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Los Angeles Trade Technical College *

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Course

046

Subject

Accounting

Date

Apr 3, 2024

Type

docx

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2

Uploaded by BaronLightning6774

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1. Depending on state reporting requirements, when the circumstances of inpatient admission govern the sequencing of procedure codes, UHDDS Definitions are used to report inpatient data elements in a standardized manner . 2. Inpatient procedures are classified using ICD-10-PCS 3. Outpatient and physician office settings report CPT and HCPCS Level II codes for procedures and services 4. Upon implementation of MS-DRGs, CMS eliminated the requirement to SEQUENCE principal and secondary procedures. 5. When required for reimbursement purposes, the principal procedure is sequences first 6. The principal procedure is defined as being performed for _ definitive _ ____ treatment rather than for diagnostic or exploratory purposes, necessary to treat a complication, or most closely related to the principal diagnosis. 7. Other significant procedures (or secondary procedures) are defined as SURGICAL __ _ in nature, carrying a procedural (or operative) risk, carrying an anesthetic risk, requiring highly trained personnel, and/or requiring special facilities or equipment. 8. A paper-based UB-04 claim allows for the reporting of one principal procedure and up to 5 significant procedure(s).
9. An electronic inpatient claim allows for reporting of one principal procedure and up to 14 significant procedures. 10. The number of other (secondary) significant procedure codes that can be reported in DRG grouper software is 24.
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