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City of Paris <br />APARTS00 <br />May 1, 1997 <br />H ALTH HEX <br />" ' -' Selections: CODE DESCRIPTIONS AND FUNCTIONS: <br />,,::YES <br />NO <br />I' <br />RULE 1100 - CANNOT PROCESS <br />C. <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 />r` 1' <br />SOLET ,COD I+,S <br />RULT, 1101 - OT3. <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Whenever a procedure code is obsolete for the date of service (DOS) being billed, 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 />RULr,1102 - EXPERIMENTAL PROCEDURES <br />Whenever a procedure code exclusively representing an experimental procedure <br />is billed, it will pond for Utilization Review. <br />RULE 1103 - DISCRETIONARY /COSMETIC PROCEDURES <br />Whenever a procedure code considered to be cosmetic or discretionary is billed, it <br />' <br />will pend for Utilization Review unless medically qualified. <br />i;�° "ail <br />u�ry <br />RULE 1104 - APPROPRIATE Usr, Or 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 />Ji <br />RULE 1105 - 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 />I <br />RULr,1106 - ASSISTANT SURGERY <br />Whenever assistant surgery is billed for a procedure that does not warrant <br />i <br />assistance, it will deny. <br />