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NO <br />RULE, #26 - ASSISTANT SURGERY UCR <br />Whenever assistant surgery is qualified for payment, payment is reduced to not -- <br />exceed a specified amount allowed for that procedure. <br />RULE #27 - curi MISTRY LAB UNBUNDLED <br />Whenever a physician bills for more than one chemistry procedure code, they are <br />rebundled into the appropriate chemistry panel. <br />EB Ruiz. #28 - UCRirrr SCHEDULE <br />Whenever a physician bills for a procedure, payment is reduced to the maximum <br />allowed for that procedure. <br />0 RULE, #29 - 31 - NO RULES CURRENTLY rXTST <br />M RULE, 1132 - _NON- COV+;RF,D BENEFITS OR INVALID CODES <br />Whenever a procedure code that represents a non - covered benefit is billed it will <br />deny. <br />?!D RULE, #33 - MULTIPLE, DISALLOWED PROCEDURES <br />Whenever a physician bills for procedures beyond the frequency for which the <br />procedure could possibly be performed, it will deny, (i.e. more than 1 <br />hysterectomy). <br />g!!E RULE, 1134 - DUPLICATE, PROCEDURES <br />Whenever a physician bills the same procedure code more than once for the same <br />patient on the same date of service (DOS) it will deny. <br />E0 RULE, #35 - MANDATORY OUTPATIENT PROCEDURES <br />Whenever a physician bills for a procedure that is generally accepted as being <br />done only in an ambulatory setting, however is done on an inpatient basis, it is <br />flagged for investigation. <br />RULE, no - POTENTIAL COORDINATION OT BF,NF,FITS <br />Whenever a physician bills for a diagnosis that is representative of possible motor <br />vehicle accident origin or workers' compensation, it is flagged for review. <br />RULE, or - OFFICE VISIT UPCODING <br />Whenever a physician bills for an extensive or comprehensive office visit that is <br />in excess of the appropriate frequency for that diagnosis of the patient, it is <br />flagged for review. <br />,1 <br />