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Correct vs incorrect adjudication
Check a claim
Look up a code
Bundling & units
Add-on codes
Coverage (LCD)
Assistant surgeon
Revenue crosswalk
Inpatient-only
Unit limits (MUE)
National (NCD)
Drugs outside the DRG
Denial triage
Remit / EOB
Workbench
Service lines
Paste codes
#
Date of service
Place
CPT / HCPCS
Modifiers
Units
Dx
1
—
11 · Office
19 · Off-campus outpatient
21 · Inpatient hospital
22 · On-campus outpatient
23 · Emergency department
24 · Ambulatory surgical center
31 · Skilled nursing facility
32 · Nursing facility
49 · Independent clinic
50 · FQHC
51 · Inpatient psychiatric
61 · Inpatient rehabilitation
62 · Outpatient rehabilitation
65 · ESRD facility
71 · Public health clinic
72 · Rural health clinic
81 · Independent laboratory
✕
2
—
11 · Office
19 · Off-campus outpatient
21 · Inpatient hospital
22 · On-campus outpatient
23 · Emergency department
24 · Ambulatory surgical center
31 · Skilled nursing facility
32 · Nursing facility
49 · Independent clinic
50 · FQHC
51 · Inpatient psychiatric
61 · Inpatient rehabilitation
62 · Outpatient rehabilitation
65 · ESRD facility
71 · Public health clinic
72 · Rural health clinic
81 · Independent laboratory
✕
3
—
11 · Office
19 · Off-campus outpatient
21 · Inpatient hospital
22 · On-campus outpatient
23 · Emergency department
24 · Ambulatory surgical center
31 · Skilled nursing facility
32 · Nursing facility
49 · Independent clinic
50 · FQHC
51 · Inpatient psychiatric
61 · Inpatient rehabilitation
62 · Outpatient rehabilitation
65 · ESRD facility
71 · Public health clinic
72 · Rural health clinic
81 · Independent laboratory
✕
+ Add line
Dx letters point into the diagnosis list below, as on a 1500.
Diagnoses
A
B
C
D
Try:
Clear
A 59 that won't work
Units over the cap
Necessity unproven
Hospital-only, billed in a clinic
A second surgeon who can't be paid
Bilateral on a code that isn't
ED visit billed from an office
Nothing wrong with it
Wellness visit, then a problem the same day
Preventive physical billed to Medicare
Annual wellness visit — what Medicare covers
Flu shot, given and administered