ej o u r n a l june8, 2022
Physician Supervision Requirements For Procedures Performed By An RN
Autonomous Coding
How Does This Streamline W orkflow?
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PARA Weekly eJournal: June 8, 2022
MISSING DEVICE CHARGE
Q.
We had a recent claim for a surgery charge for HCPCS 54410, and it appears to have a
device charge for $60,780. However, there is no HCPCS code for this device. We reached out to the department and they are unfamiliar with what code should be added. Can you assist with this?
A
. The CPT® code 54410 (REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A
MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION) indicates that the implant is likely to be a penile prosthesis. We used the PARA Dat a Edit or Pr icin g Dat a t ab to run the report ?APC Claim Analysis? . This tells us what other codes were reported last year on all claims submitted to Medicare with HCPCS 54410:
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PARA Weekly eJournal: June 8, 2022
MISSING DEVICE CHARGE
The report generated indicates that 94% of all claims submitted to Medicare reporting the procedure 54410 also reported C1813 (Prosthesis, Penile, Inflatable):
Please double check the medical record to verify that C1813 is the correct match for the implant charge. If it is, C1813 should be reported under implant revenue code 0278.
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PARA Weekly eJournal: June 8, 2022
PHYSICIAN SUPERVISION OF NURSING PROCEDURES IN A FACILITY SETTING
Q.
What is the physician supervision requirement for procedures performed by an RN in the
outpatient hospital setting?For example, wound care services like negative pressure wound therapy, compression wraps, and Unna boot application?
A
. Medicare requires ?General? physician supervision for wound care procedures performed
by a nurse in the facility setting. General supervision means that the procedure is furnished under the physician?s overall direction and control, but the physician?s presence is not required during the performance of the procedure. While internal hospital policies may or may not require closer supervision, Medicare requires only general supervision for most services. Medicare relaxed supervision requirements for most services in the hospital setting in January, 2020. Here?s a link and an excerpt from the Medicare Benefits Policy Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c06.pdf
Medicare Benefit Policy Manual Chapter 6 - Hospital Services Covered Under Part B 20.5.3 - Cover age of Ou t pat ien t Th er apeu t ic Ser vices In ciden t t o a Ph ysician?s Ser vice Fu r n ish ed on or Af t er Jan u ar y 1, 2020 ? Ch an ges t o Su per vision Requ ir em en t s (Rev. 10541; Issued: 12-31-20; Effective: 01-01-21; Implementation: 01-04-21) Starting January 1, 2020, CMS requires, as the minimum level of supervision, general supervision by an appropriate physician or non-physician practitioner in the provision of all therapeutic services to hospital outpatients, including CAH outpatients. ?General supervision? means the definition specified at 42 CFR 410.32(b)(3)(i), that is, the procedure or service is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure. CMS may assign certain hospital outpatient therapeutic services either direct supervision or personal supervision. When such assignment is made, ?direct supervision? means the definition specified at 42 CFR 410.32(b)(3)(ii), that is, the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. 4
PARA Weekly eJournal: June 8, 2022
PHYSICIAN SUPERVISION OF NURSING PROCEDURES IN A FACILITY SETTING
It does not mean that the physician or must be present in the room when the procedure is performed.?Personal supervision? means the definition specified at 42 CFR 410.32(b)(3)(iii), that is, the physician must be in attendance in the room during the performance of the service or procedure. The list of services starting January 1, 2020 and ending December 31, 2020 that are defined as non-surgical extended duration therapeutic services where the initiation of the service must be performed under direct supervision is available on the OPPS Website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ HospitalOutpatientPPS/Downloads/Hospital-Outpatient-Therapeutic-Services.pdf
Starting January 1, 2021, the minimum level of supervision for non-surgical extended duration therapeutic services will be general supervision for the entire service including for the initiation of the service. The hyperlink displayed in the excerpt from the Benefits Manual provides a list of HCPCS which require ?direct? supervision, and it identifies pulmonary rehab, cardiac rehab, and intensive cardiac rehab as also requiring direct supervision. The list of Outpatient Therapeutic Services does not include any of the wound care codes you inquired about.Therefore, the supervision requirement is ?General.?
This is a good opportunity to recap the four basic requirements for Medicare coverage of therapeutic services in the hospital outpatient setting. To be covered by Medicare as hospital outpatient therapeutic services, the services and supplies must be: - Medically necessary; - Furnished in the hospital or at a department of the hospital that has provider-based status in relation to the hospital; - Furnished under the order of a physician or other practitioner; - Furnished by hospital personnel practicing within the scope of practice applicable to their licensure under State law. 5
PARA Weekly eJournal: June 8, 2022
DELETED HCPCS FOR CMS ONCOLOGY CARE MODEL
CORRECTION ? PARA previously reported that G9678 was a new HCPCS effective 7/1/2022; in fact, this HCPCS will be discontinued effective 7/1/2022.The HCPCS had been used in the Oncology Care Model:
The OCM was a Six-year model (2016-2022) to test innovative payment strategies that promote high-quality and high-value cancer care. Procedure code G9678 was established to represent a monthly MEOS care management payment for participating Medicare Fee-for-Service (FFS) beneficiaries. The model was originally scheduled to end in June 2021, but the timeline was extended through June 2022 due to COVID. Details regarding the OCM are available on the CMS Innovation Center webpage at the link below: https://innovation.cms.gov/innovation-models/oncology-care
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PARA Weekly eJournal: June 8, 2022
STREAMLINING WORKFLOW THROUGH AUTONOMOUS CODING
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PARA Weekly eJournal: June 8, 2022
STREAMLINING WORKFLOW THROUGH AUTONOMOUS CODING
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PARA Weekly eJournal: June 8, 2022
STREAMLINING WORKFLOW THROUGH AUTONOMOUS CODING
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PARA Weekly eJournal: June 8, 2022
STREAMLINING WORKFLOW THROUGH AUTONOMOUS CODING
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PARA Weekly eJournal: June 8, 2022
STREAMLINING WORKFLOW THROUGH AUTONOMOUS CODING
Download this free report, and find out!
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PARA Weekly eJournal: June 8, 2022
PLACE OF SERVICE CODES FOR TELEHEALTH
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PARA Weekly eJournal: June 8, 2022
JULY 2022 OPPS CODING UPDATE
This paper summar izes t heJuly 2022 OPPS updat eas conv ey ed in t he CMS t r ansmit t al dat ed May 26, 2022. For a det ail ed l ist ing of t he OPPS codes, st at us indicat or s, and coding updat es, v isit t he OPPS t r ansmit t al at : https://www.cms.gov/files/document/r11435cp.pdf
Readers are advised that the July 2022 update to the OPPS Addendum A and Addendum B files was not available as of the date of this publication. The status indicator and payment information reported herein was derived entirely from the transmittal cited above.
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PARA Weekly eJournal: June 8, 2022
JULY 2022 OPPS CODING UPDATE
Su m m ar y of Ch an ges The update includes HCPCS additions, HCPCS changes, and payment policy indicators are generally described below; where the list of included HCPCS codes was lengthy, the list is provided on separate pages at the end of this paper. - Pr opr iet ar y Lab An alysis Codes ? added 9 new codes for lab tests that are proprietary ? in other words, the test method applicable to that CPT® is owned by the patent holder for the test - Advan ced Diagn ost ic Lab Test - 1 new code was retroactively approved as an Advanced Diagnostic Lab Test (ADLT) to 3/24/2022. The ?TissueCypher Barrett?s Esophagus Assay?, CPT® 0108U, is OPPS Status Indicator A (paid under a fee schedule) - 24 n ew CPT Cat egor y III - codes have been added effective 7/1/2022. The AMA releases new codes in July and January of each year; Category III codes are temporary codes for emerging technology, services, procedures, and service paradigms - Pr ocedu r es assign ed t o New Tech n ology APC?s were updated: - Added CPT® 0721T -- The Optellum Lung Cancer Prediction (LCP) Procedure, which applies an algorithm to a patient?s CT scan to produce a raw risk score for a patient?s pulmonary nodule.Status indicator S, APC 1508 ($600-$700); effective 7/1/2022 - Added CPT® 0723T ? Quantitative Magnetic Resonance Cholangiopancreatography Procedure, which produces a three-dimensional reconstruction of the biliary tree, pancreatic duct, along with volume and duct metrics.Status indicator S, APC 1511 (Level 11, $900-$1,000), effective July 1, 2022 - Excluded the Argus®II Retinal Prosthesis implant codes, as the device is no longer available in the marketplace. The implantation procedure and programming procedures (0100T, 0472T, 0473T, C1841) will be assigned status E2, excluded from coverage, effective July 1, 2022 - Updated the description for HCPCS C9782 (CardiAMP cell therapy IDE study), which was established 4/1/2022.CMS revised the HCPCS description to specify inclusion of the device within the procedure code; assigned Status Indicator T, New Technology Level 39 ($15,001-$20,000.)
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PARA Weekly eJournal: June 8, 2022
JULY 2022 OPPS CODING UPDATE
- Sk in Su bst it u t es - Four Skin Substitute codes are newly assigned to the High Cost skin substitute group effective July 1, 2022.Among the four,A2001 (Innovamatrix ac, per square centimeter), will be retroactively payable as High-Cost effective April 1, 2022
- Dr u gs, Biologicals, an d Radioph ar m aceu t icals -Sixteen new drug codes were established effective July 1, 2022 ? of those, nine new codes were assigned pass-thru status, and four existing drugs with prior HCPCS assigned to pass-through status will have HCPCS updates to a new code:
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PARA Weekly eJournal: June 8, 2022
JULY 2022 OPPS CODING UPDATE
- J0879 (Injection, Difelikeafalin, 0.1 microgram (for End Stage Renal Disease on dialysis)) will become retroactively payable as status K under OPPS effective April 1, 2022. - Covid-19 Labor at or y t est s an d ser vices (an d on e ot h er lab code)
- CMS provided a comprehensive list of COVID-19 lab tests and related services and OPPS status indicators. CPT® 87913 is relatively new, having been added in February 2022 - One lab code listed along with the COVID test codes, 0014M, is listed in this section, although it is not a COVID-19 lab test.It had been inadvertently omitted in the April OPPS update - HCPCS K1034 (Over-the-Counter Covid-19 Tests Demonstration) for providers who wish to supply home COVID-19 test kits to Medicare beneficiaries.HCPCS K1034 has been available to report dispensed test kits since April 4, 2022 - New Covid-19 Vaccin e an d Adm in ist r at ion codes - Effective 3/29/2022, CMS will recognize and reimburse the Moderna COVID-19 vaccine booster dose (91309) and its administration (0094A), which coincides with the date this vaccine received an Emergency Use Authorization (EUA) from the FDA - Several other new CPT ® codes were established by the AMA but cannot be billed to Medicare until they receive an Emergency Use Authorization (EUA), including the Sanofi Pasteur booster vaccine for adults 18 years and older, and the Pfizer booster code for pediatric patients 5-11 years old
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PARA Weekly eJournal: June 8, 2022
JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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JULY 2022 OPPS CODING UPDATE
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PARA Weekly eJournal: June 8, 2022
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PARA Weekly eJournal: June 8, 2022
CMS CORRECTS PART-B ONLY CAH CLAIMS PROCESSING
Medicare recently published Change Request 12636 directing Medicare Administrative Contractors to correct reimbursement processing for Critical Access Hospital (CAH) claims billed on Type of Bill (TOB) 12X for inpatient care provided to a beneficiary with Part B coverage only. The MACs are not required to change claims processing, however, until October 1, 2022.The Change Request instructs contractors to allow payment for CAH ancillary services, including status B facility fees, using the reasonable cost (percent of charges) methodology. The Change Request indicates that CAHs may have been improperly denied reimbursement for certain facility fee HCPCS billed on TOB 12X, specifically HCPCS which have been assigned OPPS Status Indicator B. OPPS Status Indicator B codes can be valid for CAH claims, but are not recognized by OPPS when submitted on an outpatient OPPS hospital type of bill 12x or 13x. Typically, status B codes are not eligible for OPPS hospital claims because an alternate code may be reported (such as G0463 -HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT) for facility fees.Medicare permits CAHs to report OPPS status B HCPCS for facility fees. Here are a few HCPCS examples:
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PARA Weekly eJournal: June 8, 2022
NEW PRESENTATION: COVID-19 BILLING AND CODING DETAILED GUIDANCE
Par aRev h as cr eat ed a n ew , in f or m at ive pr esen t at ion f illed w it h det ails on t h e pr oper an d ef f ect ive COVID-19 billin g an d codin g. An d, n ow it 's h er e f or you t o dow n load an d r eview. Th en con t act on e of ou r Accou n t Execu t ives f or m or e in f or m at ion an d det ails on h ow Par aRev can h elp.
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PARA Weekly eJournal: June 8, 2022
ACR REPORTS 2023 ANTICIPATED CODE CHANGES
The ACR Radiology Coding Source? section of the American College of Radiology website offers a narrative of anticipated coding changes in both radiology and evaluation and management CPT® codes for 2023. The article is available at the following link: https://www.acr.org/Advocacy-and-Economics/Coding-Source/March-April-2022/2023-CPTAnticipated-Changes
The CPT® changes anticipated by the ACR include:
- New Category I codes for percutaneous arteriovenous fistula creation and neuromuscular ultrasound - Category III codes which will be released on July 1, 2022 for CT Tissue Characterization (formerly 0689T and 0690T) and Quantitative Magnetic Resonance Cholangiopancreatography (MRCP) - Revision of the E/M Services Guidelines to reflect changes to the Inpatient and Observation Care Services, Consultations, Emergency Department Services, Nursing Facility Services, Home and Residence Services, and Prolonged Services subsections - Revised codes for somatic nerve injections, pulmonary angiography, and paravertebral spinal nerves and branches.
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PARA Weekly eJournal: June 8, 2022
CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022
CMSissuedadocument reporting HCPCScodingdecisionsinresponseto manufacturer appl ications for newcodeassignment eachquarter. The first quarter 2022report incl udes anumber of HCPCSfor drugsand biol ogics, whichwil l becomeeffectiveJuly 1, 2022. https://www.cms.gov/files/document/2022-hcpcs-application-summary-quarter-1-2022drugs-and-biologicals.pdf
A summary of the decisions is provided below in three sections ? Medicine, Wound Care, and Radiopharmaceuticals.
M edicin e - FYARRO® -- which is currently reported with temporary HCPCS C9091, will be assigned HCPCS J9331 ? ?Injection, sirolimus protein-bound particles, 1 mg.? This drug is used to treat advanced unresectable or metastatic malignant perivascular epithelioid cell tumor (PEComa) - LEQVIO® -- will be assigned HCPCS J1306 ? Injection, inclisiran, 1 mg. LEQVIO® is indicated as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia (HeFH)] or clinical atherosclerotic cardiovascular disease (ASCVD), who require additional lowering of low-density lipoprotein cholesterol (LDL-C)
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PARA Weekly eJournal: June 8, 2022
CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022
- SUSVIM O? , an intraocular injection used to treat patients with age-related macular degeneration, will be assigned two HCPCS, one for the injection, and another for the implant. The recommended dose of SUSVIMO? is 2 mg (0.02 mL of 100mg/mL solution) continuously delivered via the SUSVIMO? ocular implant with refills administered every 24 weeks (approximately 6 months). The new HCPCS are: J2779 ?Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg?, and C9093 ?Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg? - RYPLAZIM ® , which is indicated for the treatment of patients with plasminogen deficiency type 1 (hypoplaminogenemia), will be assigned HCPCS J2998 ?Injection, plasminogen, human-tvmh, 1 mg?. Apparently this medication is considered a self-administered drug unless delivered by IV infusion; modifier JA ?administered intravenously? must be appended when delivered by IV infusion to qualify for Medicare coverage - XIPERE? (Triamcinolone acetonide) is a synthetic glucocorticoid (glucocorticoids are often referred to as corticosteroids) with immunosuppressive and anti-inflammatory activity. The newly assigned HCPCS will be J3299 ?Injection, triamcinolone acetonide (xipere), 1 mg? - VYVGART? , is indicated for the treatment of adult patients with generalized myasthenia gravis who are anti-acetylcholine receptor antibody positive. This drug may have been reported with miscellaneous/unclassified codes previously. The newly assigned HCPCS is J9332 ?Injection, efgartigomod alfa-fcab, 2 mg? - cu t aqu ig®, which prevents infections of a wide variety of bacterial and viral agents in immunodeficient adults by temporarily restoring IgG levels in circulating plasma, will be assigned HCPCS J1551, ?Injection, immune globulin (cutaquig), 100 mg? - TEZSPIRE? is an add-on maintenance treatment of adult and pediatric patients aged 12 years and older with uncontrolled asthma while receiving treatment with medium- or high-dose inhaled corticosteroids (ICS) plus at least one additional controller medication with or without oral corticosteroids (OCS). The newly assigned HCPCS will be J2356, ?Injection, tezepelumab-ekko, 1 mg? - APRETUDE, which reduces the risk of sexually acquired HIV-1 infection, is an intramuscular injection kit that must be administered by a healthcare provider. The new HCPCS assigned by CMS will be J0739, ?Injection, cabotegravir, 1 mg?.
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PARA Weekly eJournal: June 8, 2022
CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022
Sk in Su bst it u t es an d Wou n d Car e Pr odu ct s - Celer a? Du al M em br an e an d Celer a? Du al Layer skin substitutes will be assigned new HCPCS Q4259 ?Celera dual layer or celera dual membrane, per square centimeter.? Previously, this product may have been reported with Q4100 ?Skin Substitute, Not Otherwise Specified.? - Sign at u r e APat ch , a wound protection barrier/cover will be assigned HCPCS Q4260 ?Signature APatch, per square centimeter ? - TAG, a wound protection barrier/cover, will be assigned HCPCS Q4261, ?Tag, per square centimeter ?.
Radioph ar m aceu t icals - Illu cix ® , a radioactive prostate cancer PET imaging product, will be assigned HCPCS A9596 ?Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie?. Providers using this agent in PET scans are hopeful that the new HCPCS will offer better reimbursement for this expensive radiopharmaceutical. (The payment status will be announced with the next update to the OPPS Addendum B, expected in June, 2022.) - TAUVID? , a radioactive diagnostic agent used in PET imaging of the brain to evaluate patients for Alzheimer ?s disease will be assigned HCPCS A9601 ?Flortaucipir f 18 injection, diagnostic, 1 millicurie?
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PARA Weekly eJournal: June 8, 2022
CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022
The CMS document also listed the applications for which it declined to assign a HCPCS for various reasons: - RETHYM IC® - used only in inpatient settings - Lidocidex? - a compounded drug (CMS does not issue HCPCS for compounded drugs) - Cocoon Du al-Layer an d Sin gle-Layer M em br an es ? due to differences in the HCPCS application and information submitted to the FDA - Palin Gen ® Du al Layer M em br an es are dehydrated, human allografts derived from the placenta ? due to differences in the HCPCS application and information submitted to the FDA - Esan o AAA, a triple layer decellularized, dehydrated human amniotic membrane allograft for wound care, due to differences in the HCPCS application and information submitted to the FDA - San opellis are dehydrated, human allografts derived from the placenta for wound care, due to differences in the HCPCS application and information submitted to the FDA - 3L Biovan ce® Tr i-Layer an d 3L Biovan ce ® , a human amniotic membrane allograft for wound care, due to differences in the HCPCS application and information submitted to the FDA - Pem et r exed, a single agent in the treatment of locally advanced and metastatic non-squamous non-small cell lung cancer, due to an incomplete HCPCS application.
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PARA Weekly eJournal: June 8, 2022
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PARA Weekly eJournal: June 8, 2022
MLN CONNECTS
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Th u r sday, Ju n e 2, 2022
New s -
Medicare Shared Savings Program: Application Deadlines for January 1 Start Date
Claim s, Pr icer s, & Codes -
ICD-10-PCS Procedure Codes: Fiscal Year 2023 July 2022 Integrated Outpatient Code Editor (I/OCE) Specifications Version 23.2
M u lt im edia -
Inpatient Rehabilitation Facility & Long-Term Care Hospital Virtual Training Program ? Part 1
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r a n s mi t t a l s
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Ther e w er e SIX new or r evised Tr ansmittal r el eased this w eek . To go to the ful l Tr ansmittal document simpl y cl ick on the scr een shot or the l ink .
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TRANSMITTAL R11447BP
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TRANSMITTAL R1148BP
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TRANSMITTAL R11445CP
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TRANSMITTAL R11443CP
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TRANSMITTAL R11440CP
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TRANSMITTAL R11439CP
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ed l ea r n s
Ther e w er e TW O new or r evised MedLear n r el eased this w eek . To go to the ful l Tr ansmittal document simpl y cl ick on the scr een shot or the l ink .
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MEDLEARN MM12615
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MEDLEARN MM12723
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FOR YOUR INFORMATION
The preceding materials are for instructional purposes only. The information is presented "as-is" and to the best of ParaRev?s knowledge is accurate at the time of distribution. However, due to the ever changing legal/regulatory landscape this information is subject to modification, as statutes/laws/regulations or other updates become available. Nothing herein constitutes, is intended to constitute, or should be relied on as, legal advice. ParaRev expressly disclaims any responsibility for any direct or consequential damages related in any way to anything contained in the materials, which are provided on an ?as-is?basis and should be independently verified before being applied. You expressly accept and agree to this absolute and unqualified disclaimer of liability.The information in this document is confidential and proprietary to ParaRev and is intended only for the named recipient. No part of this document may be reproduced or distributed without express permission. Permission to reproduce or transmit in any form or by any means electronic or mechanical, including presenting, photocopying, recording and broadcasting, or by any information storage and retrieval system must be obtained in writing from ParaRev. Request for permission should be directed to sales@pararevenue.com.
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