Course Code: REL-RCC-OPPS-C07
Hours: 0.5
Type: Online Course
Content Expiration Date: 12/31/2025
Learning Objectives:
Recall the function of the OCE edits.
Identify which OCE edits include the PTP edits.
Recognize how the MUEs work.
Locate Add-on edits.
Understand the distinctions among OCE edits, NCCI edits, PTP edits, and MUEs.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: Integrated Code Editor
Integrated Outpatient Code Editor Background
Integrated Outpatient Code Editor Software
Section 3: OCE Edits
Current OCE Edits
Current OCE Dispositions
Review
Sample RTP Edits
OCE Edit 17 Associated with the Bilateral Modifier
OCE Edit 74 Associated with the Bilateral Modifier
OCE Edit 21
OCE Edits Associated with Observation Services
Review
Section 4: PTP Edits
OCE Edits and NCCI Edits
Procedure to Procedure (PTP) Edits
Allowable Modifier Designation
Non-modifiable NCCI Edits: OCE Edit 20
Modifiable NCCI Edits: OCE Edit 40
Review
NCCI Coding Policy Manual for Medicare Services
Section 5: Medically Unlikely Edits
Medically Unlikely Edits, Part 1
Medically Unlikely Edits, Part 2
Adjudication of Medically Unlikely Edits
Examples of Medically Unlikely Edits
Examples of Laboratory Medically Unlikely Edits
Review
Add-on Code Edits
Section 6: Conclusion
Course Summary
Course Contributor(s)
References
Glossary
Reviewer: Veronica Ziac, MBA
Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Target Audience:
The target audience for this course is: Coding Specialists; in the following settings: Acute Care Facility.
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To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.