare Carrier Locality 00000 00 NCD Ntnl Coverage Determinations amp Make default Medicare Carrier Locality r Total Payment Calculation Global 26 Facility 0 00 A a Non Facility soo Na A Cancel Help The Payment Information field allows you to select a Medicare locality from a drop down menu You may also choose to make a default locality from the check box The Total Payment Calculation area displays the calculated Medicare payment information for the selected Medicare carrier locality Calculated fees are shown for Facility and Non facility Where modifiers apply fees are shown for Global values Modifier 26 Professional Component and Modifier TC Technical Component Special Coverage Instructions not in CIFI9 The Special Coverage Instructions dialog box CPT or HCPCS provides important information about Medicare payment policies for either CPT or HCPCS codes depending on the type of code selected Select a HCPCS or CPT code from the Code Detail and click the CMS button or select Medicare Policy from the HCPCS or CPT menu C
17. AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 11 Administrator Logins Refer to System Administrator Login for information regarding Administrator logins and privileges User Passwords A minimum of four characters is required for user password and they are not case sensitive If you selected Remember User Name and password in your previous login session then these fields will be populated in future logins Changing User Passwords You can change your User Password by selecting Change Password from the File menu s Administration submenu If you are logged in as an Administrator and want to change your User Name log out as Administrator first Invalid Logins and Passwords If you enter an invalid password in the User Login or Administrator Login dialog boxes you will be notified your attempt was unsuccessful via a message box PREFERENCES This section explains how to set the preferences in order to modify how your product behaves You access the various Preferences tabs by selecting Preferences from the Edit menu Copy Tab When you copy code information from the Code Detail or Notepad the default 1s to copy the code and the full description However in the Copy tab of the Preferences dialog box you can decide what pieces of data to copy The code and full description click the radio button The code number only click the radio button The dates of service check the box Th
18. Delete User from the User Maintenance dialog box From here the System Administrator can delete any user An important side benefit 1s to remind the System Administrator that deleting a user from the system also deletes any personal Sticky Notes or Bookmarks that user created IF vau delete a User Mame From the system then any personal sticky notes andfor bookmarks assigned to that user are deleted To proceed with deleting user BLIMPIE select OK Otherwise select Cancel E Cancel Reset Password Clicking this button will reset the selected user s password to match the user s login name This tool is utilized by the System Administrator when a user forgets their password Reset Password 2 Do vou really wank to reset the user password to the user name Cancel CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 124 Menus FiLE MENU File Print Ctrl P Page Setup E M Assistant Ckrl E Administration k Exit Ctro Print Ctrl P Opens the Print Report dialog box which lets you print tabular results and information from dialog boxes Page Setup Opens the standard Windows Page Setup dialog box E M Assistant Ctrl E EXPT and PRO only Opens E M Assistant Select Service dialog box If you are searching for a CPT evaluation and management E M code that is based on key components the E M Assistant helps you find the appropri
19. F CPT ONLY 2005 AMERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 113 Exam Calculator Examination Level of Service This dialog box appears when you select at least one check box from the Exam Calculator Examination dialog box It informs you of the examination type that is appropriate based on the radio buttons elements selected according to CMS s 1997 Documentation Guidelines for Evaluation and Management Services The Level of Service field is non editable and shows the examination type based on the selections made in the Exam Calculator Examination dialog box There are four types of examinations that can result in this field Problem Focused Examination Expanded Problem Focused Examination Detailed Examination Comprehensive Examination The text displayed explains the result The following is an example xam Calculator Examination Level of Service E xj Level dl Service Problem Focused Enano Ths sen as based on lhe elements you selected bor lhe systems and or body armas bor the green general m b oyatem ot single cegan tyctem examination This centena it based on CMS 1997 Evaluation and Managemert Documert hon ouadelne t Bock Cancel Heb CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro Users Manual ag COMPLIANCE EDIT EXPT ONLY This dialog box allows you to run a compliance edit for coding conflicts affecting the ICD 9 CM C
20. Generally the modifiers which are most likely to add specific or further information to the billed codes are E1 E4 FA F1 F9 TA T1 T9 LT RT LC LD RC 58 59 78 and 79 Tabs At least one of the following three tabs are also included in this dialog box depending on the code selected CCI Component tab If the selected CPT code represents a comprehensive procedure these unbundles list the CPT codes that represent the components of the comprehensive procedure CPT Unbundles 24075 E x CCI Component CCI Mutually Exclusive CCI Greater Px Find Code Reason Modifie 01710 Anesthesia Included in Surgical Procedure Not Allowed Anesthesia Included in Surgical Procedure Standards of Medical Surgical Practice Standards of Medical Surgical Practice Standards of Medical Surgical Practice Standards of Medical Surgical Practice Standards of Medical Surgical Practice Standards of Medical Surgical Practice Most Extensive Procedures CPT HCPCS Separate Procedure Definition Standards of Medical Surgical Practice Standards of Medical Surgical Practice Anesthesia for procedures on nerves muscles tendons fascia and bursae of upper arm and elbow not otherwise specified Version E Cancel Help CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 53 CCI Mutually Exclusive tab Codes listed here represent those procedures that cannot be performed during
21. Integumentary skin rashes moles dryness lumps pigmentation Endocrine polyuria polydipsia cold heat intolerance diabetes Genitourinary Desiree hematuria nocturia menopause hernia Hematologic Lymphatic anemia bruising bleeding lymph node enlargement Eyes diplopia blurred vision Cardiovascular chest pain or pressure palpitations murmur hypertension Musculoskeletal arthritis joint stiffness swelling myalgia gout Neurologic dizziness syncope seizures vertigo weakness tremor Allergic Immunologic allergies to medicine food dye hepatitis HIV Respiratory cough hemoptysis pleuritic chest pain wheezing asthma Psychiatric depression agitation panic anxiety memory disturbance The physician must elaborate on any positive responses by obtaining further information from the patient The Past Family and Social History 1s final element of the history They are described by Past Medical History Adult and childhood illnesses or trauma vaccinations and screenings and past surgical history Family History Describes marital status married widowed divorced and so forth parents siblings children genetic diseases of the family or other familial history Social History Descriptive information about the patient s habits For example smoker alcohol consumption drug use sexual orientation place of birth residence occupation education level religion These systems may be reviewed by havi
22. Maex LIS inenen E 36 Viewing Codes in the Code Detail ooocccccccccccccooncccnnnccnonanncnnnnnnnononanncnnnnnnnonnnnnnennnnnnns 37 CODE DB AM Mw a lidi 38 Selecting a Code from Code Detalle ore EE Dena te eeracte de 39 IC D 9 CM Code Detail retra 39 CPT and HCPCS Code Detall sinaloa 40 CODE SPECIFIC DIAEOG BOXES 41 ICD 9 CM VOL 1 Dialog BOXES iicet li dd ada 41 IGD 9 GM instructonal Notes ici AS 41 CDS EMANAN Sd it od 42 DRG Grosscodes motn 9 TIND s ous sodipd usq soneto a a S iege cente d uptiss intel 43 IGD 9 Vol 1 Golor Godirig Legend 5 it did 44 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual V ICD 9 CM Vol 3 Dialog BOX CS iii i e Rocio da 46 IGD OCM AIO RAMON RTT I D M 46 ICD 9 Vol 3 Crosscodes EXPT and PRO Only cocccccococccccnncccccccnocccononnnnononancnnononononanncnnnnnnnnnnanos 46 DRG Grosscodes Tobin SU ND aite dee A 46 ICD 9 Vol 9 Color Coding Legend ii leads SiS ells 47 CPT Dialog BOX Sia aos 48 CPT Section Notes notin CIFIO j cater tuti ero pO etta vi bre don lcd uon ec leu a Pe ena nne s Rr 48 CPT EAR eedem 50 GPT Mode Ot Ih CUI em cr Ee dees 51 OPT Grosscodern EXP Tiana PRO Only seid enata caido bauen divas deed uv nU eaten aes 51 CPT CCI Unbundle Edits EXPT and PRO ONly ooocccccccccccccconcccnnnccnnccooncccnnncnnnononcnnnnncnnnnnnancnnnns 51 APP oe ee ere ee reer eee ee ee ee eee 52
23. Management Services examination of at least eight organ systems or one comprehensive single system examination Concurrent care Medical care provided by two or more physicians on the same day If care is medically necessary third party payers usually pay both physicians Generally payers expect the physicians to be of different specialties and caring for different conditions or different aspects of the same condition or disease process Detailed physical examination Examination of at least six organ systems or body area including at least two bullet point elements for each organ system or body area from the general multisystem examination OR examination of at least 12 bullet point elements from one of the single organ system examinations The requirements for the eye and psychiatric single system examinations must include at least nine point bullet elements Or under CMS s 1995 Documentation Guidelines for Evaluation and Management Services examination of at least two to seven organ systems with at least one system being documented in detail Expanded problem focused physical examination Examination of at least six bullet point elements in one or more organ systems from the general multisystem examination OR examination of at least six of the bullet point elements from one of the 10 single organ system examinations shaded or unshaded boxes Or under CMS s 1995 Documentation Guidelines for Evaluation and Management Services examination o
24. New Bookmark You can add as many codes to the bookmark list as you want To add a bookmark 1 From the Code Detail select the code that you want to add to the bookmarks list 2 Open the Add Code dialog box by clicking the Add button from the toolbar or selecting Add from the Edit menu The Add Code dialog box lists the code and description of the selected code You choose to add the code to your personal bookmarks list personal sticky notes or notepad If you are logged on as a System Administrator you may also choose to add the code to Global bookmarks Add Code Y xj Code E1212 Description Motorized wheelchair fied full length arme swing a Add Code To select all that apply Bookmarks Sticky Mates uu ro iter Global Global Cancel Help 3 Select the Bookmarks Personal or Global check box to specify you are adding a bookmark 4 Click OK The Personal or Global Bookmark dialog box appears Assign your bookmark a category not required and modify the code s description if you d like 6 Click OK Shortcut To quickly add a code to Bookmarks opening the Add Code dialog box l 4 Right click the desired code in the Code Detail The Add Code shortcut menu appears Add to Global Bookmarks Add to Personal Bookmarks Add to Global Sticky Makes Add to Personal Sticky Notes Add to Notepad View Carriers with LMRP Select Add to Personal or Global Bookmarks The Personal or Global Bookmark dialog bo
25. O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 75 The View Personal or Global Sticky Note dialog box opens and the code you selected and its description appears 3 Type the name you d like to give the Sticky Note in the Sticky Note Name field and then your comments in the text box below it Sticky Note Indicator When a sticky note has been created for a code and you select it in the Code Detail you see the Sticky Notes icon in the color code box below the Code Detail plus a pink flag next to the code itself Viewing or Editing an Existing Note In order to read or edit an Sticky Note you have previously created you must open the View Sticky Note either Personal or Global depending on whether you are logged in as the System Administrator dialog box There two ways to access this dialog box Click the View Note button from within the Sticky Notes dialog box refer to page 72 Double click the blue Sticky Note link for a selected code in the Color Code box in the lower portion of the Code Detail Note that if you have multiple notes assigned to the selected code then double clicking this link opens the Sticky Notes dialog box and selects the first note for the code x Date Modified or amp dded jor 229 2003 Sticky Note Name or Brown Does not use this code for patients 1 200 r Sticky Note Code Assignment Selected Code 24 02 You can assign multiple codes to this s
26. ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 104 The counseling is only considered when it 1s the dominant factor in determining the level of evaluation and management service over 50 percent of the visit time is spent in this activity See Time below 6 Coordination of care This includes contact with other physicians or health care practitioners on behalf of the patient When coordination of care does not include a patient encounter on that day the services should be reported using the case management codes However the case management codes are not covered by many third party payers Coordination of care in the inpatient setting does not require face to face time with the patient but includes time spent with parties who have assumed responsibility for decisions regarding the patient s care Time spent reviewing records or test results or other medical data may be included in quantifying the time Coordination of care is only considered when it is the dominant factor in determining the level of evaluation and management service over 50 percent of the visit time 1s spent in this activity See Time below 7 Time This is used in selecting an E M code only when counseling or coordination of care represents more than 50 percent of the time the physician spent face to face outpatient or bedside and on the floor or unit with the patient or family inpatient Both time elements total le
27. Open surgery or any manipulation of the fractured pieces in Z7 815 Separately reportable x rays confirm the fracture of the malleolus of the ankle with the bony fragments in stable position The physician applies a cast or brace to hold the fracture in place until it heals In 27818 separately reportable x rays confirm trimallealar ankle fracture that is unstable and requires manipulation Using anesthesia as needed the physician pushes pulls or maneuvers the foot ankle and leg until the fracture is in F CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 51 CPT Modifiers not in CIFI9 This dialog box displays a list of CPT modifiers and descriptions that are appropriate for the selected code You can sort by either column Select a CPT Code in the Code Detail that has a modifier and click the Modifiers button on the toolbar or select Modifiers from the CPT menu to open the CPT Modifiers dialog box CPT Modifiers 10040 l X UNUSUAL ANESTHESIA ANESTHESIA ETY SURGEUN MULTIPLE PROCEDURES REDUCED SERVICES DISCONTINUED PROCEDURE SURGICAL CARE ONLY POSTOPERATIVE MANAGEMENT ONLY PREOPERATIVE MANAGEMENT ONLY STAGED RELATED PROC BY SAME PHYS IN POST OP DISTINCT PROCEDURAL SERVICE x re CPT Crosscoder EXPT and PRO only This dialog box displays applicable ICD 9 CM diagnosis Vol 1 ICD 9 CM procedure codes Vol 3 HCPCS codes Dental codes CPT anest
28. Primary Diagnosis d Male Diagnosis Unspecified Code Code as Secondary Diagnosis Q pando Diagnosis ae Specified Code pon ar Complication 7 jen Mote The following explains each ICD 9 CM Vol 1 color coding symbol vad PEU This symbol identifies codes that require an Fourth Digit Code Required Ei additional fourth digit be added to the ICD 9 CM Vol 1 code Either the code category or subcategory contains more specific codes or the code choices are listed with the main category TE TT This symbol identifies codes that require an Fifth Digit Code Required Ei additional fifth digit be added to the ICD 9 CM Vol 1 code Either the code category or subcategory contains more specific codes or the code choices are listed with the main category New Code This symbol identifies ICD 9 CM Vol 1 codes that are new Revised Code This symbol identifies ICD 9 CM Vol 1 codes that have been revised This symbol identifies ICD 9 CM Vol 1 codes Male Diagnosis amp i that are considered a male diagnosis CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Female Diagnosis Adult Diagnosis EY Maternity Diagnosis M Newborn Diagnosis H Pediatric Diagnosis P Unspecified Code Other Specified Code Manifestation Code Not a Primary Diagnosis g Medicare Secondary Payer Primary Diagnosis IMSP Duplicate Primary Diagnosis V
29. a HCPCS code in the Code Detail that has a modifier and click the Modifiers button from the toolbar or when you select Modifiers from the HCPCS menu HCPCS Modifiers L2180 x Description REDUCED SERVICES DISCONTINUED PROCEDURE DISCON OUT PT ASC PROC BEFOR ANESTHES ADMIN DISCON OUT PT ASC PROC AFTER ANESTHES ADMIN REPEAT PROCEDURE BY SAME PHYSICIAN REPEAT PROCEDURE BY ANOTHER PHYSICIAN RETURN OPERAT RELATED PROC POST OP UNRELATED PROC SERVICE SAME PHYS POST OP MULTIPLE MODIFIERS BENEFICIARY INFORMED OF PURCHASE amp RENTAL PURCH BENEFICIAR Y INFORMED OF PURCHASE amp RENTAL RENT HCPCS Crosscodes EXPT and PRO only This dialog box displays applicable ICD 9 CM diagnosis Vol 1 ICD 9 CM procedure codes Vol 3 and CPT codes that are crossed to the selected HCPCS code Tabs are displayed that contain the applicable code sets Select a HCPCS code in the Code Detail that has crosscodes and click the Crosscoder button 5 on the toolbar or select Crosscoder from the HCPCS menu This dialog box contains code number links that go to the appropriate code in the Code Detail Double click the link or select 1t and click the Select button HCPCS Crosscodes M0064 90 0 Sende dementia imcomplealed AE 290 10 Presende dementis uncomplicaled 1290 11 Presende dementia wth dekmam 290 12 Presenile dementia wth delusional feshures 1290 13 Presende dementis wth depiestie Features z90 20 Senie dementia vith delusional fe
30. a non editable text field that provides definitions for terms used The text presented applies to the range of codes listed in the Codes tab and is not code specific Guidelines Tab Selecting this tab gives you a non editable text field that provides CPT guidelines that assist in determining which codes should be used The text presented applies to the range of codes listed in the Codes tab and is not code specific Exam Calculator Button EXPT only When the Exam Calculator button is clicked the Key Components dialog box stays open but the Exam Calculator Select Examination dialog box opens as the active dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 96 Specifics of Evaluation and Management Coding The levels of E M services define the wide variations in skill effort time responsibility and medical knowledge required for preventing or diagnosing and treating illness or injury and promoting optimal health At first glance selecting an E M code appears to be complex but the system of coding medical visits is actually fairly simple once the requirements for code selection are learned and used Levels of E M Services Codes for E M services are categorized by the place of service e g office or hospital or type of service e g critical care or preventive medicine services Most of the categories are further divided by the status of the medical visit e g new v
31. and PRO only Opens the HCPCS Crosscodes dialog box CCI Unbundle Edits EXPT and PRO only Opens the HCPCS CCI Unbundle Edits dialog box Local Medical Review Policies EXPT and PRO only Opens the LMRP Edits dialog box National Coverage Determinations EXPT and PRO only Opens the NCD Edits dialog box Medicare Policy Opens the Special Coverage Instructions dialog box Color Coding Legend Opens the HCPCS Color Code Legend dialog box Previous Codes Displays the Code Detail view for the previous section of codes Refer to Code Detail for further information Next Codes Displays the Code Detail view for the next section of codes Refer to Code Detail for further information Carriers with LMRP EXPT and PRO only Opens the Carriers with LMRP Edits dialog box UPDATE MENU Updates Data Updates Opens the Data Updates dialog box to download data sets that are specific to your Encoder Pro product HISTORY MENU This menu displays a list of codes that you have selected during the current lookup session The code trail shows up to 15 of the latest code selections with the most recent at the top Use the trail to go back to codes you ve already searched CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 132 History EQ650 E06 3 Pneumatic Co L3970 Sen addition to m L3972 Sen addition to m L3968 Shoulder elbow art 12005 Simple repair of s HELP MENU
32. box use either of the following methods Click the Sticky Notes button B Select Sticky Notes from the View menu Sticky Notes E xi Personal Global Note Name Repair of laceration of eyelid involving lid margi 01 24 2003 84 02 Amputation and disarticulation of thumb 01 23 2003 Dr Brown 64893 Nerve graft includes obtaining graft single stra 01 24 2003 E1222 Wheelchair with fixed arm elevating legrests 01 24 2003 E1222 Wheelchair with fixed arm elevating legrests 01 24 2003 E0650 Pneumatic compressor nonsegmental home m 01 24 2003 12042 Layer closure of wounds of neck hands feet a 01 29 2003 Delta Clinic A6025 Silicone gel sheet each 01 23 2003 Invalid after 1 1 01 L3968 SED mobile arm support attached to wheelchai 01 24 2003 Go to Code Delete View Note OK Cancel Help Comcel Hel The Code column displays all codes that have a Sticky Note The Description column gives the code s description The Date Modified column shows the date and time the Sticky Note was added or modified The Note Name column shows the name you or the System Administrator typed in when creating the Sticky Note In order to view the note itself you must click the View Note button Multiple User Version Note If you have the multiple user version of this program the Sticky Notes dialog box contains a Global tab Click this tab to view global sticky
33. changes are not identified This symbol identifies a CPT code that has age restrictions as identified by Ingenix clinicians This sumbol identifies procedures that by definition should only be used for maternity patients generally between 12 and 55 years of age This symbol identifies CPT codes that are considered a male diagnosis as identified by Ingenix clinicians This symbol identifies CPT codes that are considered a female diagnosis as identified by Ingenix clinicians This symbol indicates codes for which modifier 51 is exempt This symbol indicates nonspecific CPT codes i e unlisted codes This symbol indicates add on subsidiary codes as identified by the American Medical Association in the CPT Book The principal procedure code s that the add on code is supplemental to are listed after the code description in the Code Detail This symbol indicates additional add on codes as identified by Ingenix clinicians The principal procedure code s that the code is supplemental to are listed after the code description in the Code Detail This symbol identifies CPT codes that are commonly miscoded as identified by Ingenix clinicians CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 63 Medicare Policy EE This symbol identifies services that have special Medicare coverage policies and or rules This symbol indicates codes for which modifier 63 is exempt Modifier 63 E
34. doicia an E M eode Medeae la Hh High CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 95 Select Visit Option Dialog box you will be presented Home Established Patient nen Type of area Home Humba ol Kg Compared ipaa Jai EIE T of Vir Eitablubed Patent Egan akculeinr Coder Distritos Gudelees Me distent for CAM codes ane Hiiop Examination and Medcal Decinon Making The level cl x f aijr incide rests Od S 12537 EM Guedes ien Counting are comin domi waa i nas mm thar SU pecera al fim el vik ere then Time shed be ther determining hasta in ti E Esparded Probl Eypanced ies Less Detail Li estaa Wa Lompreber ra Lonpeehenirre di Codes Tab All columns within this tab s view are non editable From the Code column you can select a code and double click it to go to that code in the Code Detail The codes that display match the Result value that corresponds with the visit status selected 1n the E M Assistant Select Visit dialog The History column shows what type of History is required to be submitted The Examination column shows what type of exam is required The Medical Decision Making column shows how complex the decision making is for this visit The Problem Severity column provides a value for the severity of the problem The Time column shows how much time the visit is expected to take Definitions Tab Selecting this tab gives you
35. field to display a list of applicable modifiers Select the desired modifier 4 Click the Append button to attach the modifier to the selected code The code appears with the modifier attached 5 Click OK to save changes and close the dialog box Duplicating Codes To duplicate a row in the Notepad 1 Select the code you want to duplicate 2 Click the Duplicate button to insert a copy of the same code in the Notepad code list Note Right click in the Notepad list to open a shortcut menu Use this menu as another way to add delete and duplicate and clear all codes Deleting Codes To delete a row from the Notepad 1 Under the Contents tab select the row you want to delete 2 Click the Delete button to remove the code from the Notepad Sending Data to the Clipboard You can copy just the codes or both the codes and descriptions to the clipboard To send the Notepad information to the clipboard click the Copy to Clipboard button Use the Copy tab in the Preferences dialog to specify whether codes or both codes and descriptions are copied For various preferences regarding this functionality refer to Copy Tab UsiNG THE COPY FUNCTION Copying Codes and Descriptions When you select a code in the Code Detail you use Ctrl C or the Copy option under the Edit menu to copy the code and description directly to the Windows clipboard You can select only one code at a time because each code is considered a link to the Code
36. in the results The Tabular Results display initial search results Click a code to view it in the Code Detail Displays the total number of Tabular Results Type search criteria in the Search Prompt 5 Encoder Pro Expert Encoder Pro Expert a 2733 tom BH 0 5 v ICD 8 Vol 1 M ICD 3Vo 3 M CPT v HCPCS EE Ge rm E El m HE DETRE 9 L3960 L3969 Abduction Position Custom Fitted a L3970 L3974 Additions to Mobile Arm Supports 880 Open wound of shoulder and upper arm 887 Traumatic amputation of arm and hand comple 711 Arthropathy associated with infections 12031 12057 Repair Intermediate 12001 12021 Repair Simple 84 Other procedures on musculoskeletal system 912 Superticial injury of shoulder and upper arm 343 Burn of upper limb except wrist and hand 24065 24155 Excision 64885 64907 Neurorrhaphy With Nerve Graft E0650 E0673 Pneumatic Compressor and Appliance 34001 34203 Arterial With or Without Catheter 24900 24940 Amputation 34401 34490 Venous Direct or With Catheter 23930 24006 Incision E1220 E1238 Wheelchair Special Size 716 Other and unspecified arthropathies 20802 20838 Replantation Q0035 04051 Temporary Codes First Subsection 01710 01782 Upper Arm and Elbow 755 Other congenital anomalies of limbs P b CMS Click Narrow results by section to choose additional criteria to narrow
37. may be a valid choice if it most closely describes your diagnosis or procedure but use only after checking all other options Frequently Miscoded This code may be a valid choice if it most closely describes the procedure or service but be aware that this code is frequently miscoded and another code may be more appropriate Male Gender Conflict Code is a male specific diagnosis or procedure Patient sex conflicts with this code Female Gender Conflict Code is a female specific diagnosis or procedure Patient sex conflicts with this code Primary DX Conflict Code does not report a primary diagnosis Known as a manifestation this code should only be listed as a secondary diagnosis Additional Digits Required Code requires additional third fourth and or fifth digit to be coded correctly Either the code category or subcategory contains more specific codes Medicare Noncovered Conflict Code reports a procedure service or supply that is not covered by or valid for Medicare Medicare Coverage Conflict Code reports a procedure service or supply that has restricted or no coverage from Medicare CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Edit Conflict Name Edit Conflict Description Primary PX Conflict Add on Without Primary LMRP Edit Conflicts Tab 117 Code does not report a primary procedure Known as an add on code this code describes additional intra serv
38. medical decision making is based on two of three of the medical decision making areas meeting the definition of the level of decision making Those definitions are listed below Straightforward Minimal number of possible diagnoses or management options minimal if any amount and complexity of data to be reviewed and minimal risk of complications and or morbidity or mortality Low complexity Limited number of possible diagnoses or management options limited amount and complexity of data to be reviewed and low risk of complications and or morbidity or mortality Moderate complexity Multiple number of possible diagnoses or management options moderate amount and complexity of data to be reviewed and moderate risk of complications and or morbidity or mortality High complexity Extensive number of possible diagnoses or management options extensive amount and complexity of data to be reviewed and high risk of complications and or morbidity or mortality Number of Diagnosis or Management Options Number x Points Result Self limited or minor stable improved or Max 2 ing Est problem to patient stable improved Est problem to patient worsening A Transfer total to line A of Final Result for MDM table New problem to patient no additional Max 1 work up planned New problem to patient additional work up planned Amount and or Complexity of Data to be Reviewed Hs Review and or order of clinical la
39. party payer Select Service Select Visit dialog box you will be presented Option Outpatient Type of Wini hen ca Dez ibarra Seon New Peri i Epabinhed Pyer CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 88 Select Service Select Visit dialog box you will be presented Option E M Assistant Select Visit Inpatient Type of Vest inostert Horetal ing stert Sorner eal Hosptali Care New or Evtatished C Subsequent Hospital Care Oibrervahon ex roert Care Serices Adnvenons Dincharges C Monptai Dechyge Seres Hospital Observaton Services C irha bseeeaton Caen Mew o E tiabithad Observation Care Diochaige Services Consultations E M Assistant Select Visit Trade Cormbtabior ina Inpatiert Consultation New or E stablitihed C Follow Up Inpatient Consultation Established C Contematery Conputstiont New ot E tablished Assistant Selec isit Emergency REM Nursing E M Assistant Select Visit Type of Vei e Nuning Facility Services G Comprenenerse Nurmg Factty Arverimerts New or E stabiihed C Subrequent Nursing Fociity Care New or Established C Hunting Facility Dechage Services CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 89 Select Service Select Visit dialog box you will be presented Option Domiciliary Type of Ves Domc ary Domclkany Rest Home fog Boarding Homel or Cus
40. ranges Depending on the search this dialog box may display a tab for just one code set two or all three Use the Revert link to jump back to your original search results in the Tabular Results area x ICD 3Vol1 cPr HCPCS The search results contain codes from different sections ICD 3 Vol 1 of ICD 3 Vol 1 Use the check boxes below to specify which codes you want to see in the results A perire tt v Health Status Factors V Codes a Evternal Causes E Codes Cancel Help Note The Specify Code Type dialog box appears only for the code sets you select before initiating a search For example if you search on biopsy but only have the ICD 9 check box marked when you click Narrow results by section you won t see the range categories tab for CPT Codes even if CPT Codes appeared in your initial tabular results You must initiate the search again and make sure the CPT check box is marked when you click Narrow results by section In the Specify Code Type dialog box a tab appears for each code set ICD 9 CM Vol 1 CPT and HCPCS that has results listed for multiple code ranges Depending on the search this dialog box may display a tab for just one code set two or all three Here are all possible categories you may see when you click Narrow ICD 9 CM CPT HCPCS Diagnosis Anesthesia A Codes Transportation Medical and Surgical Supplies Health Status Factors Surgery B Codes Enteral and V
41. search results GH o FEE Repair Intermediate Layer closure of wounds of scalp axillae Layer closure of wounds of scalp axillae Layer closure of wounds of scalp axillae Layer closure of wounds of scalp axillae Layer closure of wounds of scalp axillae Layer closure of wounds of scalp axillae Layer closure of wounds of neck hands Click buttons on the toolbar to access information or perform commands la xi Select and click View to LT CTE d access new deleted and Powered by Ingeris Code Logic L revised codes and the code book sections 32 O B View online help View section headers trunk and or extremities excluding hands and feet 2 5 cm or less trunk and or extremities excluding hands and feet 2 6 cm to 7 5 cm from th e associated trunk and or extremities excluding hands and feet 7 6 cm to 12 5 cm trunk and or extremities excluding hands and feet 12 6 cm to 20 0 cm trunk and or extremities excluding hands and feet 20 1 cm to 30 0 cm trunk and or extremities excluding hands and feet over 30 0 cm C M book feet and or external genitalia 2 5 cm or less CPT HCPCS or ICD 9 Layer closure of wounds of neck hands feet and or external genitalia 2 6 cm to 7 5 cm Layer closure of wounds of neck hands feet and or external genitalia 7 5 cm to 12 5 cm Layer closure of wounds of neck hands feet and or external genitalia 12 6 cm to 20 0 cm 1 Layer closure of wounds of nec
42. the multi user versions of Encoder Pro User Logins The User Login dialog box appears every time the program is launched Once properly logged in you are then identified on the system and will have access to personal sticky notes and bookmarks After closing this dialog box the program then launches Encoder Pro Expert Login E gt LY aer E a Ee a WE wW In nix E LARS E Em Enter your User Name and password to access the software on the network including user specific sticky notes and bookmarks User Name fei Password M Remember User Name and Password Cancel Help First Time Logins If your System Administrator has not yet added your User Name this dialog box allows you to accomplish a first time login However if you have already logged in once using a different User Name to bypass security is NOT a good idea Doing so will prevent you from accessing your personal Bookmarks and Sticky Notes Set Password d y m ort lt R Oe NL COSES TA Y T V 3 orl ALES 000 7 Minn Hn This User Name was not found If you are a new user enter and verify your new password Or click Cancel to return to Login User Name fick Old Password A 8 New Password EN Confirm New Password Po Cancel Help Note Your User Name may not be less than 4 characters or more than 10 characters If you violate this convention you will receive an error message CPT ONLY 2005
43. vary widely The Medicare program requires that a proposed LMRP be published for comment before it is instituted Proposed LMRPs are published by carrier and intermediary in infrequent bulletins Sometimes proposed LMRPs are flawed and need revision Often providers get stuck with an LMRP that may inappropriately restrict Medicare coverage for services due to their very unrefined nature LMRPs become effective 30 days from the date of publication The following general Medicare guidelines apply to all published LMRPs Medically Necessary and Reasonable Title XVIII of the Social Security Act Section 1862 a 1 A states no payment may be made under Part A or Part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of ilIness or injury or to improve the functioning of a malformed body member Medicare limits coverage of many procedures to certain ICD 9 CM diagnosis codes Please be aware that it is not enough to link the procedure code to a payable ICD 9 CM diagnosis code The diagnosis must be present for the procedure to be paid but in addition the procedure must be medically reasonable and necessary and representative of the patient s condition Medicare may require documentation of medical necessity on a pre payment and or post payment basis or comprehensive medical review basis Please note that the ICD 9 CM codes must be coded to the highest level of specificit
44. who belongs to the same group practice within the past three years Ifthe physician is on call or covering for another physician the patient status is based on the relationship with the physician who is not available Here are the CPT Book guidelines that can help you determine which menu selections are appropriate not all menu selections are referenced here for type of care in an inpatient setting Select initial type of care for services that are the first inpatient encounters with the patient by the admitting physician If the patient is admitted to the hospital as an inpatient from another site of service e g emergency department physician s office etc all E M services provided by that physician 1n conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission according to the CPT Book CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 87 Select subsequent type of care for services that include review of the medical record and diagnostic study results and changes in the patient s status since the last assessment by the physician Here are the CPT Book guidelines that can help you determine counseling and or coordination care time Counseling and or coordination of care includes the face to face time in the office or other outpatient setting or floor unit time in the hospital or nursing facilit
45. 003 Modifers Info LMRP Medical Necessity Edits and NCD Fourth quarter 2002 LMRP Info CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 83 ENVIRONMENT INFORMATION The Environment Information dialog box appears when you select Environment Info from the Help menu It provides information regarding the environment detected on your PC This information is helpful to our Technical Support staff if you need to call in with an issue Environment Information E E x Operating System M ame Windows 2000 Operating System Version 8 0 Build 2195 Service Pack 2 Available Memory 209678 KE Total Memory E35216KB User Path C Angenis EncoderPro userdata ad Processor Type Inte Esport Print MEDICARE CARRIER LOCALITY EXPT AND PRO ONLY This dialog box is accessed through the Edit menu s Select Carrier Locality option It allows you to specify a default Medicare carrier to be used when viewing area specific information such as calculating fees from the Medicare Fee Schedule It also determines the medical necessity edits that are available for CPT Codes The data provided in this dialog box comes from the local Medicare review policies LMRP and vary by carrier Select Medicare Carrier Locality El Select the Medicare carrienlocality that medical necessity edits should be based on These edits are from the local Medicare review Holi
46. 10 01782 Upper Arm and Elbow 55 Other congenital anomalies of limbs q k Dee Indes listing ad Viewing Additional Digit ICD 9 CM Codes The Tabular Results box displays the code results The parent grouping for ICD 9 CM codes is the 3 digit category 1 e code number without decimal ICD 9 CM codes with additional digits are consolidated into a common category Codes that require additional digits have a plus sign to the left of their folder Click the plus to expand the category and display subcodes E 660 Open wound of shoulder and upper arm E coy Traumatic amputation of arm and hand comple E T11 Arthropathy associated with infections B 84 Other procedures on musculoskeletal system E 912 Superficial injury af shoulder and upper arm Click the minus sign to hide subcodes E 887 Traumatic amputation of arm and hand comple 2 897 0 Traumatic amputation of arm and hand c 897 6 Traumatic amputation of arm and hand c m 11 Arthropathy associated with infections gt 84 Other procedures on musculoskeletal system Note Only those subcodes that pertain to the search results are listed not all third fourth and or fifth digit codes are listed CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 33 Viewing CPT and HCPCS Codes CPT and HCPCS codes are consolidated into subsections identified by the range of codes in that subsection For example if CPT Code
47. 21031 Excision of torus mandibularis 1s part of your results it will be listed under this subsection range 21015 21070 Excision Each subsection range has a plus sign E to the left Click the plus to expand the subsection listing and display codes EE 223 Fracture of tibia and fibula E 21015 21070 Excision H Dz44D0 D 7480 Removal of Tumors Cysts and Neoplas Click the minus sign El to hide codes BE 223 Fracture of tibia and fibula Er 21015 21070 Excision e 21031 Excision of torus mandibularis 21032 Excision of maxillary torus palatinus E D r440 D 7430 Removal of Tumors Cysts and MNeoplas Note Only those codes that pertain to the search results are listed not all codes in the subsection are listed Narrowing Search Results Every time you perform a search the Tabular Results box shows the matches found Occasionally you may enter a term that is too broad or too narrow In either case when you enter a search term that does not return tabular results but does return index results you ll see a Results Alert dialog box When it appears clicking the Index Results button takes you directly to the Index Listing Results Alert Mo tabular results are available because pour search criteria is too specific or too broad However there are entries in the index es that match pour search criteria IF You want to view tabular resulte initiate a new search that uses Fewer search items To view the index result
48. 25066 i Bursa Bypass Graft 35903 Cast 29075 i CT Scan 73200 73206 Decompression 25020 25025 i Exploration p Fasciotomy 24435 25020 25025 Hematoma 25028 l Incision and Drainage 23930 H Lesion Tendon Sheath E Magnetic Resonance Imaging MAI 73223 3218 73221 H Reconstruction H Removal CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 38 Code Detail Viewing the selected code in the Code Detail is like looking up the code and description in the ICD 9 CM CPT or HCPCS code book 14 Operations On The Musculoskeletal System 76 84 84 Other procedures on musculoskeletal system a 84 0 Amputation of upper limb Excludes revision of amputation stump 94 5 l l 84 00 Upper limb amputation not otherwise specified d Closed flap amputation of upper limb NOS Kineplastic amputation of upper limb HOS Open or guillotine amputation of upper limb NOS Revision of a current traumatic amputation of upper limb HOS 84 01 Amputation and dizarticulation of finger Excludes ligation of supernumerary finger 86 26 P 64 02 Amputation and disarticulation of thumb 64 03 Amputation through hand Amputation through carpals 64 04 Disarticulation of wrist 84 05 Amputation through forearm Forearm amputation 84 06 Disarticulation of elbow 64 07 Amputation through humerus Upper arm amputation 84 08 Disarticulation of shoulder 84 09 Interthoracoscapular amputation
49. 3 Color codes x New Revised OR Sex Medicare Find Procedures and interventions not elsewhere classified Therapeutic ultrasound Therapeutic ultrasound of vessels of head and neck Therapeutic ultrasound of heart Therapeutic ultrasound of peripheral vascular vessels Other therapeutic ultrasound Pharmaceuticals Implantation of chemotherapeutic agent Infusion of drotrecogin alfa activated Administration of inhaled nitric oxide Injection or infusion of nesiritide Injection or infusion of oxazolidinone class of antibiotics Other cardiovascular procedures Implantation of cardiac resynchronization pacemaker Revised The Revised tab shows all ICD 9 CM Vol 3 codes that have been revised and their descriptions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual ICD 9 Vol 3 Color Codes E xj New Revised or Sex Medicare Find Irrigation and exploration of ventricular shunt Insertion of non drug eluting coronary artery stent s Other endovascular repair of aneurysm of other vessels Insertion of non drug eluting non coronary artery stent s Cancel Help OR The OR tab shows all ICD 9 CM Vol 3 Operating Room procedures and their descriptions ICD 9 Vol 3 Color Codes E xi New Revised OR Sex Medicare Find Implantation of cardiac resynchronization pacemaker without mention of defibrillation total system CRT P Implantation of cardi
50. 5 cc or greater each 4214 Sterile saline or water 30 cc vial 4230 Infusion set for external insulin pump nonneedle cannula type 4231 Infusion set for external insulin pump needle type 4232 Syringe with needle for external insulin pump sterile 3cc 4244 Alcohol or peroxide per pint 4245 Alcohol wipes per box 4246 Betadine or pHisoHex solution per pint 4247 Betadine or iodine swabs wipes per box 4250 Urine test or reagent strips or tablets 100 tablets or E inal arm Medicare The Medicare tab shows all the HCPCS codes that are exclusive to Medicare The Code column shows the HCPCS code The Coverage column indicates whether the code 1s used at the carrier s discretion or 1s not covered The xl x 28 Description gives the code s description The data can be sorted by any of the three columns HCPCS Color Codes 1 New Revised Quantity Medicare Find Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Not Covered Carrier Discretion Not Covered Carrier Discretion CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Ambulance service outside state per mile tr Non emergency transportation per mile veh Non emergency transportation per mile veh Non emergency transportation taxi Nonemergency transportation and bus intra Non emergency transportation
51. 9 CM instructional notes AHA Coding Clinic references and annotations ICD 9 CM to DRG and MDC crosswalk Enter search terms Search History Copying Codes to the Notepad New Revised and Deleted Codes Code Book Section lookup Index Listing of ICD 9 CM code book All color codes associated with the selected code Customized Sticky Notes and Bookmarks Invalid codes unspecified codes CC exclusions Data Updates Print Reports Taskbar search tool CPT Lay Descriptions All the above except ICD 9 CM CPT Section Notes CPT Assistant References Special to DRG and MDC crosswalk with these added features Coverage Instructions CPT color codes identify add on modifier 51 exempt age and sex specific codes HCPCS color codes identify codes carrying quantity coverage and policy flags HCPCS Notes Medicare Coverage Instructions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 2 Encoder Pro Professional CPT Modifiers All the above with these added HCPCS Modifiers features LMRP Medical Necessity Edits National Coverage Determinations Edits CCI Unbundle Edits Surgical Crosscoder for CPT to ICD 9 CM ICD 9 CM to CPT HCPCS to CPT CPT to Dental codes CPT to CPT Anesthesia CPT to CPT Medicine CPT to CPT Radiology CPT to CPT Lab E M Assistant Medicare Physician Fee Schedule dialog box Encoder Pro Expert Fee Calculation by Locality All the above with these added Exam C
52. 9291 Standards of Medical Surgical Practice Allowed 99292 Standards of Medical Surgical Practice Allowed 30154 Standards of Medical Surgical Practice Allowed i epidural of blood or clot patch Version 9 0 Cancel Help HCPCS Color Coding Legend not in CIFI9 This information box displays a legend showing all HCPCS Color Codes and their definitions Color coding symbols identify special Medicare coverage issues affecting HCPCS codes You access this information box first by clicking a HCPCS code in the Code Detail and then click the Color Coding Legend button select Color Coding Legend from the HCPCS menu from the toolbar or CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED 67 Encoder Pro User s Manual e LL BEEN a Revised Code Le a yy Q m VI prrsc E CMS uu HCPCS Color Coding Legend 68 The following explains each HCPCS color coding symbol New Code Revised Code Carrier Discretion gt Not Covered By or Valid for Medicare Y Quantity Alert Medicare Policy CMS Sticky Notes lt This symbol identifies new HCPCS codes This symbol identifies revised HCPCS codes This symbol identifies codes that require carrier discretion Contact your carrier for specific coverage information for these codes This symbol identifies codes that are not covered by or valid for Medicare Click the Medicare Information button to read pertin
53. A disclaims responsibility for any consequences or liability attributable to or related to any uses non use or interpretation of information contained or not contained in this product The Correct Coding Policies do not supersede any other specific Medicare coding coverage or payment policies The Physicians Current Procedural Terminology developed by the American Medical Association and HCPCS Level II codes developed by the Centers for Medicare and Medicaid Services CMS are listings of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians The codes in the CPT Manual are copyrighted by the AMA and updated annually by the CPT Editorial Panel based on input from the AMA Advisory Committee which serves as a channel for requests from various providers and specialty societies The purpose of both coding systems and annual updates is to communicate specific services rendered by physicians CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 54 and other providers usually for the purpose of claim submission to third party insurance carriers A multitude of codes is necessary because of the wide spectrum of services provided by various medical care providers Because many medical services can be rendered by different methods and combinations of various procedures multiple codes describing similar services are frequently necessary to accurately refle
54. CM codes you must enter a decimal for codes with additional digits CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 30 If doing a word search do not enter numbers For example type chest x ray two views instead of chest x ray 2 views Unless you are entering a code number the search doesn t recognize numbers The Search recognizes several acronyms as search criteria You can enter these terms just as they appear in your documentation Encoder Pro automatically locates the correct code s For example to locate CPT codes for Computerized Axial Tomography you can enter the acronym CAT To locate codes for arterial blood gases you can type the acronym ABG Determining Search Criteria When choosing search criteria from your documentation it is important that you use terms that best identify the service or symptom Entering the proper terms ensures that searching is quick and accurate The suggestions below help you determine which terms to enter as search criteria Criteria for CPT Codes To determine the criteria for a procedure code search first ask yourself what was performed and where anatomical site 1t was performed Generally the first two words of your documentation identify what and where enter these terms as search criteria For example the key terms arthroscopy shoulder answers both what arthroscopy and where shoulder Entering these two t
55. CPT Color Codes x New Revised Addon 51 Exempt Find Ps Percutaneous mbadical annuloplasty any method undaberal or bilateral including Huorcopas guidance angle level 00637 Percutanecus mhradecal annuloplasty ang method undsberal or bisteral including lluarsteapic guidance one or mote additional bevels List separate m addition to O0B2T for pamaty procedure 00647 Spectrezcopy expired gas analysis eg rire conde cantbon dicoade best 00657 Ocular pholesereening vath inberpretation and report bilateral UDEBT Computed bemographic CT eolenography ie vilbual colenoscopy screening CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Revised The Revised tab shows all revised CPT codes and their descriptions CFT Color Codes New Revised Addon 51 Exempt Compulter azcisted musculoskeletal surgical navigational ofhopedie procedure esth gnage guidance based on CT MRI images List separately in addition lo code for pinay procedure 191560 Masectoma partial amp g lumpectomg Lylectornu quadianteciony segmentectomy 19162 Mastectomy partial eg lumpectomy tylechoeny quadiantectomy segmentectomy with alay lymphadenectomy 31530 Bronchoscopy ad or lebe wath ca watho fluoroscopic guidance with racheal brenchial diation or ceed reduction of facture 31531 Bronchoscopy nd or essble ath ca veihiout y LETTELE OE i a o mo
56. Code as a Primary Diagnosis mi V Code as a Secondary Diagnosis SDx Comorbidity or Complication Sticky Notes 45 This symbol identifies ICD 9 CM Vol 1 codes that are considered a female diagnosis This symbol identifies ICD 9 CM Vol 1 codes that are considered an adult diagnosis This symbol identifies ICD 9 CM Vol 1 codes that are associated with maternity This symbol identifies ICD 9 CM Vol 1 codes that are considered a newborn diagnosis This symbol identifies ICD 9 CM Vol 1 codes that are that are considered a pediatric diagnosis This symbol indicates that a code is classified as unspecified other or ill defined Codes identified by this symbol are also known as dump codes or catch all codes An unspecified code can be a valid choice if it most closely describes your diagnosis but use these codes only after checking all other options This symbol indicates a specified diagnosis but the ICD 9 CM system does not have a specific code that describes the diagnosis These codes may be stated as Other or Not elsewhere classified NEC This symbol identifies ICD 9 CM Vol 1 codes that do not report primary diagnoses Also known as manifestations these codes should only be listed as secondary diagnoses where appropriate Simply stated these codes are never used alone This symbol identifies ICD 9 CM Vol 1 codes that are Medicare Secondary Payer codes and
57. Codes Parenteral Therapy External Causes E Radiology C Codes Outpatient PPS Codes Temporary Codes Pathology and Laboratory D Codes Dental Procedures Medicine E Codes Durable Medical Equipment Evaluation and Management G Codes Procedures Professional Services Temporary CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 36 ICD 9 CM CPT HCPCS Category Ill H Codes Alcohol and Drug Abuse Treatment Services J Codes Drugs Administered Other Than Oral Method Chemotherapy Drugs K Codes Temporary L Codes Orthotic Prosthetic Procedures M Codes Medical Services P Codes Pathology and Laboratory Services Q Codes Temporary R Codes Diagnostic Radiology S Codes Temporary National Codes Non Medicare T Codes Codes Established for State Medicaid Agencies V Codes Vision Hearing Services Revert Button After you use the Narrow results by section button to view a level of more specific results in the Specify Code Type dialog box you can click the Revert button to go back to the previous broader level of search results This button is not available when you first perform a search because the first listing of results is the broadest level Viewing Index Listing You find codes from the ICD 9 CM CPT and HCPCS books by either searching the Code Detail or looking in the Index Similar to the code books y
58. Color Codes dialog box Code Book Sections Opens the Code Book Sections dialog box ICD 9 VoL 1 MENU This menu is available only when an ICD 9 CM Vol 1 code is selected in the Code Detail Information is specific to the currently selected code Items not available are dimmed ICD 9 Vol 1 ICD 9 Section Makes Annotations DRG Crosscodes Color Coding Legend Previous Codes Next Codes ICD 9 Section Notes Opens the ICD 9 Section Notes dialog box Annotations Opens the ICD 9 Annotations dialog box DRG Crosscodes not in STND Opens the DRG Crosscodes dialog box Color Coding Legend Opens the ICD 9 Vol 1 Color Coding Legend Previous Codes Displays the Code Detail view for the previous section of codes Refer to Code Detail for further information Next Codes Displays the Code Detail view for the next section of codes Refer to Code Detail for further information CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 128 ICD 9 VoL 3 MENU This menu is available only when an ICD 9 CM Vol 1 code is selected in the Code Detail Information 1s specific to the currently selected code Items not available are dimmed ICD 9 vol 3 amp nratatians Crosscoder DRG Crosscodes Color Coding Legend Previous Codes Next Codes Use 38 12 Annotations Opens the ICD 9 Annotations dialog box ICD 9 Vol 3 to CPT EXPT and PRO only Opens the ICD 9 Vol 3 to CPT dialo
59. GHTS RESERVED Examination dialog box you will be presented Cardiovascular OE 0s Eni Type For th ios adn becky aret eect all eben puse bee the py dung Pe manae A ek A xe emere Heer O n Cmdm Corio Ca Mae Mouth Thes mim Eom vor T Aucun of hast raf colas of abroad acne andi munus learned bio perr ran r Feci a mere celeste een rok gil mu mote Sept c an ond Puipaben cl heart jag locaton spe and lorca of ha port of mammal meai chars its palpable I a 4 Lsarsnabon ot V Canh aereo jeg enel pulus ampliare beats pacta delis beean sesta jeg nire haa Teral wiesen eq paa ampliada bros Pedal sten leg polos amplia Ear toe zampe at dona bi IT Ears Nose Mouth and Throat 3 ate A Fin iac ritr A all remet cebat ber Ph cec Dung the ureter eed Mercal Prior Fra Camdersnicalos Corinda Ex Mew ah Theat Ere HemiFace yaris V Augrulishon ni Fast retis pion pl abnormal voundz ad mmu Existe of peripheral vitulos nien by torah Je mein vicc ari papiros jeg bubi apis le ende ol Ee le Fia mac riter aahit bes ama cred all rnm cetur ber Pe cease Jong the ureter trm noc r E mieria dl occ acier incidir ida leg pln cn legos dra chances lacra dire cir and eec ube yop noces p Exterior of pueda and einen including shape debct arid corner nisachon aferra pupil sine jeg aniieecnel and bio V aora vul bado Sing bs co
60. Note that some checkboxes are not available depending on the product you purchased To use the Print Report dialog box 1 Click the Print button amp or select Print from the File menu The Print Report dialog box appears Print Report q x Select the reports you would like to print Selected Code 29806 General Reports Code Specific Reports Code Detail Guidelines Notes References Tabular Results Annotations or Lay Descriptions Index Listing Modifiers Bookmart Crosscoder Sticky Notes All Codes CCI Unbundle Edits Compliance Notepad Local Medical Review Policies LMRIP AMA Copyright Carriers with LMBP License Agreement National Coverage L age Wereminations N Medicare Physician Fee Schedule CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 81 2 Select the item s you want to print 3 Click the Setup button to display the Page Setup dialog box You can also access this dialog box by selecting Page Setup from the File menu Use the Page Setup dialog box to identify the type of printer you use to specify the paper tray and to set up other print preferences 4 Click the Print button General Reports Code Detail For CPT and HCPCS codes prints the current screen view in the Code Detail For ICD 9 CM codes prints all fourth and fifth digit codes excludes includes modifiers and other tabular infor
61. Note exists for codes selected in the Code Detail a Sticky Note icon is also displayed in the Color Code box For a quick view of the Sticky Note s text hold your mouse pointer over the Sticky Note icon and a help balloon appears with the Note s contents Otherwise double click on the Sticky Note icon to take you directly to the View Sticky Note dialog box SELECTING A CODE FROM CODE DETAIL When you select a code from the Code Detail you can view the CPT Book guidelines modifiers unbundles and cross coding information through Code Specific Dialog Boxes To select a code from the Code Detail 1 Click any code to identify it as the selected code 2 To scroll quickly to a code in the list enter the code number at the search prompt ICD 9 CM CODE DETAIL The ICD 9 CM Code Detail arranges codes according to three digit categories for Vol 1 codes and two digit categories for Vol 3 codes You see the includes and excludes notes and government notes and instructions that affect all codes in each category Codes that require additional digits are shown in red For example the Code Detail for fourth digit code 056 7 scrolls to the code within the three digit category 056 You can view all applicable fifth digit codes 056 71 and 056 79 and see all other fourth digit codes in 056 You also see the Includes and Excludes notes that affect all codes in 056 You can double click any code that is cross referenced in the Code Detail such a
62. Other prostatectomy Der ib mmm samir shimin af Sce M iiu b Cancel Help CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED 26 Encoder Pro User s Manual 27 Medicare The Medicare tab shows all the ICD 9 CM Vol 3 codes that are exclusive to Medicare The Code column shows the ICD 9 CM Vol 3 code The Coverage column indicates whether the code is covered by Medicare The Description column gives the code s description The data can be sorted by any of the three columns ICD 9 Vol 3 Color Codes E xi New Revised OR Sex Medicare Find I Not Covered Keratomileusis Not Covered Keratophakia Not Covered Radial keratotomy Not Covered Epikeratophakia Not Covered Lung volume reduction surgery Not Covered Lung transplantation NOS Not Covered Unilateral lung transplantation Not Covered Bilateral lung transplantation Not Covered Combined heart lung transplantation Not Covered Other transmyocardial revascularization Not Covered Partial ventriculectomy Not Covered Heart transplantation Not Covered Implant of implantable pulsatile heart assist system Not Covered Extracranial intracranial EC IC vascular bypass Not Covered Bone marrow transplant not otherwise specified Not Covered Autologous bone marrow transplant without purging nbl i Mak Caunrned Alle mm mim hana moran renis ri irata Cancel Help HCPCS Color Codes not in CIF 19 To open th
63. PT and or HCPCS codes that you have selected for the Notepad It also gives you an opportunity to enter patient data to enhance the compliance edit This dialog box appears when you click the Compliance Edit button from the Notepad Compliance Edit P x The Compliance Edit checks for coding conflicts affecting the ICD 9 CPT and or HCPCS codes that you have selected for the Notepad Patient Information Some edits check for age and sex conflicts To include these edits enter the patient s date of birth and sex x Sex None y Date of Birth frs Use Patient Information m Medicare Carrier Locality Select the Medicare carrier locality that medical necessity edits should be based on These edits are from the local Medicare review policies LMRP and vary by carrier NCD edits are also included 00000 00 NCD Ntnl Coverage Determinations amp Make default Medicare Carrier Locality HN The compliance edit identifies CCI unbundle edit conflicts LMRP Medical Necessity and NCD conflicts based on Locality selection CD 9 CM codes that require an additional digit Nonspecific codes Commonly miscoded procedures Age edit conflicts Sex edit conflicts ICD 9 CM codes that can t be primary diagnoses Medicare noncovered codes CPT codes that can t be primary procedures CPT add on codes that require primary procedure codes The Patient Inform
64. User s Manual Encoder Pro INGENIX 525 Lake Park Blvd West Valley City UT 84120 800 INGENIX Encoder Pro User s Manual II Copyright 2006 Ingenix Inc Encoder Pro All rights reserved Printed in the United States of America This document is designed to be an accurate and authoritative source of information about Encoder Pro and its suite mates Every effort has been made to verify the accuracy of the information and all information is believed reliable at the time of publication However absolute accuracy cannot be guaranteed Since the policy of Ingenix is to make continuous improvements this document is subject to change without notice All attempts are made to ensure that the information presented in this document is correct However if you should find any error please notify an Ingenix representative No liability expressed or implied will be assumed by Ingenix or its affiliates for any damage resulting from the use of the information in this manual AMA Notice CPT Codes descriptions and other CPT material only are copyright 2005 American Medical Association AMA All Rights Reserved No fee schedules basic units relative values or related listing are included in CPT AMA does not directly or in directly practice medicine or dispense medical services AMA assumes no liability for data contained or not contained herein NTIS Notice The responsibility for the content of any National Correct Coding P
65. You open this dialog box by selecting E M Assistant from the File menu It also opens automatically when you enter a key term e g office that describes an E M service that is reported by a CPT code with a key component In this first screen Select Service you are to select the type of service and then click Next This will take you to the Select Visit dialog box To exit out of the E M Assistant click Cancel E M Assistant Select Service E xj The E M Assistant can help you find the appropriate evaluation and management code for services with key components To use the E M Assistant select the type of service and then select Nest to proceed To Exit out of the E M Assistant and perform a regular search select Cancel C Inpatient C Consultations C Emergency C Nursing Domiciliary C Home coca Heo CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 86 Here are the CPT Book guidelines that can help you determine which menu selections are appropriate not all menu selections are referenced here Select outpatient unless the patient has been admitted as an inpatient to a healthcare facility Select inpatient hospital for patients admitted as inpatients in a hospital or partial hospital setting Select consultations when service is provided by a physician whose opinion or advice regarding evaluation and or management of a specific problem is requested by another
66. a 126 EDI VOlL 3 COROS dd 127 CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual IX HOPOS Color Godes MOUM Ol ies 127 Gode BOOK SOCOM 4e diese us sistema a in patate t a ico res osemaus a 127 ICD 9 Vol 1 MEDU oiii aia ite eed ici adds 127 GD SOCOM NOIBS aussi alados 127 ANNOTA LON cce T P TURN 127 DRG Grosscodes notin 9 ND soa lios 127 Solo r Godina LEGON Mt PE 127 Previous GO Ss m DR 127 Next Ode E M 127 ICDS VOR 3S Mena EESR 128 AMOS dali E a S 128 ICD 9 YOLS to CPT EXPT and PRO Only inet 128 DAG Grosscodes notin SUND estrias 128 Color Coding 6G end oc 128 Previous OCS cm MMC CE 128 INGE COGS T IT a a 128 CPT Esse ur e n 129 GPT SOCOM NOLES o H 129 LAY Describa a 129 Modifiers EXPT and PRO Only ect eske ete Retest nese depo abcr os 129 Grosscoder EXPT and PRO OMIY areena teri veas ruta ie an uae oso he ree e N 129 CCI Unbundle Edits EXPT and PRO Only ccccccccccccnccnnncccccccoonccnnnncnoncnnanonnnnonononannnnnnnnonononanennnns 129 Local Medical Review Policies EXPT and PRO only oocccccccccncccncccccocccnncccnanonnncononncncnonannnononnnnos 129 National Coverage Determinations EXPT and PRO only esses 129 Medicare Fee Schedule EXPT and PRO ONly ooccccccoccncnnncccnccccon
67. ac resynchronization defibrillator total system CRT D Implantation or replacement of transvenous lead electrode into left ventricular coronary venous system Implantation or replacement of cardiac resynchronization pacemaker pulse generator only CRT P Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only CRT D Dpen biopsy of cerebral meninges Dpen biopsy of brain Cancel Help Sex The Sex tab shows all ICD 9 CM Vol 3 codes that are attributable to either a male or female diagnosis The Code column provides the ICD 9 CM Vol 1 code The Type column shows the gender for which the procedure is intended The Description column gives the code s description The data can be sorted by any of the three columns ICD 9 Vol 3 Color Codes xj New Revised OR Sex Medicare Find Code Sex Description o Incision of prostate Closed percutaneous needle biopsy of prostate Open biopsy of prostate Closed percutaneous biopsy of seminal vesicles Open biopsy of seminal vesicles Biopsy of periprostatic tissue Dther diagnostic procedures on prostate and periprostatic ti Dther diagnostic procedures on seminal vesicles Transurethral ultrasound guided laser induced prostatecto Dther transurethral prostatectomy Suprapubic prostatectomy Retropubic prostatectomy Radical prostatectomy Local excision of lesion of prostate Perineal prostatectomy
68. active only when there is at least one code entered in the Diagnosis Codes field or the Procedure Service and or Supply Codes field When clicked the program first checks to make sure no other code is already assigned as primary there can be only one primary code per code description box f no codes have been selected as primary the Make Primary Code dialog box displays to confirm that you want to designate the selected code as Primary Jfa code is already selected as primary the New Primary Code dialog box displays to tell you that only one code can be considered primary and that continuing with this action makes the selected code the primary code f you want to deselect a code as primary you select the code that is primary and click the Designate Primary button The Deselect Primary Code dialog box displays to inform you that this code is already designated as primary and that continuing with this action turns off the Primary designation CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 78 Once a selected code is made primary a check appears in the field If a code is deselected as primary then the check no longer appears The Copy to Clipboard button is described in Sending Data to the Clipboard The Edit Compliance button available only in EXPT allows you to perform a code validation edit from this dialog box It is active only when there is at least one code entered in t
69. ailable for the selected code the corresponding button and menu option are dimmed to indicate that the information is not applicable to that particular code ICD 9 CM VoL 1 DIALOG BOXES ICD 9 CM Instructional Notes This dialog box can be used to view notes from the code book that pertain to the selected code and to view references to AHA Coding Clinic issues You access this dialog box by selecting an ICD 9 CM code that has associated notes references from the Code Detail Then click either the Notes button EZ from the toolbar or go the ICD 9 Vol menu and select ICD 9 CM Instructional Notes Instructional Notes This tab displays notes that apply to the selected code These instructional notes which appear at the beginning of certain sections in the Code Detail of ICD 9 CM further define terms clarify information and provide fifth digit information They also contain includes and excludes notes that pertain to the selected code CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 42 ICD 9 C Instructional Motes 716 210 719 ARTHROPATHIES AMD RELATED DISORDERS 710 719 Excludes disorders of spine 720 0 724 3 710 733 13 DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 710 733 The following fifth digit subclassificatian is for use with categories 711 712 715 715 718 713 and 730 O site urispecified 1 shoulder region Acromioclayicular joint s Glenohumeral jo
70. ailable to network users IV Personal Sticky Notes v Unbundle E dits v Personal Bookmarks IV Crosscodes v Section Notes Iv CMS Policy v Medicare Fee v Annotations Y DRG Crosscodes v Modifiers Setldle Time Shutdown 1200 Minute MAX Minutes Zero minutes NO shutdown 0 4 Data Versions Tab EXPT and PRO only This preference tab has an arrow down box to select one of the last four CCI data versions in Encoder Pro EXPT and PRO only The default is the latest version The program closes when the version is changed The new version selection appears when Encoder Pro is launched Preferences O x Copy Search View Network Data Versions Cancel Help LAUNCHING FROM THE TASKBAR There is an option that can be installed to launch Encoder Pro product from the Taskbar This option is separately installed 1 From the Explore menu select C Ingenix EncoderPro 2 Double click on IngenixToolBar exe 3 Follow the installation instructions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 15 After installation is complete an Ingenix icon displays on the Start Taskbar to browse for codes when Ingenix Tools is selected l Right click on the Start Taskbar 2 Select Toolbars Ingenix Tools The Ingenix icon displays Ingenix D Enter a code in the search box and press the enter key 3 4 5 The product login box di
71. al multisystem examination OR perform and document examination of at least 12 elements in two or more organ systems or body areas from the general multisystem examination OR perform and document examination of at least 12 bullet elements from one of the single organ system examinations shaded or unshaded boxes EXCEPT eye and psychiatric single system examinations perform and document at least nine bullet elements shaded or unshaded boxes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 101 Comprehensive Perform and document examination of at least nine organ systems or body areas with all bullet elements for each organ system or body area unless specific instructions are expected to limit examination content with at least two bullet elements for each organ system or body area from the general multisystem examination OR perform and document examination of all bullet point elements from one of the ten single organ system examinations with documentation of every element in shaded boxes and at least one element in each unshaded box from the single organ system examination 1995 Documentation Guidelines for Evaluation and Management Services Problem focused One body area or system Expanded problem focused Two to seven systems of which one may be a body area s Detailed Two to seven systems of which one may be a body area s with one organ system being examined and documented in d
72. alculator features Compliance Edit Edit Reports Select Multiple CCI Versions ABOUT INGENIX Ingenix is a recognized leader in providing accurate and meaningful healthcare data and information Ingenix has the reputation for providing authoritative and comprehensive coding compliance billing and benchmarking tools Ingenix has the ability to empower organizations giving them control over profits consistent performance and better quality of care The power of Ingenix expertise offers an unparalleled resource for your financial clinical and operational needs GETTING HELP Consult this User s Manual It explains all product features and guides you through all basic functionality Note that certain features may not be available to you depending on which product you purchased from Encoder Pro Access the online help by selecting an item from the Help menu or clicking the button on the black toolbar Online help includes information about how to use the program and provides clinical information about coding Call 800 765 6797 to speak with an Ingenix software technical support representative SOFTWARE FEATURES CodeLogic Search Technology Simultaneous code search across ICD 9 CM CPT and HCPCS code sets Your search results can be limited to just one code set a combination of two or all three Search results and code information display on one screen Code It Fast I 9 returns results on ICD 9 CM volumes 1 and 3 only
73. are carriers and intermediaries have significant authority through their medical directors to define what is medically necessary LMRPs can include incorrect or incomplete information as they are relative to a specific region carrier or procedure and can vary widely Encoder Pro Expert and Professional review procedure and diagnosis codes against edits for active Part B LMRPs for all carriers and regions to ensure that providers billing Medicare can receive proper reimbursement These LMRP edits are designed to give information as to which diagnoses are considered medically necessary and are covered by Medicare If a relationship exists to support medical necessity then there is no LMRP Edit Conflict If a relationship does not exist in the LMRP data for a certain CPT ICD combination then there is an LMRP Edit Conflict This conflict is shown as an alert and it could be due to several different reasons At times a Medicare carrier does not list a particular diagnosis with a procedure code that it may match clinically and meet valid cross coding requirements This may be due to the fact that they require submission of a different diagnosis for the procedure to be covered They may not accept a diagnosis just because it may clinically seem valid for the procedure EXPT and PRO alert providers to this type of conflict and others and asks the provider to rely on their history of billing and reimbursement with their carrier to override any pote
74. areas and organ systems compose the elements of the physical examination Body Areas Head including face normocephalic scalp Chest including breasts and axillae symmetry skin changes dimpling nipple area Neck trachea larynx thyroid goiter nodules mass tenderness bruit crepitus Abdomen rebound scars distension palpate liver spleen tenderness Genitalia groin buttocks visual inspection nodes Back including spine contour tenderness swelling Each extremity clubbing edema asymmetry Note Body Areas count only as one element of the examination in quantifying the level of physical examination even if all body areas are inspected Organ Systems Constitutional general appearance vital signs blood pressure pulse temperature respiration height weight Eyes pupils equal round reactive to light and accommodation discs retinal vessels extraocular movements Ears nose throat pinnae external auditory canal tympanic membrane mucosa septum polyps turbinate lips gingiva posterior pharynx tonsils gag reflex CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 100 Cardiovascular murmur rub gallop hypertension peripheral vascular pulses varicose veins Respiratory breath sounds wheezes rales rhonchi resonance contour Gastrointestinal Bowel sounds soft abdominal bruits ascites fluid waves Genitourinary Male
75. as s nsss 135 Crosscodes EXPT and PRO only cccccsssssssssssssssssssssssssssesssssssssssssssessssssssssssssssesecesssssssssseceeees 135 CCI Unbundle Edits EXPT and PRO only eese canina nr 135 LMRP Edits EXPT and PRO onlly ccccccsssscssssssssssessessessesseeseeseessessesseesneseeseesaesausevsnvsneeneas 135 HGD NCD Edits EXPT and PRO ly rre 135 CMS Fee Schedule EXPT and PRO only esee eene nnne nnne nnns 135 CMS Policy EM nol in CIRIO ccoo uam e Spa c x ka n cus teudu si ceu a un nnmnnn nan 135 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual XII CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Welcome Welcome to Encoder Pro the powerful medical coding solution Encoder Pro searches ICD 9 CM CPT and HCPCS Level II code sets provides information from Medicare policies and Ingenix publications and helps you confidently select the proper codes quickly and accurately The following products are available in Encoder Pro Code It Fast I 9 CIFI9 Encoder Pro STND Encoder Pro Professional PRO Encoder Pro Expert EXPT All features explained in this User s Manual apply to all products in Encoder Pro unless otherwise noted Feature availability per product is noted in the table below Code It Fast l 9 Encoder Pro ICD 9 CM Volume 1 and 3 codes ICD
76. ate code Administration Administrator Login All Multi User Versions Opens the Administrator Login dialog box that allows you rights such as adding global bookmarks and sticky notes The default login password is ingenix You only see this option if you are not already logged in as the System Administrator Administration Administrator Logout All Multi User Versions Selecting this option logs you out as the System Administrator You only see this option if you are already logged in as the System Administrator Administration Change Admin Password All Multi User Versions If you have logged in as an Administrator this selection opens the Set Password dialog box that allows you to change the Administrator password CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 125 Administration Change Password All Multi User Versions If you are not logged in as an Administrator this selection opens the Set Password dialog box that allows you to change your User password Administration User Maintenance All Multi User Versions Opens the User Maintenance dialog box This option is only available if you ve already logged in as the System Administrator Exit Ctrl Q Closes the program EDIT MENU Edit Copy CEri c Add Preferences Select Carrier Lacaliby Copy Ctrl C Copies the selected highlighted Code Detail code description depending on the pre
77. atient E M services provided by the same physician on the same date and performed in multiple outpatient setting s e g hospital emergency department clinic see Evaluation and Management Emergency Department or Preventive Medicine Service codes Medicare requires Modifier GO in place of Modifier 27 at the time of this printing 32 Mandated Services Services related to mandated consultation and or related services e g PRO third party payer governmental legislative or regulatory requirement may be identified by adding the Modifier 32 to the basic procedure or the service may be reported using the five digit modifier code 09932 52 Reduced Services Under certain circumstances a service or procedure is partially reduced or eliminated at the physician s discretion Under these circumstances the service provided can be identified by its usual procedure number and the addition of the Modifier 52 signifying that the service is reduced This provides a means of reporting reduced services without disturbing the identification of the basic service Modifier code 09952 may be used as an alternative to Modifier 52 Note For hospital outpatient reporting of a previously scheduled procedure service that 1s partially reduced or canceled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia see Modifiers 73 and 74 57 Decision for Sur
78. ation area of the dialog box allows you to input the patient s date of birth and select the patient s gender You are not required to complete these fields to continue with the edit For the Date of Birth you may choose to enter the patient s date of birth if you want the Edit Compliance to check for age edits For the Sex drop down list you can select the patient s gender if you want the Edit Compliance to check for sex edits CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 115 The Use Patient Information check box should be marked if you want the patient s birth date and gender to be part of the compliance edit The Medicare Carrier Locality area shows the Medicare locality information that is used for the LMRP Medical Necessity and NCD edits You may use the default established in the Select Medicare Carrier Locality EXPT and PRO only dialog box or you can change it from the drop down list to view the calculated fee for any Medicare locality The Make default Medicare Carrier Locality check box is active only if you select a Medicare Carrier from the Medicare Carrier Locality drop down list that is different from that selected in the Select Medicare Carrier Locality dialog box If the user selects this check box then the carrier selected in the Medicare Carrier Locality drop down list becomes the new default carrier Once you ve adjusted the above fields to your spe
79. atures 290 21 Sende dementa wih depressree feabures 290 3 Senie demenba wah deiu 1230 40 Vascular dementia uncomp caled 290 41 Vascular dementia wath deben 1290 42 Vascular dementia vath delusion 1290 43 Vascular dementia wth depressed mood 230 8 Other speched sende psychotic conditions 1290 3 Unepeched sende psychobe condon 291 0 Alcohol withdrawal delium 1291 1 Akcoholmducsd passing amnesic CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 66 HCPCS CCI Unbundle Edits EXPT and PRO only This dialog box allows you to see HCPCS codes that have unbundle edits based on Medicare s Correct Coding Initiative CCI It shows CPT codes that should not be billed with the selected HCPCS code The reason for the unbundle edit as defined by the Medicare Correct Coding Initiative 1s also shown You open this dialog box by selecting a HCPCS code in the Code Detail that has CCI unbundle edits and then either clicking the CCI Edits button from the toolbar or selecting CCI Unbundle Edits from the HCPCS menu This dialog box contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking them or by selecting them and then clicking the Select button Tabs At least one of the following three tabs are also included in this dialog box depending on the code selected CCI Component tab If the selected HCPCS code repre
80. ault is for the global note to take precedence as the primary note x Copy Search View Network Data Versions View search results according to v Display Edit Bookmark dialog each time a bookmark is assigned to a code m Multi User Versions Only If a code has both a personal and global note specify which type of bookmark and sticky note should appear first Global Note C Personal Note Cancel Help Network Tab Multiple User Versions The Network tab within the Preferences dialog box is only available if you are logged in as a System Administrator It gives the System Administrator the ability to activate or inactivate the following functions for ALL users Personal Sticky Notes Personal Bookmarks Section Notes Annotations Moditiers Unbundle Edits Crosscodes CMS Policy Medicare Fee DRG Crosscodes Click the check box for any feature to deselect it click again to reselect it CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 14 Note Some of the check boxes discussed in the paragraph above are not available depending on which Encoder Pro product you purchased The Network tab also has a Set Idle Time Shutdown spin box that allows the System Administrator to specify how long the program can remain idle before the product shuts itself down Preferences x Copy Search View Network Data Versions m Select the features you want av
81. b tests Review and or order of tests in radiology section of CPT 1 Review and or order of tests in the medicine section of CPT Discussion of test results with performing physician Decision to obtain old records and or obtaining history from someone other than patient health care provider Independent visualization of image tracing or specimen itself not simply review of report Transfer total to line B of Final Result for MDM table TOTAL Review and summarization of old records and or obtaining history from 2 someone other than patient and or discussion of case with another 2 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 103 Final Result for Complexity of Medical Decision Making 2 of 3 required A Number of diagnoses or 1 2Limited 3Multiple S4Extensive management options Minimal Amount and complexity of 1 Minimal 2Limited 3Moderate S4Extensive data to be reviewed C Risk of complications amp or Minimal Low Moderate High morbidity or mortality TYPE OF DECISION STRAIGHT LOW MODERATE HIGH MAKING FORWARD COMPLEX COMPLEX COMPLEX Contributory Components 4 Nature of presenting illness The E M codes divide this into five types Minimal Problem that may not require the presence of the physician but service is provided under the physician s supervision Self limited or minor Transient problem and low probability of permanently altered state or good pr
82. bed below and correlate to the CMS s 1997 Documentation Guidelines for Evaluation and Management Services For example an expanded problem focused history includes the chief complaint and a brief history of the present illness and a system review focusing on the patient s problems CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 97 Key Components 1 History The history the first of the three key components described by CPT must always include a chief complaint Even if the chief complaint describes that the patient is presenting for follow up of a previous problem the reason for the visit is clear The other areas of history are History of Present Illness Review of Systems Past Medical History Family Medical History Social History Within each area of history there is basic information that makes up the elements of the history These elements are described below in detail Once documented the elements are then quantified to substantiate the level of history The History of Present Illness includes information described by the patient about the current condition including Location Severity Timing Modifying Factors Quality Duration Context Associated Signs and Symptoms An explanation of each of these elements follows Location Refers to a specific location of the problem For example pain in the groin area elbow pain headache Severity Description of the severity o
83. box es of the code set s you want to search are marked 2 Selecta check box to include the code set clear the check box to exclude the code set m Copp Search View Network Data Versions Select the code sets below that you wish to include when searching on All Code Sets IV ICD 3 Vol 1 Iv ICD 9 Vol 3 Iv CPT Iv HCPCS Cancel Help When you enter search criteria the program searches both the standard code list and the Index for matches CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 13 View Tab There are three preferences to determine within this Preference dialog box tab View search results according to There are two selections in this drop down list Weighted ranking arranges search results so the codes that best fit your search criteria are listed first This is the default option Alphanumeric listing arranges code results in ascending alphanumeric order Display Edit Bookmark dialog each time a bookmark is assigned to a code A check in this box specifies you want the Edit Bookmark dialog box to open whenever a bookmark is added to a code The default is for this box to be checked Multi User Versions Only This area is for use by multi user version customers From here you specify which sticky note should display in the View Sticky Note dialog box when a code has both a global sticky note and a personal sticky note assigned to it The def
84. cases the patient s avocations and or hobbies may be significant such as mountain climbing skiing deep water diving and so forth Modifiers Used with E M Codes The following modifiers apply to E M codes other modifiers may apply in some situations 21 Prolonged Evaluation and Management Services When the face to face or floor unit service s provided is prolonged or otherwise greater than that usually required for the highest level of E M service within a given category it may be identified by adding Modifier 21 to the E M code number or by using the separate five digit modifier code 0992 A report may also be appropriate 24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period The physician may need to indicate that an E M service was performed during a postoperative period for a reason s unrelated to the original procedure This circumstance may be reported by adding the Modifier 24 to the appropriate level of E M service or the separate five digit modifier code 09924 may be used CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 108 25 Significant Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure or Other Service The physician may need to indicate that on the day a procedure or service identified by a CPT Code was performed the patient s condition required a significan
85. ciesi LMIRP and vary by carrier This selected carrienlocality will also be the default choice for calculating area specific fees from the Medicare Fee Schedule 00410 09 UTAH UT CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 84 CARRIERS WITH LMRP EDITS EXPT AND PRO ONLY This dialog box shows a list of all carriers that have LMRP edits You access this dialog box by selecting Carriers with LMRP from the CPT or HCPCS menu It can also be accessed via the Right Click menu Both methods are active only when the you select a code with LMRP edits from any carrier Carriers with LMRP Edits E x 93000 Carer Mame ate fa 00510 00 ALABAMA AL 00520 13 ARKANSAS AR 00521 05 NEW MEXICO NM 0522 00 OKLAHOMA Ok 00523 01 METROPOLITAN ST LOUIS MO Mo 00523 99 REST OF MISSOURI Mo 00528 01 NEW ORLEANS L LA 00528 99 REST OF LOUISIANA LA 00590 03 FORT LAUDERDALE FL FL 00590 04 MIAMI FL FL 00590 99 REST OF FLORIDA FL 00630 00 INDIANA IN 00660 00 KENTUCKY Ey 00751 01 MONTANA MT 00801 99 REST OF NEW YORK MY 00803 01 MANHATTAN NY NY 00803 02 NYC SUBURBS LONG NY MY 00803 03 POUGHKPSIE N NYC SUBURBS NY NY 00805 01 NORTHERN NJ MJ 00805 99 REST OF NEW JERSEY Show Edits Cancel Help The dialog box has three columns showing the carrier number name of the carrier and the state abbreviation From this dialog box yo
86. cific needs you click either the Cancel or OK button If you click Cancel the Edit is cancelled If you click OK the compliance edit is initiated There are only two possible results after clicking OK These dialog boxes are described in the Additional Help Topics identified below Editis Completed This message box tells you that the edit is complete and that no coding conflicts were found It appears when you click the OK button from the Compliance Edit dialog box and no edit conflicts were found The OK button closes the message box and returns you to the Notepad Encoder Pro Product Suite Edit Conflicts This dialog box presents you with a report of the codes that have edit conflicts It appears when you click the OK button from the Compliance Edit dialog box and edit conflicts were found Edit Conflicts E X Edit Conflicts LMRP Edit Conflicts CCI Unbundle Edit Conflicts Description Caution Nonspecific Code Code is classified as unspecified other or ill define Caution Frequently Misc This code may be a valid choice if it most closely de Caution Medicare Nonco Code reports a procedure service or supply that is ni Fail Add on Without Code requires a primary procedure code Known as Fail Add on Without Code requires a primary procedure code Known as Cancel Print Help CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 116 T
87. ck the Narrow results by section link This allows you to select additional search criteria to narrow the focus of your search This link is available only if the search results include codes that are in multiple sections of CPT ICD 9 CM or HCPCS Narrow results by section Many search terms bring back results from multiple sections of ICD 9 CM Vol 1 CPT and or HCPCS e g the Tabular Results may list codes from the surgery radiology and medicine sections of CPT If you have performed this type of search the Specify Code Type dialog box appears when you click the Narrow results by section link This dialog box allows you to narrow your search results by including or excluding code range sections that are appropriate Note The Specify Code Type dialog box appears only for the code sets you select before initiating a search For example if you search on biopsy but only have the ICD 9 Vol 1 check box marked when you click Narrow results by section link you won t see the range categories tab for CPT codes even if CPT codes appeared in your initial tabular results You must initiate the search again and make sure the CPT check box is marked when you click Narrow results by section link CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 35 In the Specify Code Type dialog box a tab appears for each code set ICD 9 Vol 1 CPT and HCPCS that has results listed for multiple code
88. ck toolbar All Code Sets Y Deleted Codes 7 At the far left the Code Search drop down list that allows you to determine if your search looks at all codes or a specific code set CPT HCPCS ICD 9 CM Vol 1 or ICD 9 CM Vol 3 You define what you mean by All Code Sets in the Search tab of the Preferences dialog box CFT HCPCS ICD 3 Vial 1 ICD 9 Wol 3 The Search box is used to enter search terms You can also type in a valid code number to bypass the search and go directly to the Code Detail Click the Search button to the right of the Search Box or click the Enter key to initiate the search The drop down list on the right side of the black toolbar provides four ways to quickly access New Codes Revised Codes Deleted Codes and Code Book Sections Make your selection and then click the View button to access the dialog boxes Mew Codes Revised Codes Deleted Codes Code Book Sections CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 19 New Codes New Code x CPT HCPCS ICD 3 vol 1 ICD 3 val 3 Endovascular repair of infrarenal abdominal aortic aneurysm or dissection modular AA A AAA ASA c E 0002T Endovascular repair of infrarenal abdominal aortic aneurysm or dissection aorto uni iliac or aorto unifemoral prosthesis 0003T Cervicography 0005T Transcatheter placement of extracranial cerebrovascular artery stent s percutaneous
89. code set s you aren t interested in viewing ICD 9 CM Vol 1 ICD 9 CM Vol 3 CPT or HCPCS Multiple User Version Note If you have the multiple user version of this program the Bookmarks dialog box contains a Global tab Click this tab to view global bookmarks added by the System Administrator To add edit or delete a global bookmark you must login as the System Administrator Refer to System Administrator Login for instructions Updating Bookmarks The Bookmarks dialog box doesn t contain any codes or sticky notes when you first install this program You must add all bookmarks codes to the dialog box If you are installing over a previous version all bookmarks are preserved However if you in a previous version had a bookmark assigned to a code that the AMA has decided to delete you receive this warning dialog box when you first open the Bookmarks dialog box Bookmarks Update E X rou have bookmarks assigned to invalid cades Click Delete to remove the bookmarks For all invalid cades Click Save to keep the bookmarks IF you choose this option pau can use Encoder Pro ta look up codes and create new bookmarks hor valid codes You can then delete the bookmarks for invalid codes by clicking Delete in the Bookmarks window Discontinue showing this dialog E Save Take the appropriate actions according to your needs CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Adding a
90. ct what service a physician performs While often only one procedure is performed at a patient encounter multiple procedures are performed at the same session at other times In the latter case the pre procedure and post procedure work does not have to be repeated and therefore a comprehensive code describing the multiple services commonly performed together can be defined Third party payers have adopted the CPT coding system for use by providers to communicate payable services It therefore becomes more important to identify the various potential combinations of services to accurately adjudicate claims LMRP Medical Necessity Edits EXPT and PRO only This dialog box allows you to see which ICD 9 CM codes are allowable for a selected CPT code and Medicare carrier You access this dialog box by selecting a CPT or HCPCS code in the Code Detail and clicking the LMRP Edit button 1e or by selecting Local Medical Review Policies from the CPT or HCPCS menu The button and menu are only active if there are LMRP edits for the selected code and carrier preference code The Local Medical Medicare Review Policy is an administrative and educational tool to assist providers physicians and suppliers in submitting correct claims for payment Local policies outline how contractors review claims to ensure that they meet Medicare coverage requirements Under the Medicare program the government pays only for medically necessary services The Medic
91. d Medicare Rules for the selected CPT code Or prints CIM MCM references for the currently selected HCPCS code CMS Coverage Instructions This check box is grayed out in CIFI9 Prints any special coverage instructions This is not visible in CIFI9 DRG Crosscodes This check box is grayed out in STND Prints the DRG code and description MDC medical surgical designation and Medicare calculation information GMLOS AMLOS RW etc for the currently selected ICD 9 CM code Sticky Note Prints the View Sticky Note dialog box contents for the specified code DATA VERSION The Data Version dialog box appears when you select Data Version from the Help menu It provides information regarding what version of the data 1s contained in a given release Click the blue links at the right of the dialog box to link to the data sources The sample below is a snapshot The versions noted may not match what you see when you access the dialog box from Encoder Pro Data version x The following is a list of the data components installed for the Encoder Pro Product Suite ICD 9 CM Vols 1 and 3 codes and descriptions 2003 ICD 3 CM Info CPT Codes and descriptions 2003 CPT Info Medicare Physician Fee Schedule 2003 CMS Fee Info HCPCS codes and descriptions 2003 HCPCS Info Dental Codes 2003 Dental Codes Info ICD 3 to DRG cross walk 2003 ICDS To DAG Info Medicare NCCI Version 9 1 NCCI Info Cross codes 2003 Crosscodes Info Modifier cross walk 2
92. d by or valid for Medicare have special coverage instructions are reimbursed based on carrier discretion etc Refer to HCPCS Color Coding Legend not in CIFI9 for further information CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 41 Code Specific Dialog Boxes You can quickly view additional information from St Anthony Publishing Medicode s top selling publications for the selected code You can open various dialog boxes for ICD 9 CM CPT and HCPCS codes selected from the Code Detail This code specific information is accessed from the buttons that appear at the top of your screen and depending on the product you have from the ICD 9 Vol 1 ICD 9 Vol 3 CPT or HCPCS menu The name of the menu changes depending on the type of code selected in the Code Detail The code specific dialog boxes that are available are specific to the type of code selected Refer to ICD 9 CM Vol 1 Dialog Boxes ICD 9 CM Vol 3 Dialog Boxes CPT Dialog Boxes and HCPCS Dialog Boxes for the various dialog boxes you are able to access depending on the code selected The following paragraphs explain each code specific dialog box First they show all dialog boxes available for ICD 9 CM codes then dialog boxes for CPT Codes and finally those available for HCPCS codes Notes You must select a code in the Tabular Results to identify it as a selected code and display itin the Code Detail If a dialog box is not av
93. d code at the Search box the deleted code you entered 1s selected but you can scroll through the list to view other deleted codes Code Book Sections This dialog box gives you all of the convenience of looking up codes by section just as they are arranged in the Contents pages of the ICD 9 CM CPT and HCPCS code books It is also accessible through the View menu s Code Book Sections It presents you a table of contents for the code books with the range of codes that are listed in each section Click on the Code Range to go to the first code in that range in the Code Detail Code Book Sections E x CPT HCPCS ICD 3 Vol 1 ICD 3 val 3 Category IIl Codes Anesthesia Anesthesia Head Anesthesia Neck Anesthesia Thorax Chest Wall and Shoulder Gird Anesthesia Intrathoracic Anesthesia Spine and Spinal Cord Anesthesia Upper Abdomen Anesthesia Lower Abdomen Anesthesia Perineum Anesthesia Pelvis Except Hip Anesthesia Upper Leg Except Knee Anesthesia Knee and Popliteal Area 1462 1522 hesi Lamer Len Relan Knee Includes dn 4 There are four tabs representing CPT HCPCS ICD 9 CM Vol 1 and ICD 9 CM Vol 3 Each tab allows you to see which code ranges are in each section and subsection of the code books To link from this dialog box to access the first code of any range of codes double click it or single click it and then click the Select button CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED
94. difiers for the currently selected CPT code and code specific modifiers for the currently selected HCPCS code Crosscoder This check box is available for EXPT and PRO only Prints ICD 9 CM Vol 1 HCPCS Dental Codes and Anesthesia codes as applicable crossed to the currently selected CPT code or prints CPT codes crossed to the currently selected ICD 9 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 82 CM Vol 3 procedural code It prints ICD 9 CM Vol 1 ICD 9 CM Vol 3 procedural codes and CPT codes as applicable crossed to the currently selected HCPCS code CCI Unbundle Edits This check box is grayed out except in EXPT and PRO Prints two lists of unbundled codes for the currently selected CPT code CCI component code unbundles and mutually exclusive code unbundles Local Medical Review Policies LMRP This check box is grayed out except in EXPT and PRO Prints the ICD 9 CM codes that are considered allowed for a selected CPT code and Medicare Carrier Carriers With LMRP This check box is grayed out except in EXPT and PRO Prints a list of Medicare Carriers with LMRP National Coverage Determinations NCD This check box is grayed out except in EXPT and PRO Prints the ICD 9 CM codes that are considered allowed for a selected CPT or HCPCS code Medicare Physician Fee Schedule This check box is grayed out except in EXPT Prints Medicare Relative Values Global Information an
95. e diabetes mellitus with neu 250 62 Type Il non insulin dependent type or unspecified type 250 63 Type insulin dependent type diabetes mellitus with neu Lo The code list box shows all of the ICD 9 CM codes that are Medical Necessity edits for the selected CPT code and Medicare It contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button Medically Necessary and Reasonable Title XVIII of the Social Security Act Section 1862 a 1 A states no payment may be made under Part A or Part B for any expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of ilIness or CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 58 injury or to improve the functioning of a malformed body member Medicare limits coverage of many procedures to certain ICD 9 CM diagnosis codes Please be aware that it is not enough to link the procedure code to a payable ICD 9 CM diagnosis code The diagnosis must be present for the procedure to be paid but in addition the procedure must be medically reasonable and necessary and representative of the patient s condition Medicare may require documentation of medical necessity on a pre payment and or post payment basis or comprehensive medical review basis Please
96. e HCPCS Color Code dialog box select HCPCS Color Codes from the View menu This dialog box allows you to look up all HCPCS codes assigned color codes It has tabs for New Revised Quantity and Medicare All four subordinate tabs contain a Find field that acts as a Go To button to maneuver within the codes in a given tab in this dialog box only This is not a search filter and accepts from 1 to 5 digits including the alphanumerics Note Ifa tab is not shown that indicates there are no codes that fit that category for this release of Encoder Pro This dialog box contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button New The New tab shows all new HCPCS codes and their descriptions HCPCS color codes x New Revised Quantity Medicare Find Diaphragm for contraceptive use Contraceptive supply condom male each Contraceptive supply condom female each Contraceptive supply spermicide e g foam gel each Tubing for breast pump replacement Adapter for breast pump replacement Cap for breast pump bottle replacement Breast shield and splash protector for use with breast pump replacement Polycarbonate bottle for use with breast pump replacement Locking ring for breast pump replacement Ostomy skin barrier non pectin based paste per ounce Ostomy skin barrier pect
97. e dates of service feature works only if you are copying data from the Notepad or Compliance Notepad and you have entered dates of service there From the Description Length drop down list you also choose what format you d like the code description to be presented The full description A 48 character description A 35 character description The shortened descriptions are abbreviated rather than truncated the program logically abbreviates the description rather than to simply cut it off after the 35 or 48 character For further information regarding copying and using the clipboard refer to Copying to the clipboard on page 80 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 12 x Copy Search View Network Data Versions Specify the code information to be copied from either the Notepad or the Code Detail with the Copy function Ctrl C Code and description C Code only Description Length Fui Description m Copy Date of Service Cancel Help Search Tab When you first install an Encoder Pro product the default preference is to include all code sets when performing a code search ICD 9 CM Vol 1 ICD 9 CM Vol 3 CPT Codes HCPCS codes You can use the Preferences Search tab to change that default and limit searches to a particular code set or code sets 1 From the Preferences dialog box make sure that only those check
98. e required by wear or by a change in the patient s condition are covered when ordered by a physician Adjustments repairs and replacements are covered so long as the device continues to be medically HCPCS Annotations not in CIFI9 From this dialog box you can view annotations from Ingenix s HCPCS Level II Expert that pertain to the code selected Annotations provide more information about medical and surgical supplies durable medical equipment drugs and certain professional services You access this dialog box by selecting a HCPCS code that has an annotation from the Code Detail Then click either the Annotations button from the toolbar or go the HCPCS menu and select Annotations CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual HCPCS Annotations 00035 Covered only in conjunction with electrocardiographic stress testing in male patients with atypical angina or nanigchemic chest pain ar female patients with angina CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED 64 Encoder Pro User s Manual 65 HCPCS Modifiers EXPT and PRO only This dialog box shows you a list of HCPCS modifiers with their descriptions that are appropriate for the selected code Modifiers that include ambulance origin destination modifiers and PET scan modifiers are listed 1n the HCPCS Section Notes You can sort by either column This dialog box is opened when you select
99. ecific codes or the code choices are listed with the main category This symbol identifies ICD 9 CM Vol 3 codes that are new This symbol identifies ICD 9 CM Vol 3 codes that have been revised This symbol identifies ICD 9 CM Vol 3 codes that are considered a male diagnosis This symbol identifies ICD 9 CM Vol 3 codes that are considered a female diagnosis Non OR Procedure Affecting DRGs Y This symbol identifies ICD 9 CM Vol 3 codes that Valid OR Procedure 1 are not operating room OR procedures as determined by the DRG grouper but do affect DRG assignment This symbol identifies ICD 9 CM Vol 3 codes that are valid operating room OR procedures as determined by the DRG grouper that may affect DRG assignment CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Non Specific OR Procedure gt Noncovered Procedure TH Limited coverage Bilateral Procedure Bl Sticky Notes CPT DIALOG BOXES CPT Section Notes not in CIFI9 48 This symbol indicates that a code is classified as unspecified other or ill defined operating room procedure This symbol identifies a procedure that is not covered by Medicare This symbol identifies a procedure that has limited coverage by Medicare This symbol identifies a procedure that is bilateral This symbol identifies codes with attached sticky notes See page 72 for details o
100. ed CC Age Sex Find Age The Age tab shows all ICD 9 CM Vol 1 codes that are age related The Code Intestinal infections due to staphylococcus Intestinal infections due to pseudomonas Intestinal infections due to campylobacter Intestinal infections due to yersinia enterocolitica Intestinal infections due to clostridium difficile Intestinal infections due to other anerobes Intestinal infections due to other gram negative bacteria Intestinal infection due to other organisms Tuberculosis of lung infiltrative confirmation unspecified Tuberculosis of lung infiltrative bacteriological or histological examination not done Tuberculosis of lung infiltrative bacteriological or histological examination unknown at present 24 column provides the ICD 9 CM Vol 1 code The Age column shows the applicable age category e g Adult Newborn The Description column shows the code s description The data can be sorted by any of the three columns ICD 9 Vol 1 Color Codes E New Revised CC Age Sex Find Pediatric Precocious sexual development and puberty not elsewher Newborn Cystic fibrosis with meconium ileus Adult Dysmetabolic Syndrome lt Adult Senile dementia uncomplicated Adult Presenile dementia uncomplicated Adult Presenile dementia with delirium Adult Adult Adult Adult Adult Adult Adult Adult Adult Adult Dai sb CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Pres
101. ed reasonable and necessary and not screening or otherwise not covered for Medicare purposes Such a policy applies nationwide An NCD is neither a practice parameter nor a statement of the accepted standards of medical practice Words such as may be indicated or may be considered medically necessary are used for this reason Where a policy gives a general description and then lists examples the list of examples is not meant to be all inclusive but merely to provide guidance The Local Medical Medicare Review Policy is an administrative and educational tool to assist providers physicians and suppliers in submitting correct claims for payment Local policies outline how contractors review claims to ensure that they meet Medicare coverage requirements Encoder Pro Expert and Professional review procedure and diagnosis codes against edits for active Part B LMRPs for all carriers and regions to ensure that providers billing Medicare can receive proper reimbursement A Find box allows you to search for ICD 9 CM codes that are allowable for a selected CPT or HCPCS code NCD Medical Necessity Edits 60247 This dialog shows ICD 9 CM codes diagnoses that determine medical necessity when reporting the selected HCPCS code procedure These edits are based on Medicare s National coverage Determinations Find 250 60 Type Il non insulin dependent type or unspecified type 250 61 Type insulin dependent typ
102. eeeeeessaasseeeeeeees 109 Exam Calculator EXPT Only sitas 109 Exam Calculator Select Examinattion 5 ccccccccesseeeececescsccesseneeescsccedeeeeseeseccccesseneedeeteccceees 109 Exam Calculator Examination lessen ener nnne nnn n nnns nnn nans 110 Exam Calculator Examination Level of Service sss 113 Compliance Edit EXPT Olinda A uu coenae uva c Ce mob 114 Edit Complete lso iaa codillo as atia tv catum ia 115 ze CO REIN IN o O E a 115 Edit COMES TA p TENEON 116 LMP Git COMmiCtS Pa e o ne eee ela 117 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual VIII GOL Unbundle Gonllicls Tae 118 SYSTEM ADMINISTRATOR ALL MULTIPLE USER VERSIONS 1 eres caer eser eene nennen nnnm n nnne nans naa snas annus 121 System Administrator LOGIN ned ii aid 121 System Administrator LOGOHUL o cct ev eie oo ti 121 Changing the Administrator Password ecce ceieeeee esee ei iieeee eene nne nn nnn ananas nean anna nns 122 Preferences Dialog Box Network Tab 1 eeeseeeeee a a enne nean nnne nnn 122 User Maintenance All Multi User Versions 11 ee eLee ee Leeee cr lleee rne n nennen nane nnns 123 E D I 123 mici c A TT TO SE 123 MENUS eT CM OA PLA t uM en ui IM MM 124 File ge
103. eg hernatcog n and eccin tokadne bles hr nemm BPrmuls nnie bee com bm E CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED 51 Exempt The 51 Exempt tab shows all CPT codes and their descriptions that should not be used with Modifier 51 CRAZE i X New Revied Addon 51 Exempt Find fs Encoder Pro User s Manual 23 ICD 9 Vol 1 Color Codes To open the ICD 9 Vol 1 Color Code dialog box select ICD 9 Vol 1 Color Codes from the View menu This dialog box allows you to look up all ICD 9 CM Vol 1 codes assigned color codes It has tabs for New Revised CC Age and Sex All five subordinate tabs contain a Find field that acts as a Go To button to maneuver within the codes in a given tab This is not a search filter and accepts from 1 to 6 digits including the V and a decimal point if applicable The data presented in these five tabs is the same no matter what code has been selected in the Code Detail or Tabular Results This dialog box contains magenta code number links that direct you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button New The New tab shows all new ICD 9 CM Vol 1 codes and their descriptions x New Revised CC Age Sex Findf i Toxic shock syndrome 066 4 West Nile fever 277 02 Cystic fibrosis with pulmonary manifestations 277 03 Cystic fibrosis wi
104. either CPT or HCPCS The NCD button 1s active only if there are edits for the selected code CMS FEE SCHEDULE EXPT AND PRO ONLY After selecting a CPT code that has a Medicare Fee Schedule from the Code Detail clicking this button opens the Medicare Information dialog box CMS PoLiCY NOT IN CIFI9 After selecting a code that has special coverage instructions from the Code Detail clicking this button opens one of the Special Coverage Instructions dialog boxes The term CMS on this button refers to the Centers for Medicare and Medicaid Services CMS DRG CROSSCODES NOT IN STND After selecting an ICD 9 CM code in the Code Detail that has a DRG Crosscode clicking this button opens the DRG Crosscodes dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 136 COLOR CODING LEGEND Opens the applicable Color Code Legend dialog box depending on which type of code is selected HELP Opens online help CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED
105. enile dementia with delusional features Presenile dementia with depressive features Senile dementia with delusional features Senile dementia with depressive features Senile dementia with delirium Arteriosclerotic dementia uncomplicated Arteriosclerotic dementia with delirium Arteriosclerotic dementia with delusional features Arteriosclerotic dementia with depressive features Unspecified senile psychotic condition Dhar Drehen Hie uh Am af abildhand ar MASA ll Cancel Help Encoder Pro User s Manual 25 Sex The Sex tab shows all ICD 9 CM Vol 1 codes that are attributable to either a male or female diagnosis The Code column provides the ICD 9 CM Vol 1 code The Sex column shows the gender for which the procedure is intended The Description column gives the code s description The data can be sorted by any of the three columns ICD 9 Vol 1 Color Codes x New Revised EG Age Sex Find Sex Male Tuberculosis of epididymis tubercle bacilli not found by bac Male Tuberculosis of epididymis tubercle bacilli not found by bac Male Tuberculosis of other male genital organs confirmation uns Male Tuberculosis of other male genital organs bacteriological or Male Tuberculosis of other male genital organs bacteriological o Tuberculosis of other male genital organs tubercle bacilli fo Tuberculosis of other male genital organs tubercle bacilli n Tuberculosis of other male genital organs tubercle bacilli n Tuberc
106. enms MOLIN GIEI9Ys eio pesa top EM AMETE psa T MEO EI E D pM ED RS 63 HOPGS Moodies EXP r and PRO Only siii an 65 HOPOSOrosseodes EXPT and PROON sait rre ded oar yn dE oe ee ee ee 65 HCPCS CCI Unbundle Edits EXPT and PRO only oocccccccccoccnncccconcnonococonccononoconccnnoccancnnnnonononons 66 A etre 66 HCPCS Color Coding Legend not in CIFI9 erranei aan aa aa aaa 67 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual VI MISE Kochen TED RR 69 Using BOOKIMANKS ondo Doc udi ea utc Dua gura 69 Updating BOOM Sid DD m 69 Adang a NEW OOK MA O sesioa a a a aa a a a 70 infolge e HEN 70 EMINI 199a e tasoneuterdiistaitonteadur viui mani daban ill 70 Delega BOOK IMAIK a eid dat 71 Importing Bookmarks from Previous VWersSiONS ooccccconncncoconcncoconcnnononcnnconannnononcnnnnoncnnnnnnnnnnonanennos 71 USING STICKY NOTES raunen Qu AS 72 WieW Only Check BOXES qe seduce botes e t vs S srt e ca 73 Linke todhe Gode A 73 Balloon n eme E 73 Color Code BO LINKS oratoria Tea caia dai dini ei cb cota wie e oi see Sectio eius 73 wine NOLES WDC ae scission e e 73 PAGING a New SUCK NOIS dicens xt e E Lu LIES E Linens EE 74 SNO 6 0 OO EGO a e a a a ae a a a e NA 74 snedaeraerc de c m a a E O 75 Viewing or Editing an Existing Note ccccccccssseeecseseeeceeeececceueeeseaseeecsaseesseseesseeeeessasseessaaeees 75 B lg ala EXISTING Noli aaa 76 Importing Sticky Note
107. ent CIM and MCM references This symbol identifies codes that have an amount associated with them This symbol identifies services that have special Medicare coverage policies and or rules This symbol identifies codes with attached sticky notes See page 72 for details on using sticky notes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 69 User Tools UsiNG BOOKMARKS The Bookmarks dialog box displays a ready reference list of bookmarks for codes that you regularly use These place markers are a convenient way to go directly to the Code Detail for a selected code The title of the dialog box changes to Network Bookmarks if you have a multiple user version of the program To open the Bookmarks dialog box click the Bookmarks button f or select Bookmarks from the View menu This dialog box contains code number links that direct you to the appropriate code in the Code Detail The program also provides you with a description of the code and the category you selected when you created it You can access the code you bookmarked by selecting it and then clicking the Go to Bookmark button You can also double click the code you bookmarked to take you directly to that code in the Code Detail The default 1s for all bookmarks to appear when you first see the Bookmarks dialog box If you want to narrow your view to only certain types of codes go to the View Only check boxes and uncheck the
108. erms brings up all codes containing arthroscopy and shoulder To further narrow the search type one or two more terms that further explain the procedure For example entering arthroscopy shoulder decompression narrows the results to just one CPT Code 29826 which contains all three terms Avoid being too specific or entering too many search terms in these instances there may be no results that exactly match your criteria It is best to choose two to four key search terms Note Some terms explain both what was performed and where For example the term colonoscopy explains what was performed scope and where colon Criteria for ICD 9 CM Codes To identify the criteria for an ICD 9 CM Vol 1 code search ask yourself why the patient received care From the documentation pull up to four key terms that best describe the reason For example if a shoulder arthroscopy was performed ask yourself why Entering joint tear returns a large variety of matches in the Tabular Results To return more specific results include the specific anatomical region Entering joint tear shoulder returns only the diagnosis codes that are specific to the shoulder To identify the criteria for an ICD 9 CM Vol 3 code search ask yourself what kind of procedure was performed e g appendectomy hysterectomy and enter this term into the Search Prompt To further define your search include the anatomical site where the procedure was performed e
109. es CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 90 Emergency Other Emergency Services Nursing Nursing Facility Discharge Services This Code Result dialog box shows CPT codes related to the type of service and visit being tracked You may select one of the codes and then click the Select button to jump to that code in the Code Detail Otherwise clicking Finish takes you back to the product s main screen Select Visit Option Dialog box you will be presented Outpatient New Patient UUM Assistant Key Commpaneste Ted Seen Oulpatert Nurbw of Key Components Requiet 343 pcs pantern Exam Cokie Caset Definitions Guidelines The hey compornemis for EA codes aee History Execution and Medea Decition Making The level ol service for each component corelate eth OMS 1957 E M Guideliner When counseling and coordination ber dol Bele SEED Bee te HAE en ee then Tine daki be the determining Factor m Mita D 2 SS701 Protters Focused Modem ate Modena to High Outpatient Established A Patient Type of Carne Diipsieni Plumber ol Kap Comp ndi Fieri 283 Slaba ol Wed EhkkhhePPXeri Epam Calcula Coder Detriers Guidate inrer ape rendi codes Examination wnt orp adir Making The level of meni nach component comiales esi DHG 15577 EM Guedes hen counseling and dicam a up rore han 5 percent a hial m then Time should be the dehernining factor in Inpatient Init
110. es Hospital Inpatient Services Consultations Critical Care Prolonged Services and Care Plan Oversight These examples do not encompass the entire scope of medical practice Inclusion or exclusion of any particular specialty group does not infer any judgment of importance or lack thereof nor does it limit the applicability of the example to any particular specialty It is important to note that these are only examples A particular patient encounter depending on the specific circumstances must be judged by the services provided by the physician for that particular patient Simply because the patient s complaints symptoms or diagnoses match those of a particular clinical example does not automatically assign that patient encounter to that particular level of service The three key components history examination and medical decision making must be met and documented in the medical record to report a particular level of service CPT Lay Descriptions not in CIFI9 From this dialog box you can view lay nonclinical descriptions for most CPT surgery and medicine codes You open this dialog box by selecting a CPT code that has lay descriptions from the Code Detail Then click either the Annotations button 3 from the toolbar or go the CPT menu and select Lay Descriptions CPT Lay Descriptions 27818 The physician treats a fracture of the ankle involving all a three of the malleoli medial lateral and posterior without
111. es the preconfigured Internet access parameters in the workstation Support at 800 765 6797 DISPLAY PROPERTIES This dialog box appears upon launch except for Windows 95 users of your Encoder Pro suite product only if the product detects less than optimal Display settings The minimum recommended settings are 16 bit color and 800 x 600 screen area Display Properties x Optimal viewing for Encoder Pro Expert requires a minimum of High Color 16 bit and 800 600 screen area Bookmarks and Sticky Notes from versions 3 0 and those from versions older than 2 4 1 are not automatically imported If you have questions please contact Technical Display Properties Recommended Min Current Setting Status Colors High Color 16 bit 256 Colors Not Optimal Screen rea e00 x 600 E 152 x 864 ok Change Display Properties Colors High Color 16 bit Screen rea 1152 y 864 y Apply Do not show this dialog again CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 17 If the Display Properties dialog box appears you may use it to change your settings to our optimal requirements If you choose to change your settings via this dialog box you will be asked whether you want to revert back to your original settings when you exit your Encoder Pro suite program If you choose not to change your color settings please be advised the product stil
112. etail Comprehensive Eight or more organ systems of which one may be a body area s or a complete single system examination 3 Medical decision making The medical decision making is the third key component of determining the level of evaluation and management service There are three areas to consider when determining the level of medical decision making Number of diagnosis es or management options The following should be considered All known diagnoses that are being treated Undiagnosed conditions that are being evaluated Treatments that are being used Treatments that are being considered Amount and complexity of data to be reviewed The following are considered Orders and review of all tests lab radiology and medical Discussion of test results with performing physician Independent review of image tracing or specimen Decision to obtain and review of old records History obtained from someone other than the patient Risk of complications and or morbidity or mortality Look for documentation of the following Presenting problem s Diagnostic procedures ordered Management options selected CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 102 Quantifying the Medical Decision Making There are point systems associated with the medical decision making much like those in the history and examination components However the ultimate conclusion of the level of
113. f at least two to seven organ systems Established patient One who has received professional services face to face within the past three years from a physician or another physician of the same specialty in the same group practice If a patient is seen by a physician who is covering for another physician the patient will be considered the same as if seen by the physician who is unavailable Extended history of present illness A detailed narrative of the presenting illness including the history elements of location quality severity duration timing context modifying factors and or associated signs and symptoms related to the presenting problems The narrative also should detail the onset of new problems or any changes since the last visit 1f 1t 1s an established condition The status of at least three chronic or inactive conditions is considered extended under CMS s 1997 Documentation Guidelines for Evaluation and Management Services Extended system review A narrative of organ systems reviewed directly related to the chief complaint and or history of present illness plus a review of a limited number of additional systems The review of additional systems helps the physician define the problem helps establish differential diagnoses helps establish the necessity for CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 106 diagnostic tests and serves as a baseline for information about other s
114. f the presenting problem Timing Refers to the interval of the pain or suffering For example every night in the middle of the night constant pain comes and goes Modifying Factors Information about how the pain is modified by other factors For instance pain 1s relieved by standing erect headache somewhat better after taking aspirin Quality Description of the pain sensation such as dull sharp aching stinging and so forth Duration The patient will describe an approximate duration of the symptoms For example For the last week since yesterday it began when I fell this morning Context Describes how the symptoms began such as after the auto accident moon after eating out at a restaurant after bumping my head CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 98 Associated Signs and Symptoms These are other significant signs or symptoms that the patient feels are related to their injury or illness For example some dizziness with nausea swelling with an ankle injury double vision with headache The Review of Systems examples in parentheses includes the patient s inventory of signs and or symptoms of the body systems described as Constitutional weight loss fever chills malaise and so forth Ear Nose Throat and Mouth hearing loss sinusitis sore throat oral cavities ulcers Gastrointestinal nausea vomiting diarrhea constipation ulcer
115. ference you ve selected to the Windows clipboard Add After selecting a code from the Code Detail choosing this selection opens the Add Code dialog box Preferences Opens the Preferences dialog box Select Carrier Locality EXPT and PRO only Opens the Select Medicare Carrier Locality dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual ViEW MENU Index Listing Bookmarks Sticky Mates Notepad Mew Codes Revised Codes Deleted Codes CPT Color Codes ICD 8 Vol 1 Color Codes ICD 8 Vol 3 Color Codes HERPES Color Codes Code Book Sections Index Listing This option is only available 1f you have initiated a search and there are Index Listing available If so this option opens the Index Listing dialog box Bookmarks Opens the Bookmarks dialog box Sticky Notes Opens the Sticky Notes dialog box Notepad Opens the Notepad dialog box New Codes Opens the New Codes dialog box Revised Codes Opens the Revised Codes dialog box Deleted Codes Opens the Deleted Codes dialog box CPT Color Codes not in CIFI9 Opens the CPT Color Codes dialog box ICD 9 Vol 1 Color Codes Opens the ICD 9 Vol 1 Color Codes dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 127 ICD 9 Vol 3 Color Codes Opens the ICD 9 Vol 3 Color Codes dialog box HCPCS Color Codes not in CIFI9 Opens the HCPCS
116. flict or is not affected by the policies for a given carrier No LMRP Policy Available The Description column gives more information about why one or the other of these codes is not considered a medical necessity Here are the possible results Edit Conflict Name Edit Conflict Description Medical Necessity Conflict No LMRP Policy Available This ICD 9 code is not considered a medically necessary diagnosis for this CPT procedure code based on the LMRP policies from the selected Medicare Carrier and or the NCD edits There are no LMRP policies or NCD edits associated with this CPT procedure code for the selected carrier Confirm with your carrier that it is reimbursable if reported with this ICD 9 diagnosis code CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 118 CCI Unbundle Conflicts Tab The CCI Unbundle Conflicts tab reports CCI Unbundle Edits Edit Conflicts xi Edit Conflicts LMRP Edit Conflicts CCI Unbundle E dit Conflicts Edit Conflict Description CCI Component The code in Col 2 is considered by Medicare to be a c Cancel Print Help The Col 1 column lists the CPT Code that is considered to be the greater procedure includes component procedures The magenta code links take you back to the Notepad where you take action according to the conflict text The Col 2 column lists the CPT Code s that are considered to be component edits of
117. flict Name Edit Conflict Description CCI Mutually Exclusive Modifier Allowed CCI Gender Mutually Exclusive CCI Gender Mutually Exclusive Modifier Allowed The code in Col 2 is considered by Medicare to be a mutually exclusive procedure of the code in Col 1 A modifier is allowed in order to differentiate between the services provided Separate payment for the services billed may be considered justifiable if a modifier is used appropriately The codes in Col 2 is considered by Medicare to be gender mutually exclusive procedures of the code in Col 1 There are no circumstances in which a modifier would be appropriate The services represented by the code combination will not be paid separately The code in Col 2 is considered by Medicare to be a gender mutually exclusive procedure of the code in Col 1 A modifier is allowed in order to differentiate between the services provided Separate payment for the services billed may be considered justifiable if a modifier is used appropriately CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 120 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 121 System Administrator All Multiple User Versions The System Administrator title designates certain rights that a basic user does not have Only the System Administrator can Add Global Bookmarks and Global Sticky Notes to the syste
118. g abdominal region pelvis CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 31 Spell Checking Search Terms When you enter a search term that is either incorrectly spelled or not found in the code databases the Spell Check dialog box appears Alternative search terms are listed for the search term you originally entered and are based on the first letter of that term or a phonetic match The highlighted term was nat found in the indes Selecta different term in the list below to change the search term Or select Ignore to not use this term in the search HAERT Suggestions To select an alternative search term Select the desired search term suggestion 2 Click Change which corrects your search term and closes the Spell Check dialog box Doing this automatically continues your search based on the alternative term Click Ignore if you want to cancel out of this dialog box 4 Start your search again Note If you enter more than one search term clicking Change accepts the alternative spelling and takes you to the next misspelled word if any Clicking Ignore on the first misspelled word still keeps you in the Spell Check dialog box if there is another misspelled or not found word in your original search Viewing Search Results After you execute a search the Tabular Results area of the main screen displays matches found in all applicable code sets The Tabu
119. g box and only applies to ICD 9 CM Vol 3 codes DRG Crosscodes not in STND Opens the DRG Crosscodes dialog box Color Coding Legend Opens the ICD 9 Vol 3 Color Coding Legend Previous Codes Displays the Code Detail view for the previous section of codes Refer to Code Detail for further information Next Codes Displays the Code Detail view for the next section of codes Refer to Code Detail for further information CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 129 CPT MENU NOT IN CIFI9 This menu is available only when a CPT code is selected in the Code Detail Information is specific to the currently selected code Items not available for a given code are dimmed CPT Section Motes Lay Descriptions Modifiers Crosscoder CCI Unbundle Edits Local Medical Review Policies National Coverage Determinations Medicare Fee Schedule Medicare Policy Color Coding Legend Previous Section Mext Section Carriers with LMRP CPT Section Notes Opens the CPT Section Notes dialog box Lay Descriptions Opens the CPT Lay Descriptions dialog box Modifiers EXPT and PRO only Opens the CPT Modifiers dialog box Crosscoder EXPT and PRO only Opens the CPT Crosscodes dialog box CCI Unbundle Edits EXPT and PRO only Opens the CPT CCI Unbundle Edits dialog box Local Medical Review Policies EXPT and PRO only Opens the LMRP Edits dialog box National Coverage De
120. ge 75 opens If you have multiple notes assigned to the selected code then double clicking this link opens the Sticky Notes dialog box and selects the first note for the code Sticky Notes Update The Sticky Notes dialog box doesn t contain any codes or sticky notes when you first install this program You must add all codes and sticky notes to the dialog box If you are installing over a previous version all sticky notes are preserved However if you in a previous version had a sticky note assigned to a code that the AMA has decided to delete you are shown this warning dialog box when you first open the Sticky Notes dialog box Sticky Notes Update E X You have sticky notes assigned to invalid cades Click Delete to remove the sticky nates for all invalid codes Click Save to keep the sticky notes IF you choose this option you can use Encoder Pro to look up codes and create a new sticky note for a valid code You can transfer the sticky note from an invalid code to the new sticky nate by using Ctrl C to copy the note from the invalid code and then Lire to paste the test into the new sticky note box Discontinue showing this dialog i Save Take the appropriate actions according to your needs CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 74 Adding a New Sticky Note To add a sticky note for a code selected in the Code Detail 1 Click the Add button fro
121. gery An E M service that resulted in the initial decision to perform the surgery may be identified by adding Modifier 57 to the appropriate level of E M service or the separate five digit modifier code 09957 may be used CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 109 Selecting an E M Code To select the appropriate level of service one should take the following steps l Identify the place of service e g office inpatient hospital emergency room visit or type of service e g consultation provided and select the appropriate category and subcategory from the CPT Book Read the E M documentation guidelines at the beginning of the category and subcategory to determine what special instructions if any apply to that subcategory of E M codes From the medical record documentation determine the extent of the history obtained the examination performed and the complexity of the medical decision making Review the code narratives in the appropriate category and subcategory Each narrative includes the specific criteria that must be met or exceeded if the code is to be assigned correctly Select the code that matches the levels of history examination and medical decision making involved If chart documentation indicates that counseling and coordination of care take up more than 50 percent of the time spent on the face to face encounter between the physician and patient and o
122. he Diagnosis Codes field or the Procedure Service and or Supply Codes field When clicked you are presented with the Compliance Edit dialog box For further information regarding Compliance Editing refer to Compliance Edit EXPT only Adding Codes to the Notepad You can add codes to the Notepad from within the Notepad dialog box or from the Code Detail To add a code to the Notepad from within the Notepad dialog box 1 Click the Add button 2 Type in the code 3 Click OK To add a code to the Notepad from the Code Detail 1 Click the code to select it 2 Open the Add Code dialog box by clicking Add button t from the toolbar or by selecting Add from the Edit menu Check the Notepad check box 4 Click OK Shortcut Right click on the code in the Code Detail and select Add to Notepad from the Right Click menu Add to Global Bookmarks Add to Personal Bookmarks Add to Global Sticky Motes Add to Personal Sticky Notes Add to Notepad View Carriers with LMRP Appending Modifiers CPT and HCPCS modifiers that are specific to a code selected in the Notepad are available in the drop down list in the Modifiers section of the Notepad dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 79 To append a modifier to a code in the Notepad 1 Select a CPT or HCPCS code to which you want to append modifiers 2 Click the drop down arrow to the right of the Modifiers
123. he Select button is available only if a magenta code is selected Clicking this button takes you back to the Notepad where you take action according to the conflict text This can also be accomplished by double clicking the magenta code The Cancel button closes the dialog box and returns you to the Notepad The Print button allows you to print a report of the edit conflicts The Help button takes you to dialog specific online help Edit Conflicts Tab The Edit Conflicts tab reports all edit conflicts except the CCI unbundle edit conflicts The magenta code links take you back to the Notepad where you take action according to the conflict text The Code column lists each code that is affected by an edit conflict The magenta code provides you with a link to the Code Detail The Edit Type column shows either Fail or Caution Fail denotes that the user should recode Caution is a warning that the use of the code may be appropriate but has been questioned The Edit Conflict column shows you the name of the edit conflict The Edit Conflict Description column gives more information on the conflict Here are the possible results Edit Conflict Name Edit Conflict Description Additional Digits Required Code requires additional third fourth and or fifth digit to be coded correctly Either the code category or subcategory contains more specific codes Nonspecific Code Code is classified as unspecified other or ill defined This code
124. hesia codes medicine codes radiology codes and lab codes that are crossed to the selected CPT code Tabs are displayed that contain the applicable code sets Click the Crosscoder button on the toolbar or select Crosscoder from the CPT menu This dialog box contains code number links that go to the appropriate code in the Code Detail Double click on the link or select it and click the Select button The Crosscodes dialog box closes and the selected code and its description appears in the Code Detail CPT Crosscoder 12031 E X ICD 3 Val 1 ICD 8 Vol 3 HCPCS Codes Anesthesia Cades Malignant melanoma of skin of scalp and neck 172 5 Malignant melanoma of skin of trunk except scrotum 172 6 Malignant melanoma of skin of upper limb including shoulder 172 7 Malignant melanoma of skin of lower limb including hip 172 8 Malignant melanoma of other specified sites of skin 173 4 Other malignant neoplasm of scalp and skin of neck 173 5 ther malignant neoplasm of skin of trunk except scrotum 173 6 9 Other malignant neoplasm of skin of upper limb including shoulder 173 7 ther malignant neoplasm of skin of lower limb including hip Select Cancel Help CPT CCI Unbundle Edits EXPT and PRO only CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 52 This dialog box allows you to see Medicare s Correct Coding Initiative unbundle edits for the se
125. ial Hospital Care EEEHZITNNNENEMMNM x New or Established medie A OREA 303 Sabri of Ved el Hospital Core Hence uabided Egan Colder Coder Detritions Guidelines The leg components for E codes ave Hio Examination and Medical Decision Making The level of seio fos nach componen comae wis Cd 1847 EH Guedes af hen counseling and ol cue poem rita td then Time should be Ha deherminang focha in Inpatient Subsequent Hospital Care Taa Sare Ire Mumbai Kap Components Requind 103 Sarde begen Hod Ee Egan akam Coder Detriers Gudelees Thae limit iacit codes aee Hiiop Examination and Medical Decision Making The leve ol sein for neck component comes estis DHG 15577 ES Guedes hen counseing and emissis ELE CERERI AVI then Time should be tha debemining facta in CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Select Visit Option Inpatient Observation or Inpatient Care Services Admissions Discharges Inpatient Hospital Discharge Services Does not have access to the Exam Calculator Inpatient Initial Observation Care New or Established Inpatient Observation Care Discharge Services Does not have access to the Exam Calculator 91 se ESSERE EE box you will be presented Types Sanc roren Humba il Lap Comporardo aqui 203 Slab ol Vink Obosrra on or inpateni Caes Services Adrasdona D inchangea Egin Calculador Coder Detrations Gude
126. ice work associated with a primary procedure Code requires a primary procedure code Known as an add on code this code is always performed in addition to the primary service or procedure and must never be reported as a stand alone code The LMRP Edit Conflicts tab reports LMRP Medical Necessity edit conflicts The magenta code links take you back to the Notepad where you take action according to the conflict text Edit Conflicts E x Edit Conflicts LMRP Edit Conflicts CCI Unbundle Edit Conflicts ICD 9 Edit Conflict Description No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p No LMRP Policy There are no LMRP policies associated with this CPT p Cancel Print Help The CPT column lists the CPT Code affected in the conflict The ICD 9 column lists the ICD 9 CM code affected in the conflict The Edit Conflict column reports instances where the CPT and ICD 9 CM Code pair conflicts with the medical necessity policies for a given carrier Medical Necessity Con
127. iers are approved for use in ASC settings LMRP Risk Compliance Edit Expert and Professional only Runs a compliance edit for coding conflicts affecting the ICD 9 CM CPT and or HCPCS codes National Coverage Determinations Edits Expert and Professional only Runs a compliance edit for coding conflicts affecting the ICD 9 CM CPT and or HCPCS codes under National Coverage Determinations What s New in Encoder Pro CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual What s New in Encoder Pro e Data versions Data Versions See the Data Versions dialog box from your product s Help menu for a complete list of applicable data versions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual WHAT S NEW FILES AND TABLES CPT Category Il Codes 0001F Blood pressure measured 0008F ACE inhibitor therapy prescribed 0009F Anginal symptoms and level of activity assessed 0010F Anginal symptoms and level of activity assessed using a standardized instrument e g Canadian Cardiovascular Society Classification CCSC System Seattle Angina Questionnaire SAQ 0002F Tobacco use smoking assessed 0003F Tobacco use non smoking assessed 0004F Tobacco use cessation intervention counseling 0005F Tobacco use cessation intervention pharmacologic therapy 0011F Oral antiplatelet therapy prescribed e g aspirin clopidogrel Pla
128. in based paste per ounce Ostomy skin barrier with flange solid flexible or ccr memi skla bal m mm mms Revised The Revised tab shows all HCPCS codes that have been revised and their descriptions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual HCPCS Color Codes E New Revised Quantity Medicare Non emergency transportation per mile vehicle provided by volunteer individual or organization with no vested interest Non emergency transportation per mile vehicle provided by individual family member self neighbor with vested interest Non emergency transportation taxi Non emergency transportation mini bus mountain area transports or other transportation systems Transportation ancillary parking fees tolls other Extra ambulance attendant ground ALS or BLS or air fixed or rotary winged requires medical review Implantable access total catheter port reservoir e g venous arterial epidural subarachnoid peritoneal etc Nakaraan ales barrier Anl did ar mmm nins Quantity The Quantity tab shows all HCPCS codes which have any quantity associated with them and their descriptions including amounts HCPCS Color Codes E New Revised Quantity Medicare Find Syringe with needle sterile 1 cc each 4207 Syringe with needle sterile 2 cc each 4208 Syringe with needle sterile 3 cc each 4209 Syringe with needle sterile
129. ing codes for the current search terms Code Detail Select any code listed in the Tabular Results to view the full description for the code and all neighboring codes in the adjacent Code Detail For ICD 9 CM codes the Code Detail also shows excludes and includes notes as well as code first and code also references CPT and HCPCS codes in the Code Detail are grouped by section subsection Code Specific Dialog Boxes for ICD 9 CM You can easily view ICD 9 CM instructional notes AHA Coding Clinic references and annotations You can also view CPT crosscodes for ICD 9 CM Vol 3 codes and for all products except STND DRG Crosswalks for ICD 9 CM Vol 1 codes Code Specific Dialog Boxes for CPT All products except Code It Fast I 9 You can easily view lay descriptions CPT Assistant references AMA guidelines and modifiers for the selected CPT code For EXPT and PRO you can also view primary procedure codes for add on codes surgical and anesthesia crosscodes Medicare Physician Fee Schedule information and unbundle edits from Medicare s Correct Coding Initiative Code Specific Dialog Boxes for HCPCS All products except Code It Fast I 9 You can easily view annotations section notes modifiers and coverage instruction references from the Medicare Carrier s Manual and the Coverage Issues Manual for the selected HCPCS code CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 4
130. initial vessel OOO6T Transcatheter placement of extracranial cerebrovascular artery stent s percutaneous each additional vessel List separately in addition to code for primary E mm ads onm This dialog box shows all new codes sorted with tabs by code set It can also be accessed via the View menu Double clicking on the pink code number brings up that code in the Code Detail but the dialog box remains active in the foreground Single clicking the pink code and then clicking the Select button closes the dialog box and takes you directly to that code in the Code Detail Revised Codes Revised Code x CPT HCPCS iCD 3 vaL 1 1CD 9Vol 3 Anesthesia for intracranial procedures 00560 Anesthesia for procedures on heart pericardial sac and great vessels of chest without pump oxygenator 00562 Anesthesia for procedures on heart pericardial sac and great vessels of chest with pump oxygenator 00563 Anesthesia for procedures on heart pericardial sac and great vessels of chest with pump oxygenator with hypothermic circulatory arrest 00942 Anesthesia for vaginal procedures including biopsy of labia vagina cervix or gt man slm ma hos ama Vem e m m mma This dialog box shows all codes that have been revised sorted with tabs by code set It can also be accessed via the View menu Double clicking on the pink code number brings up that code in the Code Detail but the dialog box remains active in the fo
131. int z Sternmociawicular jaint s Clavicle References This tab displays references to issues of the American Hospital Association s Coding Clinic the official publication for the ICD 9 CM guidelines It references Coding Clinic editions and page numbers in which the selected code has been discussed The year is listed then the range of months for issues published before 1988 or the quarter then the page number of the reference For copies of the Coding Clinic contact the AHA at 800 261 6246 ICD 9 C Instructional Motes 716 Coding Clinic iz the official publication Far ICD 9 CM coding guidelines Editions of Coding Clinic that discuss the selected ICD 9 code are referenced here Second Quarter ICD 9 CM Annotations From this dialog box you can view annotations that pertain to the code selected Annotations provide explanations of medical terminology and descriptions for specific diseases or conditions You access this dialog box by selecting an ICD 9 CM code that has an annotation from the Code Detail Then click either the Annotations button X from the toolbar or go the ICD 9 Vol 1 or the ICD 9 Vol 3 menu and select Annotations CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 43 ICD 9 Annotations 715 02 B Chronic degenerative disease of spine and peripheral joints occurs in eastern Siberian northern Chinese and Korean youth may a mycotoxicosis ca
132. k hands feet and or external genitalia 20 1 cm to 30 0 cm Th e Code Detai Layer closure of wounds of neck hands feet and or external genitalia over 30 0 cm d spl ay S th e fu Layer closure of wounds of face ears Layer closure of wounds of face ears Layer closure of wounds of face ears Layer closure of wounds of face ears Layer closure of wounds of face ears Layer closure of wounds of face ears Layer closure of wounds of face ears XX Service includes surgical procedure only Y Commonly Miscoded Procedure eyelids eyelids eyelids eyelids eyelids eyelids eyelids nose lips and or mucous membranes 2 5 cm or less nose lips and or mucous membranes 2 6 cm to 5 0 cm li de scri pti on and al nose lips and or mucous membranes 5 1 cm to 7 5 cm neighboring codes for nose lips and or mucous membranes 7 5 cm to 12 5 cm nose lips and or mucous membranes 12 6 cm to 20 0 cm nose lips and or mucous membranes 20 1 cm to 30 0 cm th e selected code nose lips and or mucous membranes over 30 0 cm Medicare Policies Apply Special Coverage Instructions Multiple Surgery Reduction Applies Click to display View color code symbols associated with the selected code in the color code box the Index Results CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 10 Product Set up LOGINS AND PASSWORDS This section applies only to those using
133. l functions but the colors will not display correctly If you choose not to change your screen area resolution settings navigation within the product will be difficult but not impossible Ingenix recommends changing your settings if this dialog box appears Windows 95 Users The recommended settings apply However the Display Properties dialog box does not appear for you To change your color settings manually adjust them through your Control Panel s Display option Settings tab CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 18 Searching for Codes LOOKING UP CODES QUICKLY Click any code in the Tabular Results to go to that code in the Code Detail There are four additional ways to locate a code in the listing Enter the code number at the Search box and click either the Enter key or the Search button refer to Performing a Code Search for instructions A list of codes that you have selected during the current lookup session is listed in the History menu Use the trail in the History menu to go back to codes already selected This code trail shows the 15 latest code selections with the most recent at the top The History menu shows codes entered as number searches as well as the selected codes Select codes from the Bookmarks dialog box Select codes from the Sticky Notes dialog box THE BLACK TOOLBAR Another feature provided to assist you in code lookup is the bla
134. l the codes to the clipboard at one time You can also use the Compliance Notepad to run the Compliance Edit EXPT only You open the Notepad dialog box by clicking the Notepad button El or selecting Notepad from the View menu CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 77 Compliance Notepad E X Diagnosis Codes DOS From DOS To L1 E0650 Pneumatic compressor nonsegmental home model 01 23 2003 01 23 2003 1 E1210 Motorized wheelchair fixed full length arms swing away detac 01 23 2003 01 29 2003 Delete Duplicate Clear Designate Primary Compliance Edit Copy To Clipboard Cancel Help Notepad Fields The Notepad dialog box presents codes in two major groupings A code when added is placed in either the Diagnosis Codes field or the Procedure Service and or Supply Codes field The Modifiers field is comprised of a drop down list and an Append button Notepad Buttons The Append button is described in Appending Modifiers The Add button is described in Adding Codes to the Notepad The Delete button is described in Deleting Codes The Duplicate button is described in Duplicating Codes The Clear button is active only when there is at least one code entered in the Diagnosis Codes field or the Procedure Service and or Supply Codes field When you click this button all of the contents of the Notepad are deleted The Designate Primary button is
135. lar Results area also displays the Total matches that let you know how many results match your search criteria including the subsection range that the code s belong to for all CPT and HCPCS The Total matches area shows 0 if no results were found The number changes when the results are filtered either through the Narrow results by section link or by changing your code set check boxes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 32 M ICD 3 Val 1 M IED 3 Val 3 v CPT v HCPCS mj Hevert Marrow results by section L3850 L 3853 Abduction Position Custom Fitted L3870 L 3374 Additions to Mobile amp rm Supports Ba Open wound of shoulder and upper arm Bar Traumatic amputation of arm and hand comple 211 Arthropathy associated with infections H 12031 12057 Repair Intermediate H 12001 12021 Repair Simple 54 Other procedures on musculoskeletal system H 912 Superficial injury of shoulder and upper arm H g43 Bum of upper limb except wrist and hand i 24065 24755 Excision i 64885 64907 Neurorhaphy with Herve Graft i EQ650 E 0673 Pneumatic Compressor and Appliance i 34001 34203 Arterial With or Without Catheter H 24900 24940 Amputation H 34401 34490 Venous Direct or With Catheter H 23930 24006 Incision H E1220 E1238 Wheelchair Special Size P16 Other and unspecified arthropathies 20802 20838 Heplantatian 0035 4051 Temporary Codes First Subsector 017
136. lected CPT code It shows CPT codes that should not be billed with the selected CPT code The reason for the unbundle edit as defined by the Medicare Correct Coding Initiative is also shown You open this dialog box by selecting a CPT code in the Code Detail that has CCI unbundle edits and then either clicking the CCI Edits button from the toolbar or selecting CCI Unbundle Edits from the CPT menu The Code column in all three tabs contains magenta code number links that take you to the appropriate code in the Code Detail These codes represent codes that you cannot bundle with the original CPT code you selected in the Code Detail You can access the links by double clicking them or by selecting them and then clicking the Select button The Reason column provides you the reason this edit is not allowed The Modifier column indicates whether the use of a modifier is allowed in order to differentiate between the services provided If allowed an appropriate modifier must be used with the code that represents a component procedure and or the code that represents the greater procedure as 1s appropriate The meaning attached to the modifier adds specificity about the services being billed which helps to differentiate between the services represented by the different codes Assuming the modifier is used correctly and appropriately this specificity provides the basis upon which separate payment for the services billed may be considered justifiable
137. lees Sint Fendt codes ace Hiiop Examination and Medical Decision Making The level of secan fie nach componen conri iss DAS T9537 EM Gudrine When counseling ana coxr imaien d cae ake up nore than percent he tl vist a then Time shed be thea determining hasta in 1104 Aacbant Cache Maalt Typs dl Sane Sidi of Viri Hostal dachaga day ranagenent mas than X rmata Hosha dachaga cay management W misie ci len Type ct Sanc roren Hierbas ol Lap Comprar Flip 3o 3 Shahri of Vl Initial Observation Care Meri oc Esiabliched Epam Cakul Coder Derio Gudelees he leg components for E codes aes Mio Examination and Medical Deecinion Making The level of sven nach component comielei ists Cii 1857 EH Guedes f hencounseing missile ECL EEEI RS then Time should be thea determinan facta in Stein E Cihservateon Care iPage hermana besson care dazharge dey management T hi code ir do ba utl CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Select Visit Option Consultations Office or Other Outpatient Consultations New or Established Consultations Initial Inpatient Consultations New or Established Consultations FollowUp Inpatient Consultations Established Consultations Confirmatory Consultations New or Established 92 Dialog box you will be presented Types el Gare Ciau Mumba al Kap Comperende Regaad METE Office a Der apriri Con
138. lick this button to displays special coverage instructions for the selected CPT or HCPCS code from these applicable Medicare References Pub 100 i perito covered sennces may alio be ipa for Fas her piolestioned services however lhe LEGS prolenmns 48271 sepsis zmce the SC incur Ihe hacky costs ok He CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 62 CPT Color Coding Legend not in CIFI9 This dialog box displays a legend showing all CPT Color Codes and their definitions You access it either by clicking the Color Coding Legend button from the toolbar or by selecting Color Coding Legend from the CPT menu CPT Color Coding Legend E xj e New Code Revised Code lh Add on Code AMA j Add on Code Inger Nonspeciic Code Age Restictioris V Commonly Miscoded Procedure Matemity cms Medicare Pokey Male Procedure Mode 63 Exempt Female Procedure Contcions Sedalion EE Su The following explains each CPT color coding symbol New Code Revised Code dh Age Restrictions Maternity M Male Procedure amp Female Procedure F Modifier 51 Exempt amp Nonspecific Code gt Add on code AMA t Add on code Ingenix Commonly Miscoded Procedure This symbol indicates new CPT codes This symbol indicates CPT codes with revisions codes with minor terminology
139. ltisystem and Single system Exams for Medicare s specific documentation policies Morbidity A diseased condition or state Mortality The condition of being mortal death New patient One who has not received any professional face to face services within the past three years from the physician or another physician of the same specialty in the same group practice On call physician encounters If the physician is on call or covering for another physician the patient s encounter is classified as it would have been by the physician who is not available Thus a locum tenens physician who sees a patient on behalf of the patient s attending physician may bill for a new patient only if the attending physician has not provided any professional service within a three year period Past history Record of prior illnesses or conditions occurring in childhood and adulthood such as infectious diseases allergies accidents current medications hospitalizations and surgical medical procedures Pertinent past family and or social history A brief narrative of the elements directly related to the problem s identified in the chief complaint history of present illness or the review of systems For Medicare any one or two of the three history areas depending on the category of E M service must be documented Present illness Current problem from the onset of symptoms to the time of the encounter Preventive medicine services An evaluation and ma
140. m Add Category Names for use with Bookmarks Change the Administrator Password Reset another user s password Access and make changes to the User Maintenance All Multi User Versions dialog box SYSTEM ADMINISTRATOR LOGIN To enable the System Administrator privileges you must log in 1 Select Administrator Login from the File menu s Administration submenu The Administrator Login dialog box opens 2 Type the Administrator password and click Login The initial password when you first open this dialog box is Ingenix Encoder Pro Expert Administrator Login Enter the administrator password to access global sticky notes and bookmarks User Mame admin Password Cancel Help Note You cannot log in as ADMIN from any of the suite s User Login screens In order to obtain Administrator privileges you have to log in as an Administrator using the password each time you launch your Encoder Pro suite product SYSTEM ADMINISTRATOR LOGOUT To disable the System Administrator privileges you must log out by selecting CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 122 Administrator Logout from the File menu s Administration submenu CHANGING THE ADMINISTRATOR PASSWORD l Loginas the System Administrator refer to page 121 2 From the File menu select Change Admin Password from the Administration Enter pour old password and enter and verify your
141. m ia ol m mur m Add on The Add on tab shows all CPT Add on codes It has three columns The Code column shows all CPT Add on codes The Type column lists whether add on 22 codes have been defined by Ingenix or the AMA The Description column gives the code s description You can sort this information by any of the three columns CFT Color Codes Mew Revised Addon 51 Exempe Prolonged extracorporeal pescutaneous ti Compulerarsebed musculoskeletal sung Compuler assisbed musculoskeletal sugi Computer artisbed musculoskeletal sums Perculsneous inlradiecal annuloplsshy ar Acoustic heat sound recording and com Accushe heat sound recording and com Acoute heat sound recording and comp Transcatheter placement of extracranial Placement of virceral extension prosthesi Placement of visceral extencion prosihesi Anesthena for second and third degree b _ Anses fe resi inline mu ole k 17004 Destruchon eg laser surgery electrasungen easurger chemodungen surgical curettement all benign of premalignant lesions eg achric kerabones olher than gkir lagi of cutaneous vascular prolilesalive lesions 15 01 more lesiona 17304 Chemotungery Mohs resrograptec technique including removal of all gross tumor surgical exciti n of lrsue specimens mapping color coding of specimens micioscopie esarmealion of specimens by lhe dungeon and complete histopathologec preparation including the first ruine stain
142. m the toolbar or select Add from the Edit menu to open the Add Code dialog box Code E1212 Description Motorized wheelchair fied full length arme swing a Add Code To select all that apply Bookmarks Sticky Motes uus Ene Notepad Global Global Cancel Help The Add Code dialog box lists the code and description of the selected code You choose to add the code to your personal sticky notes If you are logged on as a System Administrator you may also choose to add the code to global sticky notes 2 Click the Sticky Notes Personal or Global check box to specify you are adding a sticky note to the selected code 3 Click OK to close the Add Code dialog box and open the View Personal or Global Sticky Note dialog box 4 Type the name you d like to give the Sticky Note in the Sticky Note Name field and then your comments in the text box below 1t Note that there is a 4 000 character limit for sticky note text 5 Click OK to close the dialog box and save your comments Or click Cancel to close the dialog box without saving Shortcut To quickly add a code to the Sticky Notes dialog box without opening the Add Code dialog box 1 Right click the desired code in the Code Detail 2 The Add Code shortcut menu appears Click Add to Personal or Global Sticky Notes Add to Global Bookmarks Add to Personal Bookmarks Add to Global Sticky Motes Add to Personal Sticky Notes Add to Notepad View Carriers with LMRP CPT ONLY
143. mation for the currently selected 3 digit category Tabular Results Prints codes and descriptions of all results for the current search Number of lines printed is based on the number of total results not the number of codes and descriptions in the screen view Index Listing Prints codes and descriptions in each tab of the Index Listing for the current search Bookmarks Prints all bookmarks Sticky Notes All Codes Prints all sticky notes Notepad Prints contents of the Notepad dialog box AMA Copyright Prints the AMA s copyright information License Prints your license agreement with Ingenix Notes If you are using a Network version of Encoder Pro you must be logged in as Administrator in order to have access to the Index Listing and Code Detail reports These reports are available to all standalone users Both the Index Listing and the Code Detail reports may take some time to process Please be patient Code Specific Reports Guidelines Notes References Prints AMA guidelines parenthetical commentary and AMA CPT Assistant references for the currently selected CPT code section notes for the currently selected HCPCS code and ICD 9 CM tabular notes and AHA Coding Clinic references for the currently selected ICD 9 CM code Annotations or Lay Descriptions Prints annotations for the currently selected ICD 9 CM or HCPCS code and lay descriptions for the currently selected CPT code Modifiers Prints range specific mo
144. n using sticky notes This dialog box allows you to view CPT guidelines that depending on the code you select provide parenthetical commentary instructions references to AMA CPT Assistant issues primary procedure codes that are appropriate for use with CPT add on codes and examples for CPT Evaluation amp Management Codes The CPT Section Notes dialog box contains five possible tabs Section Notes Instructions References Primary Px and Examples You only see the tabs applicable to the code you selected You open this dialog box by selecting a CPT Code that has associated notes references examples from the Code Detail Then click either the Notes button EF from the toolbar or go the CPT menu and select CPT Section Notes Section Notes This tab displays information that appears at the beginning of sections or subsections in CPT for the selected code the basic services rendered The specific number assigned indicates the special circumstances under which a basic procedure is performed Code 33031 should be reported no more than once in a 30 day period to include the physician or health care provider time involved with data accession review and interpretation modification of care plan as necessary including communication to patient and or caregiver and associated documentation If the services described by code 99091 are provided on the same day the patient presents for an E M service these services y Ins
145. nagement service provided as a periodic health screening and or prophylactic service Problem focused physical examination Examination of one to five bullet point elements in one or more organ systems body areas from the general multisystem examination OR examination of one to five bullet point elements from one of the 10 single organ system examinations shaded or unshaded boxes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 107 Problem pertinent system review A narrative of the organ system s reviewed related to the system identified in the chief complaint and or history of present illness The pertinent positive and negative responses for the system related to the problem should be documented See Appendix B for the specific organ systems identified by the Medicare program Prognosis A forecast of the probable outcome of a condition or disease and the prospects of recovery and disease residual depending on the nature of the disease and the patient s response to treatment Prolonged services Inpatient or outpatient services provided by physicians that substantially exceed by 30 minutes or more the usual time the service takes to complete Social history A review of pertinent past and current activities of the patient including marital status employment or occupation use of drugs alcohol and tobacco educational background sexual history and other related social factors In some
146. nan Petter ol bulbar wel cate Conquer E Maanuaemeni of mips prar esce ws chien stipen esf osa nr infects domaj V dk Lame arao of Bh america chambers including depth cella and ue V Shh lemp scaena of he coraa rol epithelium roma enciotselum and sed Fim VO Ek lag encarar of the ence cid cant atenct and portencr zapade codes mi rashes V Ten cdm tl rd ber race aeg rent V fent vera cute Lica rod hd terete id rh peint ema ihanine exams Pra ciated puedo janie conis ane ed oit V Ferien cmm pees O med hened Genitourinary nie lt Fin eae ritr arahia beske grea meet all rmn ceat be Me crac Dong Ese runter Lee Med ee y O n Laremiua Deben Gaede Genuine Female Geri Hate V Augruliston ni Fast reti rola ol abnormal wounds aedi rae Emiten of peripheral vitulos quite by stcerratos ey relin vinda andi pain jeg pubi Cam pes dora era dal Hematologic Lymphatic Immunologic A A A ep P cec Dun the marier Hemiface A Heaegeaberehasc Pipay Laden Corina Em Hos Maik Tha Esteros Ermi V Apni ni had retis riobsion ol abnonmal sounds amd mamum Eminin ol peripheral situa titi by circa fog relin vinda ari papito jeg put as elena fencers CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 112 Musculoskeletal Tan brass Denarau Neurological Psychiatric Respiratory Ski n ITIPTTDTETDUTTUB ME
147. nccnnnnononononnconnnonononanncnnnnnnnnnnnnos 129 Quisele idueec T ERa 130 GOlOM COGING eG o E Um 130 wien m ccc EN 130 Eimer 130 Carriers with LMRP EXPT and PRO only ooocccnnccccccccnncccnonccnncncnonccononononnnnonnnancnnnononanennncnnnancnns 130 HCPCS Menu not in CIFIO octets ee eee et ee ec 130 POPGS SOCOM NOES Lt 130 ANNO ION Sartre 130 Modillers EXPT and PRADO ed 130 Grosscoder EXPT and PRO Only isosssscitestiavubesin So a aa aai ai 131 CCl Unbundle Edits EXPT and PRO Only occccccccccocnccnnncccccccnonccnnnncononononcnnnnonononanncnnnnnnnnnnnannnnnns 131 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual X Local Medical Review Policies EXPT and PRO only esee 131 National Coverage Determinations EXPT and PRO only sees 131 PSCC Ae CNC NR TETTE Sm 131 calor COMIC Led Cd aran tano 131 Previous COMES A 131 ONT COS f 131 Carriers with LMRP EXPT and PRO Only unieron aci oi 131 update MOI eee c X 131 alie MENU anette 131 POU Ment eC 132 ei 132 Program A umm 132 Environmen
148. new password User Mame mn 000 0 0 Old Password o Mew Password o Confirm New Password o Cancel Help 3 Type the current password in the Old Password field Note Each time you install an update for your Encoder Pro suite product the Administrator password is reset to Ingenix 4 Type your new password in the New Password and Confirm New Password fields 5 Click OK If you do not type the same text in the Confirm New Password field as in the New Password field you are alerted via the Password Error message box PREFERENCES DiALOG Box NETWORK TAB For details on this function refer to the Network Tab subsection under Preferences in this manual CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 123 UsER MAINTENANCE ALL MULTI USER VERSIONS This dialog box appears when the System Administrator has logged in and selects User Maintenance from the File menu s Administration submenu It allows the System Administrator to delete User Names from the system It also allows the System Administrator to rest a user password if the user has forgotten his her password User Maintenance E X All users who have login account are shown below Use this dialog to delete user names andor reset user passwords Reset Password DK Help Delete User This dialog box appears only 1f you are logged in as a System Administrator It 1s accessed by selecting
149. ng the patient complete a questionnaire regarding the Review of Systems and Past Family and Social histories The form is then reviewed by the physician to document details with respect to any positive responses CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 99 Quantifying the History There are four types described in the levels of E M codes Problem focused Chief complaint brief history one to three elements of present illness Expanded problem focused Chief complaint brief history one to three elements of present illness problem pertinent system review 1 system Detailed Chief complaint extended history of present illness four or more elements problem pertinent system review extended to include a review of a limited number of additional systems 2 to 9 systems and pertinent 1 history area past family and or social history directly related to the patient s problems Comprehensive Chief complaint extended history of present illness four or more elements review of systems that are directly related to the problems identified in the history of present illness plus a review of all additional body systems and complete past family and social history 2 Physical Examination The physical examination the second of the three key components for evaluation and management is documented by the physician physician extender and is then quantified The following body
150. ngth of time for the visit and total length of time involved in counseling or coordination of care as well as the nature of the counseling and coordination of care must be documented explicitly in the medical record In the CPT Book additional time qualifiers are found This includes time spent with parties who have assumed responsibility for the care of the patient or decision making whether or not they are family members e g foster parents person acting in locum parentis legal guardian 8 Preventive medicine services Encounters for preventive medicine evaluation and management such as a routine annual health screening examination are provided to infants children adolescents and adults Special E M code categories are provided for these encounters categories are assigned according to whether the patient is new or established and according to the age of the patient 9 Prolonged services Encounters in which the time required by the physician to provide a given service exceeds by at least 30 minutes the amount of time usually required to provide the service Separate code categories are provided for services with face to face contact with the patient and for services without direct face to face contact with the patient Prolonged service codes are used in addition to other E M codes assigned on the same date Terms Commonly Used in E M Codes Chief complaint The diagnosis condition problem symptom or other reason the patien
151. not a Primary Diagnosis This symbol identifies ICD 9 CM Vol 1 codes that are duplicate Primary Diagnoses This symbol identifies ICD 9 CM Vol 1 V Codes that are considered a Primary Diagnosis This symbol identifies ICD 9 CM Vol 1 V Codes that are considered a Secondary Diagnosis This symbol identifies ICD 9 CM Vol 1 codes that are related to comorbidity or a complication This symbol identifies codes with attached sticky notes See page 72 for details on using sticky notes CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 46 ICD 9 CM VoL 3 DIALOG BOXES ICD 9 CM Annotations Please refer to page 42 for details ICD 9 Vol 3 Crosscodes EXPT and PRO only This dialog box displays CPT surgical codes that correspond to the selected ICD 9 CM Vol 3 surgery code Select an ICD 9 CM Vol 3 code in the Code Detail that has CPT crosscodes and click the Crosscodes button amp on the toolbar or select Crosscoder from the ICD 9 Vol 3 menu to open the dialog box This dialog box contains code number links to go to the appropriate code in the Code Detail Double click on the link or select it and click the Select button The Crosscodes dialog box closes and the selected code and its description appears in the Code Detail ICD9 Vol 3 Crosscodes 79 77 E x CPT Codes 27840 Closed treatment of ankle dislocation without anesthesia Closed treatment of ankle dislocation req
152. note that the ICD 9 CM codes must be coded to the highest level of specificity coding to the fourth or fifth digit This is a requirement for all claims Documentation Documentation supporting the medical necessity of the service should be legible maintained in the patient s medical record and must be made available to Medicare upon request Reimbursement All of the coverage criteria listed for National Coverage Determinations must be met National Policy In the event that a national policy is established for any of the local medical policies the national policy takes precedence over the local policy Medicare Physician Fee Schedule EXPT and PRO only This dialog box allows you to view information for CPT codes from the Medicare Physician Fee Schedule When applicable this dialog box provides you with actual payment information such as Relative Value Units Global Information and specific Medicare Rules from the Medicare Physician Fee Schedule You access this dialog box by selecting a CPT code from the Code Detail and then clicking either the CMS Fee button or selecting Medicare Fee Schedule from the CPT menu RVUs Facility This tab shows relative value units RVUs for procedures performed in a hospital skilled nursing facility or an ambulatory surgery center The RVUs are broken out into the components of physician work Work RVU practice expense PE RVU and malpractice relative value units The total RVU is also sup
153. notes added by the System Administrator To add edit or delete a global sticky note you must login as the Administrator Refer System Administrator Login for instructions CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 73 View Only Check Boxes The default is for all sticky notes to appear when you first see the Sticky Notes dialog box If you want to narrow your view to only certain types of codes uncheck the code set s you aren t interested in viewing ICD 9 Vol 1 ICD 9 Vol 3 CPT or HCPCS Links to the Code Detail The Sticky Notes dialog box contains code number links that take you to the appropriate code in the Code Detail You can access the links by selecting the code and then clicking the Go to Code button Clicking this button exits you from the dialog box and takes you to the selected code Balloon Help Hovering your mouse over any pink flag in the Code Detail shows you the text of that Sticky Note Your View Tab in the Preferences dialog box determines whether a personal or global note appears when a code has both a personal and a global note If you have assigned multiple notes to a code the balloon help tells you This code has multiple sticky notes assigned Use the Sticky Notes dialog to select a specific note to view Color Code Box Links When you double click on a Sticky Note s blue link in the color codes box the View Sticky Notes dialog box refer to pa
154. np si Ern a rr umi n natn Making The level ol bien x path component comdales 1557 EM Guidelines when counsi phar pe aam Fw rend u Ew od vul us ihan Time shed be ther determining hacia in JM Stein CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 94 Select Visit Option Dialog box you will be presented Nursing Nursing Facility Discharge Services mi Does not have access to the Exam Calculator Harn a uraia ld Hueirag laclity dacharge day management W riie or ler mr ie Domiciliary New Patient The key components for E M coder T ce m ru Pr rr ral Heka Decinon king The kvala serene fos nach component coral 1557 E M Guidelines e hen coneselng and combination emissis ELLA CERERI ASI CR LEES cdd deleting an E JM eode Domiciliary Established Patient Type ct Sanc Doia Mumbo ol Kap Components Regie Told Glave Vi EmahhedPxert Egan Cauda Coder Detintions Guedes Mt ra components fac E Dt Ern rn mal Medical Deci on Making The level of amen fie nah 1847 EH rudis f henrcounseing of cme laha up mone than 50 percent ol the bota vini ima then Time should be the debesmining acia in electa an EM eode Home New Patient Thart components for Eh codes eer d Medical Decinon Making The level of servi fos nach component comas 15557 E M Gudenn el hern causing and of cave lake up mora than DO percent of Ghee total wind imer then Time should be ha debesmining actor in
155. ntial LMRP Edit Conflicts if they choose to do so In the event that you need access to newly published LMRP or want further clarification please see http www Imrp net CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 55 LMRP Medical Necessity Edits 61795 This dialog shows ICD 9 CM codes diagnoses that determine medical necessity when reporting the selected CPT code procedure These edits are based on the Local Medicare Review Policies for the Medicare Carrier s listed below Use the drop down menu to select a different carrier locality Select Medicare Carrier Locality 00510 00 ALABAMA AL Make default Medicare Carrier Locality Malignant neoplasm of tonsil Malignant neoplasm of tonsillar fossa Malignant neoplasm of tonsillar pillars anterior posterior Malignant neoplasm of vallecula Malignant neoplasm of anterior aspect of epiglottis Malignant neoplasm of junctional region of oropharynx Malignant neoplasm of lateral wall of oropharynx Malignant neoplasm of posterior wall of oropharynx Cancel Help LZ The drop down list shows the Medicare Carrier you selected from the Edit menu s Select Carrier Locality option see page 83 for information on selecting your Medicare Carrie Locality However you can use the drop down list to view the LMRP data for any Medicare locality The Make default Medicare Carrier Locality check bo
156. o da i 83 Medicare Carrier Locality EXPT and PRO Only cccssssssseeesceessseeeeeeenseeeeeeeesseeseeeenseeeseonenseessoes 83 Carriers with LMRP Edits EXPT and PRO Onlly cccesseeeccesseeecenseeeseenseesenseeseosseesonnseeseonees 84 E M COMPLIANCE AND EXAM TOOLS ooccoccccccncncncnnnconononononononnnnnnnnnnnnnnnnnn anna 85 E M Assistant EXPT and PRO only eee ceo coe cocoa eeu oc ca ceo out teo ee ee cotes 85 o MENT A O 85 e e e E 86 KEV COMPONE 9 camer ee sere ET a aaa TS 89 Code ResUl eie n N a oR ee eee eee 89 codes TaD E E E O OA 95 o LEUR 95 Sog 95 Exam Calculator Button EXP TON Metre tae ce eub up uode eee ee Mee cto 95 Specifics of Evaluation and Management Coding cccccncccccccconccnnnnccnnnonanncnnnnnonnnnannnnnnnnnnononanenonns 96 Levels of E M SEVICE S eriin nals o rut O cadmas Mislead 96 KEY COMPONEN cct PEN 97 Quanuryitig the ISO added s Sirsa aa rtu td ali 99 Quapttylug ihe Examinar 100 Quantifying the Medical Decision Making cccccccccccnnnnoconononoconononononocononononnnnnanonanononnnoos 102 Gontibutoy COMPONENTS assistance des eiii illo 103 Terms Commonly Used MEM C OOBS rensa iea redu oa vet eee ve dee redeo vat cei ee 104 Modifiers Used witbiE M GOGOOeSs i e acit dieto dee aD eet d etos a end Meieu ogeues 107 Selecting an E M Code cccceecccccceecceeeesseeceeeeeceaeeseeeeeeeeeeaaeeeeceeeeeseeeaeeeeeeeeessaeeese
157. oen ML MI Me IU MIU NP CMM M DUE 19 Gode BOOK SectloflS sarta a ias doren Fat du a e aea M dead tei 20 Looking Up Codes That Have Color Symbols eeeee eec eeeeeee ere reisen eene nnn nnn 21 GPT Golor Godes notin RI a ha o de hae 21 SD VOL TOO NOS Si a east ee aac cee ae dence dba ae eae 23 IG B29 Vol 3 COlOr COGS m 25 HOPGOS Golor Codes notin OlH Ps I9 auspicio tuse o adii Update a a 27 Performing a Code Seah siiis ree iae cs 29 Entering Search Criteria ccccccssssscccccssseececcceeeececseeseeeeseeuseeeeesseaeeeeesssaeeeeessaaeeeessegeesesssuageeeees 29 Tips For Entering Search Tenia 29 Determining Search Ofensa 30 Criteria tor GPT CAES o lee ee alten AS heed 30 Criteria for ICD 9 CM Codes coocccccccccccooonccononononnnonnnnnnnnononnnannnnnnnnnnnnnnnnnnnnnnnnnnnnnnrnnnnnnnnnnnannennnnns 30 Spell Checking Search Terns sanea adnan dusedeasaetzunsdebecoassauecaueeenescasoaesestse 31 Viewing Search RESUS ER T A See 31 Viewing Additional Digit ICD 9 CM Codes ccccccccccccssseeeeeeeeeeeeeeeeeeeeeseeseeeeeeeeeeeessuaeeeeeeeeeeesaaas 32 Viewing CPT and HCPCS Codes coccccccccncncccccnnnccncnnnonncnnnnnnnnononnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnrennnnns 33 Narrowing Search Res lls risa a 33 RestllS AIF eee T 33 PEC GOCE elitr T LO ELT 34 Specifying Code Type esasen a aa oae iae araa a A A e a aA 34 Revon BUON aE m 36 Vie wino
158. ognosis with management compliance Low severity Problem that has a low risk of morbidity or little if any risk of mortality without treatment full recovery is expected without functional impairment Moderate severity Problem that carries a moderate risk of morbidity or mortality without treatment uncertain outcome or increased probability of prolonged functional impairment High severity Problem that has a high to extreme risk of morbidity moderate to high risk of mortality without treatment or high probability of severe prolonged functional impairment The level of the severity of the presenting problem may vary during the encounter based on the physician s documented evaluation of the patient chart documentation should clearly define the findings and reflect the thought process of the physician in ordering diagnostic or therapeutic services to support medical necessity for those services This component is the foundation for establishing the level of service based on medical necessity 5 Counseling This is performed when one or more of the following areas are discussed face to face with the patient and or family Diagnostic results impressions or recommended diagnostic studies Prognosis Risks and benefits of management treatment options Instructions for management treatment or follow up Importance of compliance with chosen management treatment options Risk factor reduction Patient and family education CPT
159. ogram maintaining four versions of CCI Version selections are available in Preferences Data Versions Data Update is an enhancement that will be enabled when data is available It provides immediate access to new data sets The Data Update dialog box lists only the specific data available in your Encoder Pro program Updates menu option opens the Data Updates dialog box that contains the new data sets Single users and administrators for multi user versions will be able to update the data Transitional Adjustment to Medicare Payment for Certain Drug Administration Services Section 303 a 4 of MPDIMA provides for a transitional adjustment to Medicare payment for drug administration services to reflect implementation of the amendments made by section 303 of MPDIMA affecting Medicare s payments for drugs Specifically section 303 a 4 of MPDIMA requires Medicare to increase the physician fee schedule amounts otherwise determined by 32 percent for 2004 and 3 percent for 2005 Payment will be determined for CPT codes 90780 through 90781 90782 through 90788 96400 96408 through 96425 96520 96530 based on the work practice expense and malpractice RVUs shown in Addendum B and the 2004 CF of 37 3374 Consistent with section 303 a 4 of MPDIMA the physician fee schedule amount will be increased by an additional 32 percent for 2004 The physician fee schedule amounts applicable in 2005 will be increased by 3 percent UPGRADE BENEFITS
160. olicy included in this product is with the Centers for Medicare amp Medicaid Services CMS formerly known as the Health Care Financing Administration or HCFA and no endorsement by the AMA is intended or should be implied The AMA disclaims responsibility for any consequences or liability attributable to or related to any use nonuse or interpretation of information contained in this product The software and documentation is provided with restricted rights The Use Duplication or Disclosure by the Government is subject to restrictions as set forth in subdivision c 1 11 of the Rights in Technical Data and Computer Software clause at DFAR 252 227 7013 or restricted rights clauses at 48 CFR 52 227 19 or 52 227 14 as applicable Contractor Manufacturer is Ingenix 2525 Lake Park Blvd West Valley City UT 84120 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Hl Contents WELCOME coeno bat D EMEN EM M MEE ME 1 About Ingenb6ssuu end aic itm a en cv aeo Wu artes a eO Ws Mau touc eS kee ease een Qus dean nueva DON aaa 2 Getting ON Mee 2 Software Feal l68 nd oca cin 2 What s New in Encoder Pro occccccoccnccccccncccconnncoconcnnnnonnnnonnnnnnnononnnnononnnnononnnnnonannnnnnnnnnnnonnnnnnnanennss 5 A o 5 What s New Files and Tables viscosa a 6 Enhancements Iri Encoder Proa 7 Upgrade Benet iria innato inc REPE esperes 7 Hardware Requi
161. on the type of code selected ANNOTATIONS 3 After selecting a code that contains an annotation from the Code Detail clicking this button opens one of the annotation dialog boxes either ICD 9 CM Vol 1 CPT or HCPCS CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 135 MODIFIERS EXPT AND PRO ONLY After selecting a code that has a Modifier from the Code Detail clicking this button opens one of the modifiers dialog boxes either CPT or HCPCS CROSSCODES EXPT AND PRO ONLY After selecting a code that has a crosscode from the Code Detail clicking this button opens one of the crosscodes dialog boxes either ICD 9 CM Vol 3 CPT or HCPCS CCIUNBUNDLE EDITS EXPT AND PRO ONLY After selecting a code that has a CCI Unbundle associate with it from the Code Detail clicking this button opens one of the CCI Unbundle Edits dialog boxes either CPT or HCPCS LMRP Epits EXPT AND PRO ONLY After selecting a code that has a Local Medical Review Policy Edit from the Code Detail clicking this button opens one of the LMRP Edits dialog boxes either CPT or HCPCS The LMRP button is active only if there are edits for the selected code and carrier preference and or if NCD edits exist for that code NCDEpits EXPT AND PRO ONLY After selecting a code that has a NCD edit associate with it from the Code Detail clicking this button opens one of the NCD Edits dialog boxes
162. ou can use your Encoder Pro product to view codes for the current search as they are displayed in the Index as well as view codes in the Code Detail To view the Index Listing 1 Type search criteria in the Search box 2 Click the Enter key or the Search button If the search criteria you enter is found in the Index the See Index listing link is enabled If no results in the Index match your search criteria the See Index listing link remains disabled Index listing CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Note 37 Click the See Index listing link to open the Index Listing dialog box The Index Listing displays the applicable tab or tabs depending on product and search preferences for codes located in each applicable code set index ICD 9 Vol 2 the index for ICD 9 CM Vol 1 codes ICD 9 Vol 3 CPT and HCPCS e To view subcodes click the plus box in front of a main code e Click the minus box to hide subcodes Because of the number of possible index matches for certain search terms this dialog may take several seconds to open Viewing Codes in the Code Detail Select a code in the Index Listing window to view that code in the Code Detail When you view a code in the Code Detail the Index Listing remains open CPT HCPCS 100 312 Arm Lower H Abscess 25028 H Amputation 24900 24920 25900 25905 25915 i Arten i Biopsy 25065
163. our categories to both types of bookmarks if you are using both To edit a bookmark description or to add or edit its category 1 Select the personal or global bookmark you want to edit from within the Bookmarks dialog box 2 Click the Edit button The Personal or Global Bookmark dialog box appears 3 When you finish making changes to the description or category click OK Deleting a Bookmark To delete a code from the bookmark list 1 Open the Bookmarks dialog box by clicking the Bookmarks button Ef or selecting Bookmarks from the View menu 2 Select the bookmark you want to delete 3 Click the Delete button Importing Bookmarks from Previous Versions All Bookmarks you created in previous versions of Encoder Pro or Code It Fast are automatically imported into this product CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 72 Exception Bookmarks from versions 3 0 and those from versions older than 2 4 1 are not automatically imported If you have questions please contact Technical Support at 800 765 6797 UsiNG STICKY NOTES Sticky Notes are custom notes you or a System Administrator create for selected codes You can add one note to multiple codes You can also add multiple notes to any given code In order to view all the Sticky Notes either you or the System Administrator have created you must open the Sticky Notes dialog box To open the Sticky Notes dialog
164. physician or other appropriate source Select emergency if the facility is an organized hospital based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention The facility must be available 24 hours a day Select nursing for care provided in a skilled nursing facility SNF intermediate care facility ICF long term care facility LTCF or psychiatric residential treatment center Select domiciliary for rest homes or custodial facilities for the place of service that provides long term room board and other personal assistance services Select home for services provided in a private residence Select Visit This dialog box appears after you click the Next button from the Select Service dialog box The contents of this dialog box depends on which of the seven service types you selected in the Select Service dialog box The Select Visit dialog boxes allow you to select the visit type based on the selection made in the previous dialog box Once you ve selected the appropriate radio buttons simply click Next to move to the Key Components dialog box To go back to the previous screen to change your selection in the Select Service dialog box click Back Here are CPT Book guidelines that can help you determine patient status According to the CPT Book a new patient has not received any professional services from the physician or another physician of the same specialty
165. plied The 2003 conversion factor 36 7856 is displayed at the bottom of the dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 59 Medicare Information 24075 E x Global Information Medicare Rules Medicare Fee m RVUs Facility E RVUs Nonfacility Global Work AYU PE RYU Malpractice RYU Total RYU Conversion Factor 36 1 992 Cancel Help RVUs Nonfacility This tab shows relative value units RVUs for procedures performed in a physician s office patient s home or any other facility or institution such as a residential care setting that is not a hospital SNF or ASC The RVUs are broken out into the components of physician work Work RVU practice expense PE RVU and malpractice relative value units The total RVU is also supplied The 2003 conversion factor 36 7856 is displayed at the bottom of the dialog box Medicare Information 24075 x Global Information Medicare Rules Medicare Fee AVUS Faciby TE ao MERGE Global Work RYU PE RYU Malpractice AYU Total RYU Conversion Factor 36 1 992 Cancel Help Global Information This tab shows global period information for the selected CPT code The global period is the time following surgery during which routine care by the phy
166. r family or the time the physician spent bedside and on the floor or unit use time as the determining factor Apply appropriate E M modifiers as needed EXAM CALCULATOR EXPT ONLY The Exam Calculator functionality is presented in a wizard similar to the E M Assistant EXPT and PRO only It assists your coding efforts according to the appropriate exam level based on CMS s 1997 Documentation Guidelines for Evaluation and Management Services Exam Calculator Select Examination This Exam Calculator Select Examination dialog box appears when you click the Exam Calculator button from the E M Assistant Key Components dialog box It allows you to determine the appropriate level of service for the Examination key component It is based on CMS s 7997 Documentation Guidelines for Evaluation and Management Services for general multi system examinations and single organ system examinations CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 110 Exam Calculator Select Examination E x The Exam Calculator is a tool for helping you determine the appropriate level of service for the Examination key component It is based on the CMS 1997 E M Guidelines for General multi system examinations and single organ system examination A r Single Organ System E valuation C Cardiovascular C Ears Nose Mouth and Throat C Eyes C Genitourinary C Hematologic Lymphatic Immunologic C M
167. reground Single clicking the pink code and then clicking the Select button closes the dialog box and takes you directly to that code in the Code Detail Deleted Codes If you enter a deleted code number in the Search Prompt or if you select Deleted Codes from the View menu the Deleted Codes dialog box appears It is also accessed by selecting Revised Codes on the drop down list on the right side of the black toolbar and then clicking the View button next to it CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 20 Deleted Codes E x CPT HCPCS IcD 3 Vol 3 See 40430 See 40431 See 40429 See 40428 See 40429 See 40428 See 40426 See 40429 See 40427 See 40428 See 40429 See 40428 See 40426 Gee 411429 TN Deleted codes are maintained for the years 1998 through the current year The dialog box displays codes deleted prior to 1998 that are still referenced in the CPT Book The Deleted Codes dialog box shows deleted codes the year each code was deleted and any cross references There are pink cross reference codes in the third column Double click the pink code number to go to that code in the Code Detail but the dialog box remains active in the foreground Click the Cancel button to exit the dialog box The dialog box contains a separate tab for each code set Codes in each set are arranged alphanumerically by code If you are viewing this dialog box because you entered a delete
168. rements ii ca 7 Operating System REGUIFCINGINS sicui sc verdant Scop sca RR riv Eod eins ru QUv E Ugo Uo v avare Une oU Vwt og ba oos aidaa 8 About TIRE SONWANE noia aaa ici 8 Encoder Pro WIN OWN A ETA EEE EAREAR 9 PRODUCT SE FUP nannaa a A a ID a EDU te einai cata 10 Logins and PassWord Saa TAATA EAE EENE IAEE EERE 10 Eidem da 10 FPrS HMS LOdN fer Tc m 10 Administrator LOGINS aeee a a e dd T 11 SP aa A deasacendeansewuctnassances 11 Ghanging User Passwords seal talado docs 11 Invalid Eogiis and Passwords 2 5 ari bnnad tds 11 Preferente S os 11 COP Ta Dran erer e o o a ar NNI 11 me 2 106 Ta Jee mere ert EIN 12 VEW ectetuer ect E M i E Lt EM e ee 13 Network Tab Multiple User Versions ccccccccsssseececceeseececceeeeeeeceessececsseaaecessseaasesesssaaseees 13 Data Versions Tab EXPT and PRO only eise veia Vae eoo ova ee opes vete venta e ee Vete cosa va ee i 14 Launching From the Task Dal anciano uaa Se CE EUG EX XM E ev E aU CGE 14 Data WD GAC mt t a 15 Importing Global Bookmarks and Sticky Notes from a Previous Version 16 DISDIAY rogi pM ET 16 SEARCHING FOR CODES c 18 Looking up Codes Quickly tai 18 The Black TOOL nutrida 18 CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual IV MISES INR MNT TD 19 FEVISCO GOGES PORRO TOU 19 Deleted CodeS
169. s established patient or initial vs subsequent care The narratives for the levels of most E M services include seven components The key components history examination and medical decision making are most often used to select the appropriate level of service code Information regarding at least two of the three components for inpatient or outpatient follow up visits and all three for consults and inpatient or outpatient initial visits must be documented in the patient s record to substantiate most levels of service The four remaining components are called contributory components and are counseling coordination of care nature of presenting problem and time Counseling and coordination of care need not be provided at every patient visit However when counseling and coordination of care take up more than 50 percent of the total visit time face to face in the office or other outpatient setting or floor unit time in the hospital or nursing facility and the time spent is specifically documented in the chart then time is the determining factor in selecting an E M code Time is also the controlling factor in such E M services as critical care and prolonged services Time factors total length of time for the encounter and total length of time for the counseling or coordination of care must be documented in the medical record when time is used to determine a level of service The various levels of service for each component are descri
170. s select Index Results Cancel There are two ways to narrow your search as described below CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 34 Specifying Code Sets Specifying only the code types you are interested in assists you in focusing your search You can filter the results displayed by selecting or clearing one or more check boxes Each time the results are filtered by selecting deselecting a check box the Total matches area reflects the number of results 1 Select the check box for each code set in which you want to view results ICD 9 Vol 1 ICD 9 Vol 3 CPT and or HCPCS For example if you want to view just CPT code results make sure that only the CPT check box is marked A mark in the check box indicates a code set is selected If a check box is dimmed no results were found and the check box cannot be selected or cleared The check boxes that are marked are based on the results found for your search The code sets you are searching on are based on your preferences set in the Search Tab of the Preferences dialog box or through the Code Sets drop down list on The Black Toolbar 2 Referto the Total matches area to see how many results were found for the code set s selected The number displayed there automatically updates when you select or clear the code set check box Specifying Code Type A method of refocusing your search is to cli
171. s codes in the Includes Excludes notes to identify it as the selected highlighted code For example if you click 771 0 which is referenced in the Excludes note for category 056 the Code Detail redisplays showing the codes and descriptions with hierarchy for 771 0 ICD 9 CM color coding symbols provide further information for diagnosis codes e g codes that require an additional digit are nonspecific are new etc See ICD 9 Vol 1 Color Coding Legend and ICD 9 Vol 1 Color Codes for additional information CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 40 CPT AND HCPCS CODE DETAIL For CPT and HCPCS codes the Code Detail displays the code and full description for the selected code and a view of all other codes in the same section subsection CPT Codes that are shown as indented codes in the CPT code book are shown in the Code Detail with the full description instead CPT and HCPCS codes in the Code Detail are grouped by section subsection The top pane of the Code Detail displays section titles that identify where in the CPT or HCPCS books a group of codes are located CPT color coding symbols shown in the bottom pane identify add on subsidiary codes codes for which Modifier 51 is exempt new and revised codes etc Refer to CPT Color Coding Legend not in CIFI9 for further information For HCPCS color coding symbols shown in the bottom pane identify codes that aren t covere
172. s from Previous VersiONS ccccccoonncnncccononcnnnoconancnnnoonnncononononncnnnnnnnnncnnnnnnnos 76 USING the NOlEDaG uc 76 Notepad ea 6 cere ee ne erate eee D TL 77 Notepad BUON Sus TTE 77 Adding Godes tothe Notepad sitet ni rem Ev e Ev hee eee ane ee pene rude 78 To add a code to the Notepad from within the Notepad dialog box 78 To add a code to the Notepad from the Code Detail ccccocoocccnncccconncnnconcancnncononnnnnnnos 78 aper aii Crr N 78 AbpencitigIodillelS sida dites idet dodo a ed ia Se A ooa sesto ne es ace Doo p dou Dade 78 To append a modifier to a code in the Notepad ccccccoocccnncccconncnncccnnoccnnonononcnonononncnnncnnnnnnonnnos 79 DUPplcatina OCS EE E E ET 79 e o A 79 sending Data tothe OIIBBOSEG ss is 79 Using the Copy FUNCUON inca car ua Ev uc ai cae vau de cus si ee Gea Dae di ev du Ce ee 79 Copying Godes and Deserts c isasome veees eon tuboe o6 eva de ee rato coe vaa ges de etat ote Vae cart obe v da nias 79 See Me Mo qu EE 80 Copying to the Clipboard ooooccccccccccccoonnccnnncononononncnnnnnononanncnnnnnnnonnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnannnnnnnnnns 80 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual VII o emm ero 80 General A TI MEC 81 Gode Specie Repo aai aea Sat m e betae iet ba ecol t ini sema 81 Brice me 82 Environment Informallon iion aa
173. sents a comprehensive procedure these unbundles list the HCPCS codes that represent the components of the comprehensive procedure HCPCS Unbundles G0001 E x CCI Component CCI Mutually Exclusive CCI Greater Px Code Reason 1 1 1 Medie 82952 Most Extensive Procedures Allowed Glucose blood by glucose monitoring device s cleared by the FDA specifically for home use Version 3 0 Cancel Help CCI Greater Px tab This tab shows the greater procedure or comprehensive codes of which a component code could be considered an edit It allows you to see the complete CCI relationships regardless of what code 1s selected CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual HCPCS Unbundles G0001 l x CCI Component CEI Mutually Exclusive CCI Greater Px Mutually Exclusive Procedures Venipuncture child over age 3 years or adult necessitating physician s skill separate procedure for diagnostic or therapeutic purposes Not to be used for routine venipuncture Version 9 0 Cancel Help CCI Mutually Exclusive tab These unbundles are part of Medicare s Correct Coding Initiative edit Codes listed here represent those procedures that cannot be performed during the same operative session HCPCS Unbundles G0001 il E CCI Component CCI Mutually Exclusive CCI Greater Px 62273 Standards of Medical Surgical Practice Not Allowed 9
174. sician is considered postoperative and included in the surgical fee Office visits or other routine care related to the original surgery cannot be separately reported if they occur during the global period Global periods are sometimes referred to as follow up days or FUDs CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 60 Medicare Information 20075 xd acc AWUS Faciity RVUs Nonfacilty Global infomation Medicare Rules MedicareFee Global Period days 090 Global Split Preoperative E 0 00 Intraoperative g3 D Postoperative 21 00 Cancel Help The Global Split section shows a breakdown of how Medicare expects the value of an encounter to be split if different components of the encounter are performed by different physicians You see the percentages that would be paid to physicians for preoperative intraoperative and postoperative services if these services were performed separately Medicare Rules This tab lists the Medicare edits that are applicable to the selected CPT code Each rule is listed and explained in detail in the online Help Medicare Information 24075 E x RVUs Faciity RVUs Nonfacility Global Information Medicare Rules Medicare Fee t OUR Multiple Surgery Reduction Bilateral Procedure Allowed Cancel Help CPT ONLY 2005 AVERICAN MEDICAL
175. signed to Sticky Note field The Codes Assigned to Sticky Note field displays the codes and descriptions of all codes that have been assigned this particular sticky note The Unassign button allows you to delete any code from this sticky note The Sticky Notes button takes you to the Sticky Notes dialog box which lists all Sticky Notes Deleting an Existing Note 1 Open the Sticky Notes dialog box by either clicking the Sticky Notes button A or by going to the View menu and selecting Sticky Notes 2 Click the code number of the sticky note you wish to delete 3 Click the Delete button Note Use the Delete button only to delete the entire sticky note If you want to delete a block of text from the sticky note you must click the View Note button Importing Sticky Notes from Previous Versions All Bookmarks you created in previous versions of Encoder Pro or Code It Fast are automatically imported into this product Exception Sticky Notes from versions 3 0 and those from versions older than 2 4 1 are not automatically imported If you have questions please contact Technical Support at 800 765 6797 UsiNG THE NOTEPAD Note If you are using Encoder Pro Expert the Notepad and all associated buttons are named Compliance Notepad The Notepad functionality 1s used to temporarily store codes which can then be copied to the Windows Clipboard The advantage of using the Notepad is you can perform several searches and then send al
176. splays 6 Add User Name and Password and select the OK button 7 The Code Detail for the selected code is displayed Turn off the Ingenix Toolbar l Right click on the Start Taskbar 2 Select Toolbars Ingenix Tools to uncheck the option and the icon is removed from the Taskbar DATA UPDATES This Enhancement will be enabled when data is available Data Updates EC x Log Results Establishing session Opening Intemet connection Hetriesanig manifest hip rattlerepro marubest tt Status code 200 Found Manifest file Select Updates Data Updates from the menu to display the Data Updates dialog box Only the data sets that are applicable to the features in your Encoder Pro program are shown in the Name and Description fields The Update button is available to single users and administrators of multi user versions Click the Update button to update your data sets CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Administrators and single users perform the data updates l 2 3 IMPORTING GLOBAL BOOKMARKS AND STICKY NOTES FROM A PREVIOUS VERSION All Bookmarks and Sticky Notes you created in previous versions of Encoder Pro or Code It Fast are automatically imported into this product Exception Manual All external communication uses Internet read access via HTTP Y ou must have access to http www ingenixdataupdates com HTTP communication us
177. sultora Mere or Likabluhed Egam Lakculeinr Coder Detintions Guedes Shabu ol Virgi The key components for EAH ci s Hiiop Faaali mel Heka Decinon Mabing The kya serene fos nach component coma 1557 E M ruidielnerz o hen counseling and coordination emis rede ec Dei ol the total wink immer then Time haul be the deber lazio in ieleciing an EM ende Type el Barca Coria Bumba of Kap Comper rds Pegiat EE Initia noient Consultation Merv or Dissbluhed Epin Colcul drs Coder Detritions Gudeles labial Viri The key components for E M coder ird a s Ire orn and Medcal Decinon Making The level cl serva fos nach componen coma 1557 E M Gudenn ef hen counseing and coxdinaien y CERE ain then Time should be ite deberia hector in ckecting an E M ende L lr Dt AL S PFsoblem l ncured Problem T ocu Expanded Pas cime Lompeehemirre Lompiehemre Taa Sames Ciemi umber of Kap Components Regie Tdi Taila Inpatient Coraukssons E rtsblithed Egan Calculador Coder Detintions Guedes Stau al Vint Takes liie endet rie si irr T ren Medical scii Making The lll ama lor nach componen comilales 1357 EM Gude when of cave labs up mora than 50 percent of dhe total wind ima then Time shoud be ihe debesmining actor in electa an EM eode Type cl Saner Consultations Mumba ol Kap Conpor rdo Magia Jad Contrata Cordon Hew o abkbhed Egan Calculador Coder permiten Guedes labial Viri
178. t separately identifiable E M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed The E M service may be prompted by the symptom or condition for which the procedure and or service was provided As such different diagnoses are not required for reporting of the E M services on the same date This circumstance may be reported by adding the Modifier 25 to the appropriate level of E M service or the separate five digit modifier code 09925 may be used Note This modifier is not used to report an E M service that resulted in a decision to perform surgery See Modifier 57 27 Multiple Outpatient Hospital E M Encounters on the Same Date For hospital outpatient reporting purposes utilization of hospital resources related to separate and distinct E M encounters performed in multiple outpatient hospital setting on the same date may be reported by adding the Modifier 27 to each appropriate level outpatient and or emergency department E M codes s This modifier provides a means of reporting circumstance involving evaluation and management services provided by physicians s in more than one multiple outpatient hospital settings s e g hospital emergency department clinic Note This modifier is not to be used for physician reporting of multiple E M services performed by the same physician on the same date For physician reporting of all outp
179. t ined Mr TET 132 AMA Copyright not in CIFI9 00 0 ccecccceccseeeecceeceeeseceeeeeeeseeeeseeeseeeesseeeeeeeesseaseeeeessaaeeeeessageeeeeseaess 132 License Agreement TETTE NEUEN 132 Dir ocio y Tc E E 132 A 132 BIORECICK Ada Mel a 133 Add To Global Bookmarks eros uas tetur nee diehsesquemtuv etos eoe buc de arta Us stunden My ratos 133 Add To Personal boo ANS unto tios 133 Add To Global Sticky Notes esses nennen nennen nnn nnne nennen nennen nnn 133 Add To Personal Sticky Notes sss eee nnne nnn nennen nennen nnns nnn nnn 133 POG TO NOC E 133 View Carriers with LMRP EXPT and PRO ONlY ooocccnccncncccnncccncncconccononcconcnononnononnnancnnnnnnnancnnnnos 133 TOOLBAR e sce cede teases C 134 Add OED on eccsssssssssssssssssssstsssssnsssssessssussessuessssnessssesssnessssnesssaneesanesssaneessansessnessranesssaeessaneessueesseaneessans 134 Bookmarks 134 1141 134 Notepad AS 134 Cnm A ee 134 Notes iestsciese 134 Annotations Y BENNNNMMRMMMMMNMMMMMMMMMMMMMEMMMMMMMMMMM 134 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual XI Modifiers EXPT and PRO only eene tnt tntn tete tn snae anta a aaa tas
180. t scheduled a visit with the physician as stated by the patient and generally recorded in the patient s own words A chief complaint must be documented for all levels of problem oriented E M service codes 99201 99499 Complete past family and social history A comprehensive review of all elements of the patient s past family and social history For Medicare two or all three history areas depending on the category of E M service must be documented CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 105 Complete system review A narrative of organ systems reviewed including systems related to the problems identified in the chief complaint and or history of presenting illness plus a review of all other systems All positive responses and pertinent negatives should be documented For remaining systems a notation indicating that all other systems are negative is permissible otherwise at least 10 systems must be individually documented Comprehensive physical examination Examination of at least nine organ systems or body areas which must include all bullet point elements within each of the nine systems areas under the multisystem exam OR examination of all bullet point elements from one of the 10 single organ system examinations with documentation of every element in the shaded boxes and at least one element in each unshaded box Or under CMS s 1995 Documentation Guidelines for Evaluation and
181. terminations EXPT and PRO only Opens the NCD Edits dialog box Medicare Fee Schedule EXPT and PRO only Opens the Medicare Information dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 130 Medicare Policy Opens the Special Coverage Instructions dialog box Color Coding Legend Opens the CPT Color Coding Legend dialog box Previous Codes Displays the Code Detail view for the previous section of codes Refer to Code Detail for further information Next Codes Displays the Code Detail view for the next section of codes Refer to Code Detail for further information Carriers with LMRP EXPT and PRO only Opens the Carriers with LMRP Edits dialog box HCPCS MENU NOT IN CIFI9 This menu is available only when a HCPCS code is selected Information is specific to the currently selected code Items not available are dimmed HCPCS Section Notes Annotations Modifiers Crosscoder CCT Unbundle Edits Local Medical Review Policies National Coverage Determinations Medicare Policy Color Coding Legend Previous Section Next Section Carriers with LMAP HCPCS Section Notes Opens the HCPCS Section Notes dialog box Annotations Opens the HCPCS Annotations dialog box Modifiers EXPT and PRO only Opens the HCPCS Modifiers dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 131 Crosscoder EXPT
182. th gastrointestinal manifestations 277 09 Cystic fibrosis with other manifestations 357 81 Chronic inflammatory demyelinating polyneuritis 357 82 Critical illness polyneuropathy 357 89 Other inflammatory and toxic neuropathy 359 81 Critical illness myopathy 359 89 Other myopathies 365 83 Aqueous misdirection 414 06 Coronary atherosclerosis of coronary artery of transplanted heart 414 12 Dissection of coronary artery 428 2 Systolic heart failure xl CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual Revised The Revised tab shows all ICD 9 CM Vol 1 codes that have been revised and their descriptions New Revised cc Age Sex CC The CC tab shows all Complication and Comorbidity codes diagnoses that affect DRG assignments and their descriptions Malignant hypertensive heart disease without heart failure Malignant hypertensive heart disease with heart failure Benign hypertensive heart disease without heart failure Benign hypertensive heart disease with heart failure Unspecified hypertensive heart disease without heart failure Unspecified hypertensive heart disease with heart failure Malignant hypertensive heart and renal disease without mention of heart failure or renal failure Malignant hypertensive heart and renal disease with heart failure Malignant hypertensive heart and renal disease with heart failure and renal failure ICD 9 Vol 1 Color Codes New Revis
183. the greater procedure in Col 1 This column may also include codes that are considered mutually exclusive to the code in Col 1 It only lists codes that were entered into the Notepad not all codes that are considered component and or mutually exclusive procedures The Edit Conflict column shows you the name of the edit conflict The Description column gives more information on the conflict These are the possible results Edit Conflict Name Edit Conflict Description CCI Component Unbundle The code in Col 2 is considered by Medicare to be a component procedure of the code in Col 1 There are no circumstances in which a modifier would be appropriate The services represented by the code combination will not be paid separately CCI Component Unbundle The code in Col 2 is considered by Medicare to Modifier Allowed be a component procedure of the code in Col 1 A modifier is allowed in order to differentiate between the services provided Separate payment for the services billed may be considered justifiable if a modifier is used appropriately CCI Mutually Exclusive The codes in Col 2 is considered by Medicare to be mutually exclusive procedures of the code in Col 1 There are no circumstances in which a modifier would be appropriate The services represented by the code combination will not be paid separately CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 119 Edit Con
184. the same operative session CPT Unbundles 24075 E xj CCI Component CCI Mutually Exclusive CCI Greater Px Find 11012 Mutually Exclusive Procedures Debridement including removal of foreign material associated with open fracture s and or dislocation s skin and subcutaneous tissues Version gu Cancel Help CCI Greater Px tab This tab shows the greater procedure or comprehensive codes of which a component code could be considered an edit It allows you to see the complete CCI relationships regardless of what code is selected CPT unbundles 24075 x CCI Component CCI Mutually Exclusive CCI Greater Px Find 24076 Most Extensive Procedures Allowed 24077 Most Extensive Procedures Allowed 24150 Most Extensive Procedures Allowed 24151 Most Extensive Procedures Allowed 24152 Most Extensive Procedures Allowed 24153 Most Extensive Procedures Allowed 24155 Most Extensive Procedures Allowed 24341 Most Extensive Procedures Allowed Excision tumor soft tissue of upper arm or elbow area deep subfascial or intramuscular Version 3 3 Cancel Help CCI Data CPT codes Copyright 2005 American Medical Association All Rights Reserved The Centers for Medicare and Medicaid Services CMS formerly the Health Care Financing Administration is responsible for the content of CCI data No endorsement by the American Medical Association AMA is intended or should be implied The AM
185. tickynote by typing codes in the Enter Codes Box Use commas or carriage returns to enter multiple codes Use the Assign Button to complete the assignment To remove an assigned code from the list select it an use the Unassign Button Enter Codes Codes Assigned to Sticky Note Code Description 84 02 Amputation and disarticulation of thumb 84 03 Amputation through hand Sticky Notes DK Cancel Help The Date Added or Modified field shows when the Sticky Note was first added or when it was last modified The Sticky Note Name field shows the name you or the System Administrator typed in when creating the Sticky Note Or if you are in this dialog box as a result of adding a new Sticky Note it is where you type in a new Note Name If you are viewing a Global Sticky Note you have to be logged in as the System Administrator in order to change this field CPT ONLY 2005 AMERICAN MEDCAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 76 The text box below these two fields displays the note itself and 1s editable If you are viewing a Global Sticky Note you have to be logged in as the System Administrator in order to change this field The Selected Code field displays the code you highlighted from the Code Detail The Enter Codes field allows you to connect other codes to this same Sticky Note by typing them in After entering the associated code s click the Assign button to move them to the Codes As
186. to the term Search 2 Click the Search button or your Enter key to initiate a search The software searches all selected code set databases for a specific match based on the key words entered and the type of search option specified If you do not enter anything in the Search box and then click the Enter key you receive a Search Term Error that reminds you something must be entered before a search can be initiated Please enter search terms before initiating a search Tips For Entering Search Terms Choose search terms that uniquely identify the service or supply Enter as many identifying terms as possible limit is four words You can search on just one word but you may get more specific results when you enter two or three search terms The search time may also be faster when you enter more than one word e g ARM FRACTURE returns more specific results faster than searching on just ARM or FRACTURE Avoid entering too many search terms or search terms that are too specific in these instances there may be no results that exactly match your criteria Avoid connecting words such as of and or with not or punctuation such as commas periods dashes etc To go directly to a code description in the Code Detail enter a code number If the number doesn t exist 1 e has been deleted or is otherwise invalid the system displays the next valid code for CPT codes and the next valid category for ICD 9 CM codes For ICD 9
187. todial Care Servicer G New Patent C Establehed Pobent J Home Tope of Vad Home Home Services C New Paterd C Established Potent g J Key Components This dialog box allows you to view the key components based on the CPT Book guidelines It is up to you to determine which code is appropriate based on the level of service documented in the medical record Exception There are four scenarios where radio buttons clicked from the Select Visit dialog box do not result in you receiving a Key Components dialog box Instead you see a Code Result dialog box Therefore in these scenarios you do not need or have access to the Exam Calculator These four exceptions are Inpatient Hospital Discharge Services Inpatient Observation Care Discharge Services Emergency Other Emergency Services and Nursing Nursing Facility Discharge Services This Key Components dialog box consists of three tabs Codes Definitions and Guidelines The default tab it opens to is always the Codes tab as shown in the table below Code Result There are four scenarios where radio buttons clicked from the E M Assistant Select Visit dialog box do not result in you receiving a Key Components dialog box Instead you see a Code Result dialog box Therefore in these scenarios you do not need or have access to the Exam Calculator EXPT only button These four exceptions are Impatient Hospital Discharge Services Inpatient Observation Care Discharge Servic
188. tructions This tab displays CPT parenthetical commentary for the selected code CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 49 CPT Section Notes 23930 x For incision and drainage procedures superficial see 10040 10160 References This tab displays references to issues of the American Medical Association s CPT Assistant the official publication for the AMA guidelines It references CPT Assistant editions and page numbers in which the selected code has been discussed The year is listed then the quarter then the page number of the reference For copies of the CPT Assistant contact the AMA at 800 621 8335 CPT Section Notes 99050 EP x Section Notes Ref es CPT Assistant is a quarterly publication of the American Medical ssociation Editions that discuss the selected CPT code are referenced here Winter Primary Px This list shows the primary procedure code s appropriate for use with the selected add on code The tab contains magenta code number links that direct you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button CPT Section Notes 99050 x This list shows the primary procedure code s appropriate for use with this add on code Simple repair of superficial wounds of scalp neck axillae external genitalia trunk and or extremities including hands
189. u can go directly to the LMRP Medical Necessity Edits EXPT and PRO only dialog box by using the built in links To link to the appropriate LMRP edits pick a carrier by either selecting it and clicking the Show Edits button or double clicking it to see the LMRP Medical Necessity Edits dialog box CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 85 E M Compliance and Exam Tools E M ASSISTANT EXPT AND PRO ONLY If you are searching for a CPT E M code that is based on key components the E M Assistant wizard can be a useful tool for finding the correct code The E M Assistant helps you make sense of confusing CPT Book concepts like levels of service and key components Through the E M Assistant you identify place of service type of service and other relevant aspects of the E M service The E M Assistant determines which code s are appropriate The total E M Assistant 1s comprised of a series of dialog boxes called a wizard The dialog boxes you are presented as you click through the wizard change depending on your previous selections Keep in mind that not all the dialog boxes menus discussed below appear every time you use the E M Assistant nor are all dialog boxes or menu options discussed here For detailed explanations of E M terms please consult the introduction to the E M codes in CPT Note The E M Assistant includes codes that are based on level of service Select Service
190. uiring anesthesia With or without percutaneous skeletal timation Percutaneous skeletal figation of talotarzal joint dislocation with manipulation Select Cancel Help DRG Crosscodes not in STND Please refer to page 43 for details CPT ONLY O 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED 47 Encoder Pro User s Manual ICD 9 Vol 3 Color Coding Legend This information box displays a legend showing all ICD 9 CM Vol 3 Color Codes and their definitions You access it first by selecting a ICD 9 CM Vol 3 code and then click the Color Coding Legend button from the ICD 9 CM Vol 3 menu 3rd Digi Code Required WT dh Digt Code Requeed Cf Male Procedure Q Ferala Procedee BF Won OR Procedure W Aing DRG VAR dli E eT Limied Ceres age m Bilateral Procedure A Sticky Hote The following explains each ICD 9 CM Vol 3 color coding symbol Third Digit Code Required PER This symbol identifies codes that require an additional third digit be added to the ICD 9 CM Vol 3 code Either the code category or subcategory contains more specific codes or the code choices are listed with the main category Fourth Digit Code Required This symbol identifies codes that require an New Code Revised Code at Male Diagnosis o Female Diagnosis additional third digit be added to the ICD 9 CM Vol 3 code Either the code category or subcategory contains more sp
191. ulosis of other male genital organs tubercle bacilli n Tuberculous oophoritis and salpingitis confirmation unspeci Tuberculous oophoritis and salpingitis bacteriological or his Tuberculous oophoritis and salpingitis bacteriological or his Tuberculous oophoritis and salpingitis tubercle bacilli found Tuberculous oophoritis and salpingitis tubercle bacilli not fo Tuberculous oophoritis and salpingitis tubercle bacilli not fo Tuberculous oophoritis and salpingitis tubercle bacilli ie Tiber idees n Me aamital rA confirms Ser b Cancel Help ICD 9 Vol 3 Color Codes To open the ICD 9 Vol 3 Color Code dialog box select ICD 9 Vol 3 Color Codes from the View menu This dialog box allows you to look up all ICD 9 CM Vol 3 codes assigned color codes It has tabs for New Revised OR Sex and Medicare All five subordinate tabs contain a Find field that acts as a Go To button to maneuver within the codes in a given tab This is not a search filter and accepts from 1 to 5 digits including a decimal point The data presented in these five tabs is the same no matter what code has been selected in the Code Detail or Tabular Results This dialog box contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button New The New tab shows all new ICD 9 CM Vol 3 codes and their descriptions 1c0 9 vol
192. usculoskeletal C Neurological C Psychiatry C Respiratory C Skin Cancel Help Exam Calculator Examination The radio buttons you click from the Exam Calculator Select Examination dialog box will determine the contents that will display in the next dialog box of the wizard the Exam Calculator Examination dialog boxes as shown below Within these dialog boxes you select tabs and check boxes from different systems body areas for the selected examination type The Examination Type field shows the selection you made in the previous Select Examination dialog box The tabs presented in this dialog box coincide with the Examination Type you selected in the Select Examination dialog box You may access as many of them as are appropriate The check boxes change according to what tab you select You may click all the check boxes that apply in as many tabs as are needed General Multi System Comte E Evaluation Fin each vibe ars Desde ea ien al elorria pascere bee Dae paca dur Ut iere Megan Lopes Mandril eck eacus Pox He Cedrus thet Comitor Em Nom Mdh Treo Ls T heuli of hear ah notan of ara rounds aed rr V Pasar of hear jag ication mite Pelis AS V Abdon sole jeg nw beat D Castel pime jeg pulsa aplicada beta Esterna lis polis avxbv abria V Ferd aime jog puter amd inis V Pedy pdas jeg palos ampliada CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RI
193. used by eating cereals infected with fungus DRG Crosscodes notin STND This dialog box provides you with corresponding Diagnostic Related Group DRG codes and Medicare reimbursement calculation information for ICD 9 CM codes You can also view the DRGs that are crossed to the selected ICD 9 CM code You access this dialog box by selecting an ICD 9 CM code in the Code Detail that has DRG crosscodes and then either clicking the DRG button 3 or selecting DRG Crosscodes from the ICD 9 Vol 1 or ICD 9 Vol 1 menu DRG Crosscodes 428 0 E E E xj 15 jia 124 127 sar 233 DAG 115 Medical MDC5 Permanent cardiac pacemaker implant with acute Ml heart Failure or shock oar AICO lead or general procedure 3 amp ometric mean length of stay 8MLETS 5 9 Arithmetic mean length of stay AM LOS 8 3 Relative weight Fw 3 4455 Foot nate In combination with any other DA procedure listed under DAG 115 Cancel Help DRG Code and Description DRGs are groups of ICD 9 CM codes that report inpatient services to Medicare Medicaid and some private payers DRGs standardize payment by illness and treatment allowing reimbursement to be predicted prospectively before care is provided DRGs are defined as either medical or surgical Major Diagnostic Category MDC Each DRG falls into an MDC category This classification of diagnoses typically grouped by anatomic system is the basis for the DRG prospective payment system
194. vix or combination of aspirin and dipyidamole Aggrenox 0006F Statin therapy prescribed 0007F Beta blocker therapy prescribed Performance Measurement Set Chronic Stable Coronary Artery Disease CAD Chronic Stable Coronary Artery Disease CAD Chronic Stable Coronary Artery Disease CAD Preventative Care and Screening Physician Performance Measurement Set Chronic Stable Coronary Artery Disease CAD Chronic Stable Coronary Artery Disease CAD Chronic Stable Coronary Artery Disease CAD Release Implemented Dates Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 Heleased July 1 2003 Implemented January 1 2004 CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual ENHANCEMENTS IN ENCODER PRO Four CCI versions are available in Encoder Pro Expert and Professional CCI data will be available to download the latest CCI data version A new Updates menu option is available that opens the Data Updates screen where the new CCI version displays when the update is available to download With a new CCI version update the oldest CCT version will drop from the pr
195. x appears Assign your bookmark a category not required and modify the code s description if you d like Click OK Editing a Bookmark CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED 70 Encoder Pro User s Manual 71 You can change the description of your bookmark or change the category by clicking the Edit button from the Bookmarks dialog box You also have this opportunity whenever you add a bookmark to a code with either the Add Code dialog box or the Right click Add menu unless you have deselected this action from the View Tab in the Preferences dialog box Bookmarks E 2 X Personal Global View only Categor Description V alvatomy pulmonary valve open heart with Man segmental pneumatic appliance for use vw p Edit Delete Go to Bookmark Cancel Help From the resulting Personal or Global Bookmark dialog box you can create and assign categories to your bookmarks In the Category field you can enter up to 35 characters to denote a category name If there are already user defined categories entered this field displays them as a drop down menu if they match what you are typing You can enter an unlimited number of categories and can delete a category by highlighting the category and using the Delete key Any bookmarks assigned that category name are assigned to no category blank category Global and personal bookmark categories are unique You must add y
196. x can be checked if you want to make the locality you are currently viewing the default carrier A Find box allows you to search for ICD 9 CM codes that are allowable for a selected CPT or HCPCS code The code list box shows all of the ICD 9 CM codes that are Medical Necessity edits for the selected CPT code and Medicare Carrier It contains magenta code number links that take you to the appropriate code in the Code Detail You can access the links by double clicking or by selecting them and then clicking the Select button Local Medical Medicare Review Policy LMRP LMRP is an administrative and educational tool to assist providers physicians and suppliers in submitting correct claims for payment Local policies outline how contractors review claims to ensure that they meet Medicare coverage requirements CMS requires that local policies be consistent with national guidance although they can be more detailed or specific and be developed with scientific evidence and clinical practice CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 56 Under the Medicare program the government pays only for medically necessary services The Medicare carriers and intermediaries have significant authority through their medical directors to define what is medically necessary LMRPs can include incorrect or incomplete information as they are relative to a specific region carrier or procedure and can
197. xempt This symbol identifies conscious sedation services Conscious Sedation This symbol identifies codes with attached sticky notes See page 72 for details on using sticky notes Sticky Notes HCPCS DIALOG BOXES HCPCS Section Notes not in CIFI9 This dialog box allows you to view notes in the code book that pertain to the code selected These notes appear at the beginning of certain sections in the HCPCS book HCPCS section notes include ambulance origin modifiers destination modifiers and PET scan modifiers You access this dialog box by selecting a HCPCS code that has associated notes from the Code Detail Then click either the Notes button from the toolbar or go to the HCPCS menu and select HCPCS Section Notes HCPCS Section Notes L3972 LOW 00 L4398 Orthotic Procedures Braces trusses and artificial legs arms and eyes are covered when furnished incident to physicians services or an a physician s order amp brace includes rigid and semi rigid devices used for the purpose of supporting a weak or deformed body member ar restricting or eliminating motion in a diseased or injured part af the body Back braces include but are nat limited to sacroiliac sacrolumbar dorsolumbar corsets and belts Stump stockings and harnesses Including replacements are also covered when these appliances are essential to the effective use of an artificial limb Adjustments to an artificial limb ar other applianc
198. y Select More than 50 percent of encounter if the counseling and or coordination of care dominates the physician patient and or family encounter According to the CPT Book the extent of counseling and or coordination of care must be documented in the medical record Here are the CPT Book guidelines that can help you determine which menu selections are appropriate for type of consultation Select initial to identify a new consultation According to the CPT Book Follow up visits in the consultant s office or other outpatient facility that are initiated by the physician consultant should be identified as an office visit rather than a consultation In this case click Back to reselect the type of service For inpatients only one initial consultation should be reported by a consultant per admission Select follow up if the service is a completion of the initial consultation or if subsequent consultative visits are requested by the attending physician Follow up consultation codes are not appropriate if subsequent to the completion of a consultation the consulting physician assumes responsibility for management of a portion or all of the patient s conditions according to the CPT Book Click Back to reselect the type of service as attendance or visit Select confirmatory for a consultation requested by a patient and or family member Report Modifier 32 if a confirmatory consultation is required by a third
199. y coding to the fourth or fifth digit This is a requirement for all claims Documentation Documentation supporting the medical necessity of the service should be legible maintained in the patient s medical record and must be made available to Medicare upon request Reimbursement All of the coverage criteria listed for an individual Local Medical Review Policy must be met National Policy In the event that a national policy is established for any of these local medical policies the national policy takes precedence over the local policy Focused Medical Review Medicare continues to monitor the utilization of Local Medical Policies through the Focused Medical Review FMR process CPT ONLY 2005 AVERICAN MEDICAL ASSOCIATION ALL RIGHTS RESERVED Encoder Pro User s Manual 57 National Coverage Determinations Edits EXPT and PRO only This dialog box allows you to see which ICD 9 CM codes are allowable for a selected CPT code You access this dialog box by selecting a CPT or HCPCS code in the Code Detail and clicking the NCD Edit button or by selecting National Coverage Determinations from the CPT or HCPCS menu The button and menu are only active if there are NCD edits for the selected code An NCD for a diagnostic laboratory test is a national policy statement granting limiting or excluding Medicare coverage for that test It states CMS s policy with respect to the circumstances under which the test s are consider
200. ystems that might be affected Pertinent positives and relevant negatives for each body system should be listed individually Two to nine systems should be documented Or CMS s 1995 Documentation Guidelines for Evaluation and Management Services examination of at least one organ system Family history Record of the health of family members including the health status or cause of death of parents siblings and children and specific diseases related to the patient s chief complaint history of present illness and or review of systems Medical decision making The level of decision making is based on the nature of the problem at the time of the visit and considers the differential diagnoses the amount and or complexity of data to be reviewed and considered medical records test results correspondence from previous treating physicians etc current diagnostic studies ordered treatment or management options and risk Risk is further defined as complications of the patient s condition or the potential for complications continued morbidity and or the risk of mortality and any comorbidities associated with the patient s disease process Documentation of the elements of medical decision making also provides supporting documentation for medical necessity of levels of E M services as well as diagnosis and therapeutic services See Appendix B Documentation Guidelines for Evaluation and Management Services Including all 1997 Physical Exams General Mu

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