Obsolete Code Edit
The purpose of this edit is to identify procedure code ( s ) that has been deleted or no longer performed .
The edit comment may indicate “ INVALID CLAIM BILLING RECODING IS REQUIRED ” Preoperative and Postoperative Edit
The purpose of this edit is to verify claims submitted for preoperative and postoperative timeframes associated with surgical procedures and certain medical procedures are followed .
Preoperative and postoperative periods are designated in CMS ’ s National Physician Fee Schedule . With regard to medical visits :
• Minor surgical procedures have a zero day preoperative , and a zero to 10 day ( s ) postoperative timeframe
• Major surgical procedures have a one day preoperative and a 90 day ( s ) postoperative
The edit comments may indicate “ POST OP PROCEDURE OR PRE OP PROCEDURE ” Re-bundled or Unbundling Edits
The purpose of the edit is to identify claims submitted with two or more procedure coded to describe a service when a single , more comprehensive procedure exists that more accurately describes the complete service performed by a provider .
Occasionally , the appropriate procedure is not present on the claim . In these instances , our claims review system may recommend to rebundle the unbundled procedure ( s ) to the more appropriate CPT / HCPCS procedure . For example , if a claim is submitted with CPT codes 93005 ( Electrocardiogram , routine EKG with at least 12 leads ; tracing only , without interpretation and report ) AND 93010 ( Electrocardiogram , routine EKG with at least 12 leads ; interpretation and report only ) for the same date of service ; Hometown Health may recommend to rebundle CPT code 93005 and 93010 to CPT code 9300 ( Electrocardiogram , routine EKG with at least 12 leads ; with interpretation and report ).
The edit comment may indicate “ APPROPRIATE CODE FOR REBUNDLED PROCEDURE ”
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