Medical Coding Best Practices

Coding Alignment Sentry Rules

100

If x7093 flags on your RVU bill what is is directing you to do?

• Treatment billed was rendered by the provider
• Number of units billed is appropriate for total time documented in the records  

200

When processing a high level E&M bill x7081 flags. Which program should be used to review?

Codify

300

When processing acupuncture bills, how many initial treatment codes should be billed per date of service?

1

400

What endnote may flag indicating the provider may have billed for the same procedure multiple times during the same visit?

BONUS (100 PTS): What endnote should be used if denying?

X99

• X4212: Procedure once per date of service (DOS).

500

Any CPT in which Allowed Amount is greater than or equal to $150 per unit is considered which sentry rule and what is the endnote that flags?

High-Dollar Charge

X7107 

Queue Overview

100

When moving bills to additional verification, which endnotes should be removed?

Verify any flagging ENs are removed 

Example: x369, x2066, C6136, ETC

200

When working in the duplicate queue, what should you do when you receive a respond to claim level/MCR delay?

• Enter claim note of what was received and EFF scan date and time where documentation can be found in claim system
• Send diary to MCR to see note
• Commit duplicate bill out of scope

300

When processing a bill in the IME/Peer Denial Review queue what should you do if the bill is in a specialty covered by the IME and some, but not all, DOS are being denied per the IME?

• Apply appropriate endnote to denied lines 
• Note in Description box which lines are denied for IME 
• Remove overrides for any payable lines 
• Check IME N/A box
• Revise and Analyze
• Process bill if it routes to a Coding queue

400

When working the No Tax ID queue what should you do once the TIN is updated?

• Remove all overrides
• Revise and Analyze
• Save bill once moved by the system

500

When working the approved for payment queue how can verify if the should be in the AFP queue before processing?

If bill line overrides are checked and/or the Rvw Complete box is checked, bill may need moved.