Accurately report supplies and services for physician, hospital outpatient, and ASC settings with the 2023 HCPCS Level II Professional. Use this comprehensive reference for the HCPCS code set that focuses on management of reimbursement. This user-friendly book guides any coder confidently through current modifiers, code changes, additions, and deletions with information as dictated by the Centers for Medicare and Medicaid Services (CMS).

Key Features and Benefits

·         Comprehensive code updates.

·         Table of Drugs. Locate both generic and brand-name drugs and their corresponding codes based on the amount and route of administration.

·         Code level documentation tips. When appropriate, guidance is provided to assist correct coding.

·         APC status indicators and ASC designation symbols. Determine which codes are payable under OPPS and which codes enable billing using ASC groupings, as well as how to accurately use each to help ensure appropriate billing and reimbursement.

·         Comprehensive Drug Information. The C and J code sections include a listing of a common drug(s) to be used for that code. Also, as needed, a coding tip and/or drug notation is provided.

·         DMEPOS icon. Distinguish codes paid under the DMEPOS fee schedule to improve efficiency when coding for supplies that should be submitted under the system to durable medical payers.

·         In-depth illustrations. Enhance your coding process and accuracy for supplies and services with detailed visual references.

·         AHA Coding Clinic^® for HCPCS references. Receive additional support with articles on
difficult-to-code HCPCS Level II codes or sections.

·         Color-coded bars and icons. Spot important information to help reduce inaccurate and denied claims with informative flags signaling Internet Only Manual (IOM) references, age and gender edits, quantity alerts, new/deleted/revised code changes, and government coverage and rules for each code. 

·         User-friendly appendixes. Navigate additional information easily with structured references and excerpts, including a comprehensive drug table, acronyms/abbreviations, and modifiers.

Coding Clinic is a registered trademark of the American Hospital Association.

The Coders’ Desk Reference for ICD-10-CM Diagnoses provides thousands of clinical descriptions of diseases, disease processes, injuries, poisonings, and other conditions to help both novices and seasoned coders attain the knowledge and skill necessary to accurately identify and assign the most specific ICD-10-CM diagnosis code for each documented condition.

With these clinical definitions and focus points, you can reduce coding errors and improve coding confidence by gaining a better understanding of the clinical meanings behind the codes.

Key Features and Benefits

·       Optum Edge — More clinical descriptions and focus points. Expanded with clinical descriptions and focus points for new and changed 2023 codes as well as existing ICD-10-CM codes.

·       Optum Edge — Illustrations at the code level. Often an illustration is needed to enhance understanding. Illustrations of pertinent anatomy and pathological changes related to the disease process are included as a visual aid.

·       Optum Edge — Code level clinical description. Code level descriptions are provided for select diseases, injuries, symptoms, other factors influencing health status, and other reasons for contact with healthcare providers.

·       Optum Edge — Clinical focus points. Improve overall coding accuracy with additional information for complex diagnoses and injuries that require an understanding of related codes and conditions that might better describe the documented condition.

·       Alphanumeric organization by ICD-10-CM code. Locate codes quickly with a resource developed to work hand-in-hand with your Optum ICD-10-CM codebook.

·       Enhance understanding of ICD-10-CM. Understanding the clinical condition captured by each code is essential to correct code assignment, and this resource is designed to explain and highlight differences between codes that may appear similar at first glance.

·       Designed for both novices and seasoned coders. Coders of every skill level find that these clinical descriptions enhance understanding of ICD-10-CM.

The 2023 ICD-10-CM Professional for Physicians with Guidelines, with our hallmark features and format, makes facing the challenge of accurate diagnosis coding easier. Developed specifically to meet the needs of physicians, the Optum codebook contains the complete ICD-10-CM code set, which is the cornerstone for establishing medical necessity, determining coverage, and ensuring appropriate reimbursement. Symbols in the tabular section identify codes associated with CMS quality payment program (QPP) measures and CMS hierarchical condition categories (HCC) used in risk adjustment (RA) coding.

Key Features and Benefits

·         NEW — Optum Edge — Icons for April updates. Easily distinguish between April and October new and revised codes with green icons for April and black for October changes.

·         NEW — Optum Edge — Expanded Table of Drugs and Chemicals. Expanded to include updated drugs and codes listed with associated intent with icon to easily identify the added drugs.

·         NEW — Optum Edge — Icons identifying RxHCCs and ESRD HCCs. Quickly identify the RxHCC and ESRD/PACE ICD-10-CM codes used in risk adjustment coding by Medicare Advantage Plans.

·         NEW — Optum Edge — Icons identifying HHS-HCCs.  Easily identify the Department of Health and Human Services HHS-HCCs used by commercial insurance companies.

·         Optum Edge — Intuitive features and format. Visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, QPP, HCCs, unspecified codes, and more.

·       Product Updates. April and other ICD-10-CM changes and updates will be made available on the Optum Product Update page on Optumcoding.com for our valued ICD-10-CM customers.

·       Coding tips and clinical definitions. Coding tips assist in appropriate code selection, while clinical definitions provide a better understanding of complex ICD-10-CM diagnostic terms.

·         List of code changes and conversion table. A list of all 2023 new, revised, and deleted codes. Plus an ICD-10-CM conversion table from the new and changed codes to the code previously used.

·         Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms.

·         Guidelines with coding examples. Official Guidelines for Coding and Reporting including chapter-specific coding examples.

·         Helpful illustrations. Detailed color anatomy illustration appendix. Plus many illustrations at the code level identifying specific code-related anatomy.

With the implementation of ICD-10 codes in October 2015, the 2023 DRG Desk Reference (ICD-10-CM) gives access to crucial information to improve MS-DRG assignment practices, guidance on how to accurately assign DRGs under the MS-DRG system, and provides insight with the Optimizing section of the DRG Desk Reference based on ICD-10 codes. 

The DRG Desk Reference (ICD-10-CM) is designed to work hand-in-hand with DRG Expert and the Guide to Clinical Validation, Documentation and Coding, which is the clinical section from the DRG Desk Reference based on ICD-10 codes. This product helps answer your DRG questions for all inpatient stays starting after October 1, 2022, as those claims will use the MS-DRG methodology based on
ICD-10-CM.

Key Features and Benefits  

·         Optum Edge — Optimizing tips. Know the major factors involved in moving a patient from a lower-paying MS-DRG to a higher one to receive optimal payment while staying in compliance.

·         Most commonly missed CC and MCC references. Perform accurate audits by knowing the most commonly missed CCs in the medical record.

·         ICD-10-CM codes for common diagnoses and procedures. Quickly identify the key diagnosis or procedure by ICD-10-CM code.

·         Case mix index section. Discusses the importance of calculating and tracking case mix on a regular basis as well as tips for documenting case mix index changes and their causes.

·         Complete CC and MCC list. Know how codes considered MCCs and CCs will affect DRG assignment—helping to legitimately improve reimbursement.

·         Relative weights of every valid DRG. A quick reference of the relative weights of all DRGs presented as options for optimizing.

·         List of ICD-10 codes driving MS-DRG assignment.

Evaluation and management (E/M) coding is notoriously difficult because selecting the correct code from among a range of seemingly appropriate choices can be difficult.

Consequently, providers can make more mistakes with E/M coding than coding for any other item or service. This resource offers detailed and advanced guidance on selecting the appropriate E/M codes, with helpful resources designed for difficult E/M coding situations.

Key Features and Benefits

·       Optum Edge —Get online access to Physician E/M Self-Audit Forms. Protect your revenue critical services and procedures.

·       Complete 2023 update to changes in the E/M coding process.

·       Compliance guidance, checklist, and worksheets. Assists in avoiding costly revenue take-backs.

·       ICD-10-CM code assignment hinges on the quality and detail of E/M encounter data. Get the appropriate ICD-10-CM coding assignments with improved E/M coding process. Minimize physician queries and prevent delays in claims processing pending information and stop outright claims denials.

·       Includes clinical case studies. Train coders and clinicians using real-life scenarios.

·       Telemedicine services. Understand how these E/M services are reported.

·       Chapter addressing HCPCS codes. HCPCS types of services explained in one chapter.

·       Covers E/M services. Review of the E/M rules and protocols.

·       Helpful advice designed for difficult E/M coding situations. Well-patient exams, H1N1 flu, and other common but problematic coding scenarios are explained.

·       Knowledge assessments. With answers and rationale, get instant feedback on knowledge retention.

·       Targeted areas. Review what auditors are targeting, such as critical care.

·       Documentation guidance. Review key factors for proper E/M code selection, plus advice to help clinicians make an objective review of subjective information.

CPT^® is a registered trademark of the American Medical Association.