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AddendumB <br /> <br /> HEALTHCHEX <br /> <br /> Entity Name: CITY OF PARIS <br /> Group #: APART-qO 1 <br /> <br /> Effective Date: 5/1/03 <br /> <br /> Selections: CODE DESCRIPTIONS AND FUNCTIONS: <br /> <br />YES NO <br />[~ ['"-] 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 /> I--] 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 Whenever a procedure code is obsolete for the date of service (DOS) being billed, 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 available. <br /> <br /> [---'] RULE #02-EXPERIMENTAL PROCEDURES <br /> Whenever a procedure code exclusively representing an experimental procedure is <br /> billed, it will pend for Utilization Review. <br /> <br /> ~ 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 /> ~ 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 /> /--"] RULE #05- SEPARATE PROCEDURES <br /> Whenever a separate procedure, or a procedure considered to he included in the <br /> major procedure is billed, it will deny. <br /> <br /> /--~ ~ RULE #06- ASSISTANT SURGERY <br /> Whenever assistant surgery is billed for a procedure that does not warrant <br /> assistance, it will deny. <br /> <br /> <br />