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<br />YES <br />I x'l <br /> <br />m <br /> <br />m <br /> <br />[!] <br />m <br /> <br />NO <br />li:,1 RULE #26 - ASSISTANT SURGERY UCR <br />Whenever assistant surgery is qualified for payment, payment is reduced to not <br />exceed a specified amount allowed for that procedure. <br /> <br />o RULE #27 - CHEMISTRY LAB UNBUNDLED <br />Whenever a physician bills for more than one chemistry procedure code, they are <br />rebundled into the appropriate chemistry panel. <br /> <br />o RULE #28 - UCR/FEE SCHEDULE <br />Whenever a physician bills for a procedure, payment is reduced to the maximum <br />allowed for that procedure. <br /> <br />[J RULE #29 - 31 - NO RULES CURRENTLY EXIST <br /> <br />[J RULE #32 - NON-COVERED BENEFITS OR INVALID CODES <br />Whenever a procedure code that represents a non-covered benefit is billed it will <br />deny. <br /> <br />m 0 RULE #33 - MULTIPLE DISALLOWED PROCEDURES <br />Whenever a physician bills for procedures beyond the frequency for which the <br />procedure could possibly be perfonned, it will deny, (i.e. more than 1 <br />hysterectomy). <br /> <br />m [J RULE #34 - DUPLICATE PROCEDURES <br />Whenever a physician bills the same procedure code more than once for the same <br />patient on the same date of service (DOS) it will deny. <br /> <br />m 0 RULE #35 - MANDATORY OUTPATIENT PROCEDURES <br />Whenever a physician bills for a procedure that is generally accepted as being <br />done only in an ambulatory setting, however is done on an inpatient basis, it is <br />flagged for investigation. <br /> <br />@ 0 RULE #36 - POTENTIAL COORDINATION OF BENEFITS <br />Whenever a physician bills for a diagnosis that is representative of possible motor <br />vehicle accident origin or workers' compensation, it is flagged for review. <br /> <br />m <br /> <br />o RULE #37 - OFFICE VISIT UPCODING <br />Whenever a physician bills for an extensive or comprehensive office visit that is <br />in excess of the. appropriate frequency for that diagnosis of the patient, it is <br />flagged for review. <br />