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provides HIM coders with the most up-to-date coding content, reference data, edits, and optimization tips, no matter where they are located. Updated monthly, it provides the most current information that health information management (HIM) and other professional coders need to determine and verify the accuracy of medical code assignments for diagnoses and procedures under DRGs and APCs.
This online resource contains the same Optum360 data hospitals have relied on for years with the most recent coding guidelines and recommendations to help coders be more effective and efficient.
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Features and benefits
- Optum360 Edge—Robust medical necessity checker and ABN generation tool. Use to screen physician orders and generate an advance beneficiary notice (ABN) to get the patient’s signature. This valuable tool can help hospitals decrease write-offs, improve and obtain revenue capture, decrease claim denials, automatically produce required forms for patients in advance of service, and help inform patients for point-of-care decision making.
- ICD-10-PCS Code Builder. Learn the complexities of the new coding system while you identify codes. This intuitive electronic format helps you understand the relationships between root operation, body system and section. Definitions and guidelines provide insight to get you up to speed and ready for the new coding system.
- Updated Outpatient Calculator. Outpatient Calculator gives you an accurate outpatient APC payment rate based on your hospital specific criteria.
- Search for the latest CPT®, HCPCS Level II, ICD-9-CM/ICD-10, and revenue codes, modifiers, and code-specific reference data using acronyms, abbreviations, or medical terms. Your facility will be up-to-date on all code sets and rules pertaining to hospital inpatient and outpatient services.
- Code search results are provided at the highest level of specificity. Includes commonly used abbreviations linked to codes like MRSA, IUGR, and NEC—just look up the abbreviation and get the meaning and the code in one step.
- Understand Medicare coding and billing guidelines as they apply to Medicare Part A hospital services. CPT and HCPCS Level II codes are linked directly to Pub.100 references, CMS transmittals, and medical necessity rules (LCDs and NCDs). These tools will help you maintain coding compliance by providing the necessary validation for coding hospital inpatient and outpatient services, supplies, and drugs.
- Access information from top-selling Optum360 DRG products, such as the DRG Expert and DRG Desk Reference. With a click of your mouse, you will be able to identify new ICD-9-CM/ICD-10 codes, the DRGs they group to, all ICD-9-CM/ICD-10 codes associated with each MDC and DRG, detailed DRG, RW and length of stay information, transfer DRGs, and DRGs that may be optimized. Guidelines are designed specifically for improving hospital reimbursement and financial forecasting and alerting the facility to possible coding problems.
- Make sure you are using CPT, HCPCS Level II, and ICD-9-CM/ICD-10 codes correctly. Lay descriptions, code book annotations, images, and Optum360 proprietary content will help you make sure that the procedure, drug, item, and diagnosis codes submitted on claims are valid, accurately assigned, and appropriately linked.
- Easily find and resolve inpatient and outpatient edits using one source. Edit icons identify facility PPS edits—outpatient OCE, MUEs, device code edits, hospital CCI edits, and all inpatient MCE edits. Plus, clear edit explanations and edit resolution tips help you resolve them. Understanding how to resolve claim edits is one of the keys to improving your denial management process.
- Link clinical code sets to billing and payment information. Help your staff make the correct coding decisions and increase the efficiency across every revenue cycle department.
- Improve coordination and problem-solving among key revenue cycle departments such as HIM, CDM, PFS, and admitting. This will help improve revenue capture and accelerate cash flow.
- Cross-coding relationships. Quickly link to codes that are unique to hospital billing, codes used with specific revenue codes, interventional radiology codes, and related surgical procedures.
- Exclusive code crosswalks, links, and coding tips simplify the research process and increase productivity. Crosswalk from ICD-9-CM/ICD-10 procedure codes to CPT or HCPCS Level II procedure codes; ICD-9-CM/ICD-10, CPT, and HCPCS Level II codes to Medicare inpatient, outpatient, and device code edits; clinical codes to CCI, OCE and MCE edits, modifiers, revenue codes, coverage and related procedures, and CPT or HCPCS Level II codes to revenue codes.
- ICD-9-CM to ICD-10-CM and ICD-10-PCS Mapping. Simple mapping capabilities and complex combination mapping information for diagnosis and procedural information enables users to get a head start on learning the new ICD-10 coding system. Identifies GEM and Optum360-recommended mappings, as well as Optum360 proprietary MapSelects. Optum360 ICD-10 MapSelects utilizes GEMs, the ICD-10 CM/PCS index and tabular documents, and clinical and coding expertise to identify the most relevant ICD-9 to ICD-10 crosswalk code.
The price of FacilityCoder.com Expert does not include add-ons. Add-ons sold separately:
- AHA Coding Clinic for HCPCS Add-on (Item WA03) $125 per user, per year
- AHA Coding Clinic for ICD Add-on (Item WA02) $250 per user, per year
- Coders’ Dictionary Add-on (Item WA05) $75 per user, per year
- CPT® Assistant Add-on (Item WA01) $250 per user, per year
- CPT Changes: An Insider’s View Add-on (Item WA27) $199 per user, per year
- Dr. Z's Medical Coding Series: Interventional Radiology Add-on (WA30 and WA31) $350 and up per user, per year
- Stedman’s Dictionary Add-on (Item WA04) $125 per user, per year
CPT is a registered trademark of the American Medical Association.
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