Coding Based on Standard of Medical/Surgical Practice

Help Guide for NextGen® Enterprise PM 8

Mutually Exclusive CCI Edits

Mutually Exclusive codes are those codes that cannot reasonably be done in the same session.CPT codes that are mutually exclusive of one another based either on the CPT definition or the medical impossibility/improbability that the procedures could be performed at the same session can be identified as code pairs. These codes are not necessarily linked to one another with one code narrative describing a more comprehensive procedure compared to the component code, but can be identified as code pairs that should not be reported together. Parent topic: CCI Edits

Help Guide for NextGen® Enterprise PM 8

CCI Edits

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (CCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. The coding policies developed are based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice and review of current coding practice. The National Correct Coding Policy Manual and edits have been developed for application to services billed by a single provider for a single patient on the same date of service. The purpose of the Correct Coding Initiative (CCI) edits is to ensure that uniform payment policies and procedures are followed by all carriers. When services are accurately coded and reported by physicians proper payment can be guaranteed. Note: You must be licensed for CCI edit

NextGen® Adaptive Content Engine Help Enterprise 8

Patient's Medical History

The Medical/Surgical/Interim panel enables you to document the medical or surgical history of the patient. If no medical or surgical history exists, you can select the No relevant past medical/surgical history check box. You can filter the past history records by selecting the required check boxes. By default, the Show All check box is selected. Medical/Surgical/Interim panel On the Past Medical History template, the medical conditions and the surgical procedures associated with the current specialty appear alongside a check box in the respective panels. The Medical and Surgical panels include individual and grouped conditions or procedures. The individual conditions or procedures includes only a check box. The grouped conditions or procedure include [+] sign adjacent to the condition which indicates that the condition, or procedure includes sub-items. The conditions or surgical procedures, or sub-items with an asterisk (*) indicate that the condition or procedure, or sub-item is not a

NextGen® Ophthalmic Suite Help 2022.2

Patient's Medical History

The Medical/Surgical/Interim panel enables you to document the medical or surgical history of the patient. If no medical or surgical history exists, you can select the No relevant past medical/surgical history check box. You can filter the past history records by selecting the required check boxes. By default, the Show All check box is selected. Medical/Surgical/Interim panel On the Past Medical History template, the medical conditions and the surgical procedures associated with the current specialty appear alongside a check box in the respective panels. The Medical and Surgical panels include individual and grouped conditions or procedures. The individual conditions or procedures includes only a check box. The grouped conditions or procedure include [+] sign adjacent to the condition which indicates that the condition, or procedure includes sub-items. The conditions or surgical procedures, or sub-items with an asterisk (*) indicate that the condition or procedure, or sub-item is not a

NextGen® Orthopedic Suite Help 80.2.14.0

Surgery Coding Template

The final step for the surgery scheduling workflow is the Surgery Coding template. Here, billers can code and bill for the procedures performed. We recommended that you open a new encounter, drag the Surgery Sched template to the new encounter, then code and bill for the procedures on the Surgery Coding template. The Schedule/Boarding Information and Diagnosis/Procedure Information panels display all diagnoses and procedures entered from the Surgery Sched template. You can also add additional diagnoses or update the procedure if the performed procedure is different than the boarded procedure. Add Surgery Coding Biller You can add the person who does the billing for the procedures performed by the provider. Scheduling and Boarding Information You can verify the information added while scheduling the surgery and add the necessary tasks for the billing staff or providers. Diagnosis/Procedure Information Panel Parent topic: Surgery Scheduling Workflow

Help Guide for NextGen® Enterprise PM 8

CCI Bundling Anesthesia Edits

Principles of Medicare coding for anesthesia services involving administration of anesthesia are reported by the use of the anesthesia five-digit CPT procedure codes (00100-01860). These codes specify Anesthesia for followed by a general area of surgical intervention. When the following CPT codes are reported with an anesthesia code, it is assumed that these services are being reported as part of the anesthesia service and so will not be paid in addition to the anesthesia code. Because it is recognized that many of these procedures may occur on the same date of surgery but are not performed in the course of and as part of the anesthesia provision for the day, these codes will be separately paid only if the -59 modifier is appended to the code, indicating that the service rendered was independent of the anesthesia service. CPT codes describing services that, when performed as part of the anesthesia service, would be considered included in the anesthesia code include the following partia

Coding Based on Standard of Medical/Surgical Practice

Recommendations

Mutually Exclusive CCI Edits

CCI Edits

Patient's Medical History

Patient's Medical History

Surgery Coding Template

CCI Bundling Anesthesia Edits

Mutually Exclusive CCI Edits

CCI Edits

Patient's Medical History

Patient's Medical History

Surgery Coding Template

CCI Bundling Anesthesia Edits