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CRIP, Section 5-2

Certified Revenue Integrity Professional - Recurring OP and Clinical Services

QuestionAnswer
What is a Condition Code? A code used on the UB-04 to identify conditions or events relating to the bill that may affect the processing of the claim.
When was it created and what does Condition Code 44 indicate? Created in 2004, it indicates that an IP admission order was changed to OP status. Only used when the phys initially ordered IP svcs but, upon further review of the pt b4 the claim was submitted, it was determined that the svcs did not meet IP criteria.
According to the MC Claims Processing Manual, in order to use Condition Code 44, the following conditions should be met: IP claim has not been submitted to CMS Phys from hospital's utilization review committee & attending phys determine IP admission is not nec decision is made b4 discharge decision & reason documented in med rec pt notified in writing prior to discharge
When using Condition Code 44, should observation hours be billed? Only if the physician orders observation.
What type of services should be billed if using a Condition Code 44? The entire episode of care should be billed as OP.
How should a surgery be billed if Condition Code 44 requirements are not met but the stay was changed from IP to OP? Only IP part B charges can be billed. MC requires: A 110 no-pay claim A 121 claim for charges within the admit and discharge dates a 131 claim for any charges previously added to the IP claim b/c of the 72 hour rule
Describe Radiation Oncology: Utilizes high-energy ionizing radiation in the treatment of malignant neoplasms and certain non-malignant conditions.
Radiation Oncology: what is a Bite Block? A restraining device usually used in the oral cavity and often attached to an outside source for patient stability.
Radiation Oncology: What is a Block? A device fabricated of an energy-absorbing material that is used to shape or delineates the treatment portal to match the configuration of the desired area; also used to shield or protect normal structures.
Radiation Oncology: What is Bolus: A tissue-equivalent material used to change the surface deposition of a radiation beam.
Radiation Oncology: Compensator: An irregular shaped beam-modifying device that is utilized to reconfigure the beam intensity to match any irregular tissue contours.
Radiation Oncology: Collimator: A beam-shaping device attached to the head of the treatment machine to define the initial configuration of the treatment portal.
Radiation Oncology: Dosimetry: The calculation of the radiation dose that is distributed within a treatment beam.
Radiation Oncology: Isodose: The plotting of lines or a series of lines following paths of the same dose distribution within a treatment beam.
Radiation Oncology: Port or Portal: Synonymous words referring to the site on the skin where the radiation beam enters the body.
Radiation Oncology: Portal Verification: The means of verifying the placement and configuration of the treatment portal.
Radiation Oncology: Stereotactic: A three-dimensional technique that has intersecting multiple portals which create a complex interaction of the treatment beams and isodose plans.
Radiation Oncology: Wedge: A treatment beam-modifying device that acts to change the intensity of the treatment beam.
Created by: Amy17349
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