Match the following with the correct term or definition.
-Procedure codes identified by the Medicare Code Editor as Noncovered Operating Room Procedures for which Medicare does not provide reimbursement
A)Non-OR procedure affecting MS-DRG assignment
B)Limited coverage
C)Noncovered OR procedure
D)Valid OR procedure
E)Bilateral procedure

Question

Quizplus · Accepted Answer

Noncovered OR procedure refers to procedure codes that are identified by the Medicare Code Editor as noncovered operating room procedures for which Medicare does not provide reimbursement.

Answer: A 
 Non-OR procedure affecting MS-DRG assignment refers to procedure codes that are not performed in the operating room, but still affect the assignment of a patient's MS-DRG. Examples include laboratory tests or imaging studies.

Answer: B 
 Limited coverage refers to a situation where Medicare may cover a certain procedure or service, but only under specific circumstances or for certain patient populations.

Answer: D 
 Valid OR procedure refers to procedure codes that are performed in the operating room and are eligible for reimbursement by Medicare.

Answer: E 
 Bilateral procedure refers to a procedure that is performed on both sides of the body, such as bilateral hip replacements. Medicare provides a specific payment adjustment for bilateral procedures to account for the fact that both sides are being treated at once.

Match the Following with the Correct Term or Definition