Grayscale Version PARA Weekly Update For Users January 12 2018

Special E-X-P-A-N-D-E-D Edit ion

Date

PARA WEEKLY CODING FOR HPV SCREENING

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 January 12, 2018 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Transesophageal Echocardiography (TEE) - Same Day And Urgent Care In Same Building - PA's Ordering Physical Therapy - Chest X-Ray And Intubation NEW GOOGLE CHROME & MULTIPLE BROWSER VERSIONS OF PDE

5

The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

-------------------------------------------------------

2018 UPDATES TO PARA DATA EDITOR (PDE) CALCULATOR

The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

16

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

FAST LINKS: Click on the link for special areas of interest: Page

Administration: Pages 1-62 HIM/Coding Staff: Pages 1-62 Providers: Pages 2,5 Finance Departments: Pages 45,50 Imaging Departments: Pages 2,7

-

Home Health: Pages 40,46 PDE Users: Page 8 Pharmacy: Pages 41,47,48,54 Laboratory: Pages 39,42,49 DME: Pages 43,57

© PARA Healt h Car e Fin an cial Ser vices CPT® is a r egist er ed t r adem ar k of t h e Am er ican M edical Associat ion

PARA Weekly Update: January 12, 2018

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)

Question: When performing a TEE (93312), it indicates we should be billing 93320 and 93325 for facility in conjunction with 93312. The 93320 and 93325 for Medicare is bundled and showing no separate payment to be made. What is the most effective and correct way to bill for these services? All three codes are curently in our charge master.

Answer: HCPCS 93320 and 93325 are add-on codes, which are not separately reimbursed. Medicare includes payment for such add-on codes in its rate setting for the primary procedure code 93312. It is appropriate to report these ad-on codes only if the additional service they describe is performed.

While there are no CCE edits preventing reporting these codes together, that is not the same as saying they should always be reported together:

According to our claims summary, which identifies the HCPCS most commonly reported among Medicare claims for Morris, it?s peer facilities, and nationally, 93320 and 93325 are not always reported with 93312 (see screen shot on next page):

2

PARA Weekly Update: January 12, 2018

TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)

3

PARA Weekly Update: January 12, 2018

SAME DAY CLINIC & URGENT CARE IN SAME BUILDING

Question: When you have Same Day Clinic and Urgent Care located in the same building across from each other depending on what department the patient is sent to, what place of service should be used for each?

Answer: We need a little more information in order to answer your question correctly. It depends on the licensure of the space at each location, particularly whether the location is an on-campus or off-campus department of a hospital.

If the space where the patient is treated is on-campus outpatient acute care hospital space, report professional fees with place of service 22 for outpatient hospital. If it is an off-campus department of the hospital, report POS code 19 - Off Campus-Outpatient Hospital (A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.)

If the locations are not hospital-based, but freestanding clinics, the urgent care clinic would report POS code 20 -- Urgent Care Facility (Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.)

The physician clinic would report POS 11 Office (Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.)

4

PARA Weekly Update: January 12, 2018

PA'S ORDERING PHYSICAL THERAPY

Question: We have a physician?s assistant who ordered PT for a patient. Our PT registration staff stated to the PA that they needed her supervising MD to co-sign the order because the MD?s name needs to be listed as the ordering physician on the claim.

The PA was very offended and wanted documentation stating we couldn?t use her as the ordering and that a co-signature was required. Apparently it has just been a long standing understanding in the therapy department that PA?s need an MD to co-sign for PT/ OT/ ST. Is that still true or can a PA order and be listed on the claim as such? Do you know of or can you provide some documentation on what the rules are? I have been going through the Medicare Manual for the past couple of hours and just can?t find a definitive answer.

Answer: A PA who is properly enrolled in Medicare will suffice as the referring physician on a claim for PT/ OT/ ST submitted to Medicare. That being said, we need to check state law and hospital policies before we declare the ?all clear.?

To participate in Medicare, hospitals must provide care which meets the ?Conditions of Participation?

(CoP), which are found in the Code of Federal Regulations at ยง482.24(c)(2). The CoP?s require hospitals to ensure that: ?All orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or by another practitioner who is responsible for the care of the patient only if such a practitioner is acting inaccordance with State law, including scope-of-practice laws,hospital policies, and medical staff bylaws, rules, and regulations.?

Here are a couple of excerpts from the Medicare State Operations Manual, which guides how surveyors should evaluate whether a hospital meets of the Conditions of Participation: https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/som107ap_a_hospitals.pdf Determine whether all orders, including verbal orders, are written in the medical record and signed by the practitioner who is caring for the patient and who is authorized by hospital policy and in accordance with State law to write orders. ?

Non-physician practitioners Furthermore, the governing body has the authority, in accordance with State law, to grant medical staff privileges and membership to non-physician practitioners. The regulation allows hospitals and their medical staffs to take advantage of the expertise and skills of all types of practitioners who practice at the hospital when making recommendations and decisions concerning medical staff privileges and membership.

5

PARA Weekly Update: January 12, 2018

PA'S ORDERING PHYSICAL THERAPY

The scope of practice for PA?s under Wisconsin state law is readily available. It indicates that the PA may assist the supervising physician by writing orders, but it does not require that the physician must co-sign all orders: http://docs.legis.wisconsin.gov/code/admin_code/med/8.pdf Med 8.07 Practice.

(1)SCOPE AND LIMITATIONS. In providing medical care, the entire practice of any physician assistant shall be under the supervision of one or more licensed physicians or physicians exempt from licensure requirements pursuant to s. 448.03 (2) (b), Stats. The scope of practice is limited to providing medical care as specified in sub. (2). A physician assistant?s practice may not exceed his or her educational training or experience and may not exceed the scope of practice of the physician providing supervision. A medical care task assigned by the supervising physician to a physician assistant may not be delegated by the physician assistant to another person.

(2) MEDICAL CARE. Medical care a physician assistant may provide include: A. Attending initially a patient of any age in any setting to obtain a personal medical history, perform an appropriate physical examination, and record and present pertinent data concerning the patient.

B. Performing, or assisting in performing, routine diagnostic studies as appropriate for a specific practice setting.

C. Performing routine therapeutic procedures, including, but not limited to, injections, immunizations, and the suturing and care of wounds.

D. Instructing and counseling a patient on physical and mental health, including diet, disease, treatment, and normal growth and development.

E. Assisting the supervising physician in a hospital or facility, as defined in s. 50.01 (1m), Stats., by assisting in surgery, making patient rounds, recording patient progress notes, compiling and recording detailed narrative case summaries, andaccurately writing or executing orders.

F. Assisting in the delivery of medical care to a patient by reviewing and monitoring treatment and therapy plans.

G. Performing independently evaluative and treatment procedures necessary to provide an appropriate response to life?threatening emergency situations.

H. Facilitating referralof patients to other appropriate community health?care facilities, agencies and resources.

I. Issuing written prescription orders for drugs provided the physician assistant has had an initial and at least annual thereafter, review of the physician assistant?s prescriptive practices by a physician providing supervision. Such reviews shall be documented in writing, signed by the reviewing physician and physician assistant, and made available to the Board for inspection upon reasonable request.

While state law does not clearly restrict PA?s from issuing orders independently (without a supervising physician?s co-signature), hospital or medical staff policy also comes into play. You may want to check with your Medical Staff Services department to review any bylaws, rules, regs, etc. that pertain to PA?s. It is possible that the medical staff interpretation of the state Scope of Practice law is more conservative that the state law requires.

6

PARA Weekly Update: January 12, 2018

CHEST X-RAY AND INTUBATION

Question: We received a denial on a chest xray CPT® -71010 with the Intubation CPT® 31500, stating is not billable together. I reviewed the CCI edit on PARA and it states OK to bill. The insurance is Anthem Medicare.

Answer: If the chest x-ray was performed to confirm the position of the intubation procedure, then it is ?integral to? the intubation procedure and should not be separately billed. If it was performed for reasons other than confirmation of the position of the intubation, then the hospital may append modifier 59 to attest that the x-ray was not solely in service to the intubation.

A link and an excerpt from the 2018 NCCI Edit Manual follows: https://apps.para-hcfs.com/para/documents/CHAP9-CPTcodes70000-79999_FINAL111516.pdf 9. When a central venous catheter is inserted, a chest radiologic examination is usually performed to confirm the position of the catheter and absence of pneumothorax.

Similarly when an emergency endotracheal intubation procedure (CPT® code31500), chest tube insertion procedure (e.g., CPT® codes 32550, 32551, 32554, 32555), or insertion of a central flow directed catheter procedure (e.g., Swan Ganz)(CPT® code 93503) is performed, a chest radiologic examination is usually performed to confirm the location and proper positioning of the tube or catheter. The chest radiologic examination is integral to the procedures, and a chest radiologic examination (e.g., CPT® codes 71010, 71020) should not be reported separately.

7

PARA Weekly Update: January 12, 2018

NEW CHROME VERSION OF PDE & OTHER BROWSER FORMATS

We have been working on making the PARA Data Edito rcompatible with multiple web browsers so that everyone can have options when it comes to which browser to use, depending on resources or preferences.

As of today, we are making available our PARA Data Editor Multiple Web Browser (Beta) Version to everyone with a proper PARA Data Editor Login.

The Web Browsers that we are rolling out first with this version are Internet Explorer and Google Chrome.

To all users who wish to use the Multiple Web Browser (Beta) Version, please be aware that this is a PRELIMINARY version meant to work out any errors and issues that it might exhibit.

It is in the process of being updated to mirror the current production version of the PARA Data Editor.

With your help, we will be able to narrow in on fixes throughout the PARA Data Editor Multiple Web Browser (Beta) Version to then ensure full functionality and to further expand to more Web Browsers.

The PARA Data Editor Multiple Web Browser (Beta) Version can be accessed via the following link and using the appropriate login when prompted by the browser: https://www.para-hcfs.com/projects/pde_upgrade/pde_MultBrowser

8

PARA Weekly Update: January 12, 2018

NEW CHROME VERSION OF PDE & OTHER BROWSER FORMATS

Once logged in, we would like for you to please be aware of a few key features to help us improve the PDE Multiple Browser (Beta) Version.

First, please be aware of the change in look for the Multiple Browser (Beta) Version. We are attempting to update the look and feel of the PDE to be cleaner and user-friendly.

Second, if you may have any questions, need help, would like to report an error or issue with the PDE Multiple Web Browser (Beta) Version, or anything else you may think of, click on the ?Contact Support? Link in the upper-right hand corner of the PDE:

9

PARA Weekly Update: January 12, 2018

NEW CHROME VERSION OF PDE & OTHER BROWSER FORMATS

This link is available wherever you may browse throughout the PDE Multiple Web Browser (Beta) Version and is located in the same exact position for your convenience.

Once the ?Contact Support? Link is clicked, a dialogue window displays as exhibited below:

The window will detail the user?s Name, Hospital, Currently Selected PDE Tab, Operating System, Browser, and other system compatibilities.

In the Text Box within the ?Contact PARA Support? Window, please describe the issue you have encountered in as much detail.

Once you are satisfied with your comments, please click on the ?Submit Support Request? Button.

PARA Staff will immediately be notified of your created Support Ticket and will rectify the issue as soon as possible to improve your experience with the PDE Multiple Web Browser Version (Beta).

10

PARA Weekly Update: January 12, 2018

NEW CHROME VERSION OF PDE & OTHER BROWSER FORMATS

Third,once you have completed using the PARA Data Editor Multiple Web Browser (Beta) Version, please be sure to Log Out to ensure a complete and secure session by clicking the ?Log Out? Link on the upper-right hand corner:

Like the ?Contact Support? Link, the ?Log Out? Link is available to click whenever and wherever you are within the Multiple Web Browser (Beta) Version.

We are very excited to offer our clients this new way to interact with the PARA Data Editor, giving you the flexibility to view our tools.

Again, if you may have any questions or suggestions, please submit them through the ?Contact Support? window as described above.

PARA HealthCare Financial Services is looking forward to hearing from you and what you have to say about our new service!

11

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

The Calculator is a robust web-based research tool that allows the User unlimited access to search and report against a number of disparate data sources.Users have numeric and alpha query capabilities; the returned information can be exported to PDF, Excel or copied to the desktop clipboard for email applications. Users can save their preferences which are specific to their geographic and provider types; all codes, reimbursement, and claim edits are always the most current available.

The Calculator provides 25 different resources accessible 24/ 7, with up to seven years' of history for CPTÂŽ / HCPCS codes, DRG, ASC, Professional fees and twenty-seven years of CPTÂŽ Assistant Archives.

12

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Co-mingled multiple codes, wildcard and text queries One of the most useful features within the Calculator is the ability to query using a ?wildcard? or multiple codes, and/ or text queries which are comma separated. Additionally, several different target data tables can be checked for simultaneous returns.

The query pasted below is for all codes which meet the following search criteria: 1.Codes in the range of 9637X 2.The specific 47001 and 85025 codes 3.Codes which contain the word ?incision?

The query searched the available list of approximately 15,000 HCPCS codes and returned the details of 236 codes, at the same time the query was processed against the Physician Fee schedule, Medicaid Fee schedule, and Clinical Lab schedule.

The only limitation is that majority of searches are limited to 250 code returns due to the Users internet speed and computer capacity.

The PARA servers will return the search within second.

13

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

CPT® Codes As a result of the relationship PARA has developed with the AMA, PARA receives the CPT® code set four to five months prior to implementation.

PARA parses the codes into the following segments: 1.CPT® Code 2.Current Descriptor 3.Change Type 4.Link for expanded information As soon as the CMS proposed rule is published (usually in August), PARA will link the CPT® code set to the HCPCS code set to identify the codes to be used in future Medicare OPPS reimbursement.

The query string can be ?mixed? and requires comma separation.

The additional information available at the Details link include expanded descriptions, Cross References Parentheticals (additional coding guidelines), a list of CPT® Assistant documents that reference the code, and a change history.

14

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

HCPCS Codes The HCPCS query can be focused to a specific year, and PARA maintains a rolling history of codes from previous years as well.

The query can also be focused to a specific code type (HCPCS C Codes, Alpha HCPCS Codes, DME Codes, Surgical Codes, Radiology Codes, Laboratory Codes, Other Diagnostic / Therapeutic Service Codes).

The returned values include the code and its Current Descriptor, CMS Payment Status, Fee Schedule (Professional, DME, Clinical Lab), Initial APC, and APC weight, AWI adjusted payment, AWI national co-pay, and AWI minimum co-pay.

The code is a link that will open expanded data fields that include additional APC assignments (if applicable), data on Geographic market group billing, Revenue code assignment, and Change History.

Also included is a list of all other codes that also fall under the same APC as the selected code:

15

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Professional Fees The returns display the follows values: 1.HCPCS/ CPTÂŽ description 2.Global Days ? follow-up period after a surgical procedure 3.PC/ TC Indicator ?

4.Status Code ?

5.Physician Supervision ? Required attendance for the procedure 6.Facility Relative Value Unit ?

7.Non-Facility RVU ?

8.Malpractice RVU ?

9.Facility Reimbursement ?

10. Non-Facility Reimbursement ?

The RVU and Reimbursement values are repeated for the Global, ?26? Professional and ?TC? technical modifiers.

The query accepts comma separated codes, wildcards, and text.

16

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Medicaid / Workers Comp Fee Schedule The Medicaid query returns the following values (if available), for the current year fee schedule: 1.Code 2.Category 3.Description 4.Unit Value 5.Base Rate 6.Child Rate 7.ER Rate 8.Rental Rate

The Workers Comp (if available) query returns the following: 1.Code 2.Description 3.Rate

17

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

ASC Reimbursement The query accepts comma separated HCPCS/ CPTÂŽ codes, wildcard and text terms.

The returned values for the selected year (rolling four year period): 1.HCPCS Code and Description 2.ASC Status Indicator 3.Indicator for whether the code is wage adjusted 4.Ambulatory Surgical Reimbursement ? wage adjusted by CBSA

DME Reimbursement The returned values against a rolling four year period are as follows: 1.OPPS Billable ? Yes or No 2.Jurisdiction ? DMERC, Local Part B, or Joint 3.Category ? the type of item (i.e., surgical dressings) 4.Mod ? Modifier (i.e., NU ? Purchased, New) 5.Mod 2 ? Modifier (same values as Mod) 6.Mod Fee ? Fee schedule value (based on selected state in Report Selection Tab) If the OPPS Billable indicator is ?yes? a hospital may bill on a UB04 without requiring a DME license number, the DME ?L? code is required along with a 0274 revenue code.

The query accepts comma separated CPTÂŽ / HCPCS codes, wildcard and text search terms.

18

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Clinical Lab Reimbursement The query is available for a rolling four year period.

The query accepts comma separated CPT®/ HCPCS codes, wildcard and text terms.

There is a ?radio? button to select the period (year) or the complete code set with the QW (CLIA waived) tests.

The returned values are as follows: 1.CPT®/ HCPCS code 2.Description 3.Modifier 1 Fee 4.QW Modifier Fee

19

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

ICD-9 Codes Diagnosis and Procedural The two part ICD-9 tables require separate queries to be sure the correct code type is returned.

The query format is comma separated codes, wildcard, and text, no decimals in the codes.

The values returned are as follows: 1.ICD-9 Code 2.Code Description 3.Status 4.Comments 5.The ICD-9 codes are mapped to the ICD-10, with the option to display the corresponding ICD-10 codes Diagnosis Codes:

Procedure Codes:

20

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

ICD-10 Codes With the transition to ICD-10 codes, it is important to begin to understand the code structure and returns. ICD-10 codes have a completely different format and descriptions than ICD-9.

The query is text, comma separated.

The returns are as follows: 1.Code Value 2.Code Description 3.Code Type 4.ICD-9 code map

21

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Diagnosis Related Groups This query accepts comma separated codes, wildcards, and text.

The returns are as follows: 1.DRG Description 2.Major Diagnosis Category (MDC) 3.Type ? Medical or Surgical 4.Relative Weight 5.Cumulative Mean Length of Stay 6.Arithmetic Mean Length of Stay 7.Transfer Penalty Indicator 8.Associated APR-DRG

Clicking on the APR-DRG will display a pop-up with additional detail. APR-DRG?s are directly searchable by checking the APR-DRG checkbox in addition to the DRG Code checkbox. Also available are grouper versions 34 and 35 and the current Table 5 DRG listing.

22

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Device Dependent APC Codes The query is based on the CMS data table which relates a surgical procedure to the required Online Claim Editor Device Dependent HCPCS code.

The query is code, (comma separated), wildcard, and text.

The return fields are as follows: 1.Date ? CMS implementation date 2.HCPCS/ CPT® ? Code and description 3.HCPCS Status ? CMS Addendum B defined 4.Device A ? Code and description 5.Device B ? Code and description

23

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Modifiers and Revenue codes The query check box has a ?radio button? selection, one for modifiers and also revenue codes.

The query supports codes (comma separated), wildcard, and text.The revenue code query requires the leading ?0? as the first position.

The return value for the both queries is as follows: 1.Modifier / Revenue Code 2.Description Modifiers:

Revenue Codes:

24

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

ICCI OPPS Edits / CCI Physician Edits This two type query allows the User to view the last two periods of CCI edits for both the CMS Outpatient Claim Editor and the Physician 1500 Claim Editor.

The query can be a single code or wildcard for all edits tied to the code, or a comma separated series of codes which will make comparisons against all combinations of the code pairs.

The returned values are as follows: 1.Code Pairs ? Codes and Descriptions 2.Edit Type ? Comprehensive or Mutually Exclusive 3.GB Modifier Indicator ? green, yellow or red Based on the color of the GB Modifier Indicated the following actions are to be initiated: 1.Green ? the code pair is ok to be billed on the same date/ encounter.

2.Yellow ? the code pair requires the application of a modifier to clear the claim edit.

3.Red ? the code pair cannot be billed, one of the items requires removal from the claim.

Also available is a link to the NCCI Manual.

25

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

National Coverage Determination The query checks against the CMS Coverage data tables.

The query format is comma separated codes, or a HCPCS code in the top box and an ICD-9 diagnosis code in the bottom, wildcard and text arenotsupported due to the great number of returns.

The value returns are as follows: 1.National Coverage Decision 2.CPTÂŽ/ HCPCS ? Code and description 3.ICD-10 ? Code and description 4.Resolution Code 5.Effective Date 6.Termination Date Single code query:

Clicking the NCD in the first column of results will link the user to CMS.gov and additional information for the chosen NCD.

26

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

National Coverage Determination ? Articles The query checks against the CMS Coverage data tables.

The query accepts comma separated NCD ID?s and text key words The value returns are as follows: 1.National Coverage Decision and supporting documentation 2.Manual Section Title 3.Version Number 4.Effective Date of this Version 5.Implementation Date 6.Item/ Service Description

The first column of results are links to additional information. The NCD ID directs the user to CMS.gov. The supporting Document link provides and Excel spreadsheet of NCD details.

27

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Local Coverage Determination The query checks against the CMS Local Coverage data tables as defined by the Contractor chosen in the report selection tab. When using the ?Select Contractor? drop-down be sure to save your default selections. If there are no hits in the selected contractor, a message will appear in the contractor name box and the query will search the entire state for LCDs. The query will also display any relevant NCDs for the codes queried.

The query format is comma separated codes, or a HCPCS code in the top box and an ICD10 diagnosis code in the bottom for a focused query, wildcard and text arenotsupported.

The value returns are as follows: 1.LocalCoverage Decision ID Number 2.CPTÂŽ/ HCPCS ? Code and description 3.ICD10 ? Code and description 4.Title / Status ? (i.e., covered) 5.Contractor Type / Name ? (FI, MAC, Carrier) 6.Date Information Single code query:

In addition to the CMS.gov links, the first column includes lists of associated ICD10 codes.

28

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Medicare Part B ASP Drug Payments The query is conducted against the CMS Part B Average Sales Price data table.

The query format is comma separated code, wildcard and text.

The returned values are as follows.

1.CPT®/ HCPCS Code and Description 2.Dosage 3.Payment Limit 4.ESRD Limit 5.Vaccine Average Wholesale Price Percent and Limit 6.Infusion Average Wholesale Price Percent 7.DME Infusion Limit 8.Blood Average Wholesale Price Percent and Limit 9.Notes

29

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

NDC to J Code Crosswalk The National Drug Code to CMS HCPCS J code crosswalk is based on the Food and Drug Administration NDC table tied to the CMS J code reference table and the National Drug Data File.

The code query format is comma separated code, wildcard and text.

The values returned are as follows: 1.HCPCS J code 2.HCPCS Description 3.HCPCS Status 4.Drug Labeler 5.NDC Code 6.NDC Description 7.Drug Name 8.HCPCS Dosage 9.Package Size Quantity 10. Bill Units ? Code unit multiplier 11. Route of Administration 12. Wholesale Acquisition Cost Unit 13. WAC Package 14. Suggested Wholesale Price Unit 15. SWP Package

30

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Interventional Radiology Charge Mapping The purpose of the query is to provide the User the acceptable codes as defined in CPTÂŽ between the radiology guidance and the surgical codes.If there is a CMS device mapped to the code(s) the HCPCS code for the device and description are displayed.

The query format is code (comma separated), wildcard and text.

The returns are as follows: 1.Surgical Procedure HCPCS Code and Description 2.Radiology Guidance Procedure Codes and Descriptions 3.CMS Device A Mapped Code and Description 4.CMS Device B Mapped Code and Description

31

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

CPT® Assistant ? 1990 to Present PARA licenses the CPT® Assistant from the American Medical Association, the tables are updated quarterly.

The query format is comma separated code, wildcard and text.

The query returns a list of articles-the User can then review the article description and click to view the details of the article.

CPT®/HCPCS code or text query:

Selection of specific article:

32

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

HCPCS/CPT速 to ICD-9 Crosswalk This query is based on the 3M data tables, which provide a cross reference between HCPCS/ CPT速 codes and procedural ICD-9 codes.

The query format is comma separated code, wildcard and text.

The returns are as follows: 1.CPT速/ HCPCS Code 2.CPT速/ HCPCS Code Description 3.ICD-9 Code 4.ICD-9 Code Description

33

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

Quick Claim Evaluation The Quick Claim Evaluation report allows the User to view a series of CPTÂŽ codes in a UB04 claim format within the Claim Evaluation module.The User enters a series of codes (comma separated) and the Calculator displays the following:

CCI Edits are performed against the codes, and any items that would require a modifier or those that cannot be billed in the same encounter will have a color-coded indicator.

The return includes: 1.CPTÂŽ code and Description 2.Modifiers 3.APC Status 4.Service Units 5.Revenue Code 6.Service Date 7.CCI Edit result 8.Medicare Reimbursement 9.Medically Unlikely Edits 10. OCE Quantity 11. Reimbursement Comment The results can be exported to a PDF formatted report, or the User can ?create? a claim within the Claim Evaluator Module.

34

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

National Provider ID The PDE User can search the National Provider ID Database for individual or Organization NPIs in any state.The query can be performed on an NPI ID number or a keyword.T he example below was a keyword search on ?Childrens? in California.

The return displays the following data points: 1.NPI Number 2.Name (of individual or organization) 3.Address 4.City 5.State 6.Zip Code 7.Phone Number 8.Fax Number

35

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

UB-04 Data Specifications Manual Limited access is available to select users to the searchable UB-04 Data Specification Manual:

36

PARA Weekly Update: January 12, 2018

2018 UPDATES TO PDE CALCULATOR

HCPCS to Anesthesia Code Crosswalk This crosswalk allows Users to enter a surgical CPT® code to determine the appropriate Anesthesia CPT® code.As with other crosswalk files, either code will display the same result:

37

PARA Weekly Update: January 12, 2018

There were FIVE new or revised Med Learn (MLN Matters) article released this week. All new and previous Med Learn articles can be viewed under the type ?Med Learn? in the Advisor tab of the PARA Data Editor (see example below.) To go to the full Med Learn document simply click on the screen shot or the link.

38

PARA Weekly Update: January 12, 2018

The link to this Med Learn: MM10446

39

PARA Weekly Update: January 12, 2018

The link to this Med Learn: MM10372

40

PARA Weekly Update: January 12, 2018

The link to this Med Learn: MM10447

41

PARA Weekly Update: January 12, 2018

The link to this Med Learn: MM10418

42

PARA Weekly Update: January 12, 2018

The link to this Med Learn: MM10416

43

PARA Weekly Update: January 12, 2018

There were 16 new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type Transmittals in the Advisor tab of the PARA Data Editor. To go to the full Transmittal document simply click on the screen shot or the link.

44

PARA Weekly Update: January 12, 2018

The link to this Transmittal R1998OTN

45

PARA Weekly Update: January 12, 2018

The link to this Transmittal R3948CP

46

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R3947CP

47

PARA Weekly Update: January 12, 2018

The link to this Transmittal R3946CP

48

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R3945CP

49

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R1997OTN

50

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R1996OTN

51

PARA Weekly Update: January 12, 2018

The link to this Transmittal R765PI

52

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R239BP

53

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R1999OTN

54

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R476PR1

55

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R297FM

56

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R3950CP

57

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R3949CP

58

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R2000OTN

59

PARA Weekly Update: January 12, 2018

The link to this Transmittal: R477PR1

60

PARA Weekly Update: January 12, 2018

The PDE Editor Bulletin Board Tablet lists all articles added to the Bulletin Board

61

PARA Weekly Update: January 12, 2018

62