Accurately report supplies and services for physician, hospital outpatient, and ASC settings with the Optum36 HCPCS Level II Expert. Use this comprehensive reference for the HCPCS code set that focuses on management of reimbursement. This user-friendly book will guide any coder confidently through current modifiers, code changes, additions and deletions with information as dictated by the Centers for Medicare and Medicaid Services (CMS). The 217 version includes a new color palate and intuitive icons location providing a streamlined and efficient layout.

Key Features and Benefits

Exclusive to the Expert edition:

Optum36 Edge Access to Medically Unlikely Edits (MUE). Improve accuracy of claims by ensuring compliance with the CMS program through easy access to codes and their associated MUE units.

Optum36 Edge Special appendixes. Get additional information with appendixes for the listing of PQRS codes and a deleted codes crosswalk.

Most complete HCPCS code set available. Find information on codes from sources that generates HCPCS codes, including CMS, OPPS addendum B, and the Medicare fee schedule.

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

Glossary of terms. Increase your understanding of HCPCS codes to improve coding accuracy.

Medicare Average Payment Table This Medicare table is included as a baseline for payment rates.

Professional and all editions include the traditional hallmark features:

PQRS icons. Recognize potential for Medicare quality reporting bonus payments with icons denoting which HCPCS codes fall under the Physician Quality Reporting System.

Comprehensive code updates. Access OPPS files for HCPCS Level II, as well as deleted codes.

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

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 added support with articles on difficult-to-code HCPCS Level II codes or sections.

Color-coded bars and cons.

Spot important information to help reduce inaccurate and denied claims with informative flags signaling Pub. 1 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, Pub. 1 references, acronyms/abbreviations, and modifiers.

Exclusive to the Updateable edition (includes all the features of the Expert):

Optum36 Edge. Quarterly updates with code changes tracked throughout the year.