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<br />YES NO <br />lIJ [J RULE #07 ~ OBSTETRICAL GLOBAL FEE <br />Whenever office visits are billed by physician who also bills for 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 for a condition unrelated to the pregnancy. <br /> <br />[iJ D RULE #08 .. ~URGIC~k GLOBAI;t 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 />e.xce.ptions to this rule. for instance, a diagnostic procedure, as well as any visit <br />which is for a Qundition I.mr~lated to th~ sur~ery. <br /> <br />[jJ D R.ULE#~9..: N~:W.P~TI.~~:r 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 />[!] D RULE #10 - INPATIENT IBM/DISCHARGE CODE <br />Whenever a physician bIlls more than one initial IHM: code for the same patient <br />for the same hospitalization, it will deny. <br /> <br />II] <br /> <br />D <br /> <br />RULE #11 ~ ICU VISIT FREQUENCY <br />. . '., .' .-. - . ... -. -," <br />Whenever 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 />Vtilization R~vi~w. <br /> <br />[!] D 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 lat~r claims will be denied. <br /> <br />[!J <br /> <br />D <br /> <br />RULE #13 - PHYSICIAN VISIT FREQUENCY <br />Whenever a physician bills for visits for the same patient for the same date of <br />service (DOS) (except leU), the visit of highest value is paid and the other visits <br />will deny. If the other visits are for different diagnoses, how~ver, they will be <br />allowed. <br /> <br />IT] D RULE #14 - REPEAT PROCEDURES <br />Whenever a physician bills for repeating a procedure within a specified period of <br />time after the original procedure, it will deny. <br />