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YE NO RULE, , _ 1110 - RADIOLOGY UNBUNDLED Whenever more than one physician is billing for the same radiology episode, the the correct component of the radiology service:: physicians are aid accordin to ° a ' RULE #17 - MUTUALLY EXCLUSTVE PROCEDURES Whenever a physician bills for "mutually exclusive" procedures (can; not be performed during the same operative episode). The procedure of the highest value is paid, the remaining procedure(s) are denied. r�i4 •du EB RUT 1118 - POST -OP CARE, RTJLT #19 - PRT -OP CART , Whenever a physician is billing for care before or alter a procedure that another physician has performed, and if the care is within the global fee period of the procedure and for a related condition, it will be denied. RULE 1120 - MEDICAL PROTOCOL Whenever a physician bills for a procedure more frequently than is justified by the condition of the patient, it will pend for Utilization Review. i` E1110 RULE #21 - FRAGMENTED PROCEDURES Whenever a physician bills for multiple procedures on the same date of service (DOS) that are components of a major procedure for which there is a unique procedure code, the procedures are rebundled into the appropriate major procedure code. RULE 1122- SECONDARY PROCEDURE, MANAGEMENT ,•.. Whenever a physician bills for multiple procedures, all of which ualif for PY� p p q Y payment, the procedure of highest value is paid in full. The remaining second procedures are reduced to the specified amount allowed for that procedure, all other procedures are denied. RULE 1123 - BILATERAL PROCEDURE MANAGEMENT Whenever a physician bills for a bilateral procedure, the payment is reduced to not exceed the maximum allowed for that procedure. RULE #24 - UTTLTZATION REVIEW ;. ...: Whenever a physician bills for certain procedures that usually signify upcoding, are of questionable appropriateness, or are inherently vague, and the patient's ' .;. condition does not warrant it, it will pend for Utilization Review. 11 • . E111-500 RULE #25 - CAST MANAGEMENT Whenever a targeted procedure or diagnosis is identified, the patient's records are flagged for a special report which is available for review to determine the need for `` case management.