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EncoderPro.com Expert provides online access to a powerful search application for all CPT®, HCPCS Level II, ICD-9-CM, and ICD-10-CM and PCS code sets as well as Optum and Medicare coding guidelines to ensure coding accuracy, improve billing performance, and reduce rejected claims. Complimentary monthly updates let you code confidently throughout the year. Plus, a compliance editor powered by Optum’s ClaimsManager helps you review your code selections, and a fee calculator computes the Medicare reimbursement rate for your region.
- Expert Exclusive—Enhanced compliance editor (with Optum’s ClaimsManager rules). Check your work by running your selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses, and more prior to submittal to a clearinghouse/vendor/payer. Includes a 24-month historical content database for use during claim adjudication. Over 130 coding rules are reviewed.
- Medicare CCI edits. Understand coding relationships for bundled and mutually exclusive procedures and check your code combinations through a full year of CCI.
- Expert Exclusive—Fee calculator. Calculate the adjusted Medicare reimbursement rate for your area.
- ICD-10-CM and PCS– Includes mapping content from ICD9 v1 v2, and v3 codes to ICD10-CM and PCS codes (as well as backward mapping) using the GEM (General Equivalency Mappings) and Optum’s MapSelect clinical mapping content. Also includes ICD-10-CM and PCS searching and Optum tabular (ICD10-CM and PCS books) content.
- Optum Edge—Powerful CodeLogic™ search engine technology. Keyword search across all code sets (including ICD-10-CM and PCS) simultaneously using up to four terms, acronyms, abbreviations, or even misspelled words.
- Optum Edge—Lay descriptions for procedures and HCPCS. Access comprehensive Coders’ Desk Reference descriptions for thousands of procedures and services to enhance your understanding of CPT® and HCPCS code differences.
- Optum Edge—Automatic monthly updates. Real-time application service delivers code changes before implementation and updates Medicare coverage information regularly for coding confidence.
- Local coverage determinations (LCDs) and Medicare’s Pub. 100 access. Check procedures for Medicare coverage instructions and medical necessity edits across all CMS MACs. Understand which ICD-9-CM (and ICD-10-CM) procedures define medical necessity and what the documentation guidelines are for successful claim submission. Gain insight into procedures and services that carry little or discretionary coverage and how to report them.
- Modifier crosswalk. Choose from a comprehensive array of modifiers for each procedure based on millions of claim scenarios to ensure correct modifier use when billing payers.
- Cross-coder relationships. Provides valuable content from 12 coding and billing specialty reference books in one powerful solution. Cross-reference procedures to radiology, path/lab, medicine codes, and more.