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<br />YES <br />[]J <br /> <br />IE <br /> <br />I];] <br /> <br />(]J <br /> <br />[lJ <br /> <br />rn <br /> <br />[J;] <br /> <br />NO <br />I' I RULE #07 - OBSTETRICAL GLOBAL FEE <br />Whenever office visits are billed by physician who also bills fOT the delivery <br />procedure code, and the visits are within the global fee period for the delivery, the <br />visits will deny, unless the visit is fOT a condition unrelated to the pregnancy. <br /> <br />liil RULE #08 - SURGICAL GLOBAL FEE <br />Whenever a physician bills office visits, consults or hospital visits within the <br />global fee period for the surgical procedure, the visits will deny. There are <br />exceptions to this rule, for instance, a diagnostic procedure, as well as any visit <br />which is for a condition unrelated to the surgery. <br /> <br />Ii .>1 RULE #09 - NEW P A TrENT CODE <br />Whenever a physician bills more than one new patient procedure code for the <br />same patient, it will deny, and insert a more appropriate visit code associated with <br />an established patient and allow payment accordingly. <br /> <br />1....1 RULE #10 - INP A TrENT IHMIDISCHARGE CODE <br />Whenever a physician bills more than one initial IHM code fOT the same patient <br />for the same hospitalization, it will deny. <br /> <br />II RULE #11 - ICU VISIT FREOUENCY <br />WheneveT a physician bills more than a specified number of visits for the same <br />patient for the same date of service (DOS), the subsequent visit will pend for <br />Utilization Review. <br /> <br />Ii I RULE #12 - IHM VISIT FREQUENCY <br />Whenever more than one physician bills for the same date of service (DOS) for <br />the same patient, and each is billing for a condition within the same "body <br />system", the later claims will be denied. <br /> <br />1.1 RULE #13 - PHYSICIAN VISIT FREOUENCY <br />Whenever a physician bills for visits fOT the Same patient for the same date of <br />service (DOS) (except I CU), the visit of highest value is paid and the other visits <br />will deny. If the other visits are for different diagnoses, however, they will be <br />allowed. <br /> <br />I~l II RULE #14 - REPEAT PROCEDURES <br />WheneveT a physician bills for repeating a procedure within a specified peTiod of <br />time after the original procedure, it will deny. <br /> <br />[U <br /> <br />Ii> I RULE #15 - PROFESSIONAL COMPONENT <br />When the physician is billing for the professional component of a procedure only, <br />the corresponding technical component is reduced, so that the total does not <br />exceed the maximum allowed fOT that procedure. <br />