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<br />Attachment B <br /> <br />HEALTHCHEX <br /> <br />I Entity Name: <br /> <br />City of Paris <br /> <br />Group #: <br /> <br />APARISOO <br /> <br />Effective Date: <br /> <br />May 1, 1997 <br /> <br />Selections: CODE DESCRIPTIONS AND FUNCTIONS: <br /> <br />;i <br />:.~.,LL;,]>. <br />,,,,..,,.,,,,. <br /> <br />iii <br /> <br />Ei <br /> <br />E2J <br /> <br />lil <br /> <br />r-d1.< ......... <br />I!r!I <br /> <br />d <br />~ <br /> <br />NO <br />1'".:.:,::1 RULE #00 - CANNOT PROCESS <br />Whenever the claim does not have the minimum of information required by the <br />system to perform its auditing functions, the claim will need to be placed on hold <br />for review. <br /> <br />1:";:,,1 RULE #01 - OBSOLETE CODES <br />Whenever a procedure code is obsolete for the date of service (DOS) being billed, <br />it will deny. It will be replaced with the current/suggested code if one is <br />available. <br /> <br />li'i!,@:!1 RULE #02 - EXPERIMENTAL PROCEDURES <br />Whenever a procedure code exclusively representing an experimental procedure <br />is billed, it will pend for Utilization Review. <br /> <br />1:::',.,:+1 RULE #03 - DISCRETIONARY/COSMETIC PROCEDURES <br />Whenever a procedure code considered to be cosmetic or discretionary is billed, it <br />will pend for Utilization Review unless medically qualified. <br /> <br />l'n:;'ii,,1 RULE #04 - APPROPRIATE USE OF MODIFIERS <br />Whenever a modifier is used with a procedure code which should not be used with <br />that particular modifier, the procedure will deny. <br /> <br />I"I':,,~:I RULE #05 - SEPARATE PROCEDURES <br />Whenever a separate procedure, or a procedure considered to be included in the <br />major procedure is billed, it will deny. <br /> <br />li~::I'''1 RULE #06 - ASSISTANT SURGERY <br />i"'.. Whenever assistant surgery is billed for a procedure that does not warrant <br />assistance, it will deny. <br />