MIR-2007 04A, April 2007

April 2007 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 8.1 (MM5522)

Provider Types Affected
Providers submitting claims to Medicare fiscal intermediaries (FI), Part A/B Medicare Administrative Contractors (A/B MAC), and/or Regional Home Health Intermediaries (RHHI) for services provided to Medicare beneficiaries and paid under the OPPS

Provider Action Needed
This article is based on Change Request (CR) 5522 which informs the FIs and A/B MACs that the April 2007 OPPS OCE specifications have been updated with new additions, deletions, and changes. It provides the revised OPPS OCE instructions and specifications that will be utilized under the OPPS for hospital outpatient departments, community mental health centers (CMHCs), and limited services provided in a home health agency (HHA) not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness.

Background
Full details of Version 8.1 of the OPPS OCE are contained in CR5522 and will not be repeated in this article; especially since many of the details are not changing, and providers paid under the OPPS are likely to be familiar with these details. The modifications of the Outpatient Code Editor/Ambulatory Patient Classification (OCE/APC) for the April 2007 release (V8.1) are summarized in the following table:

You may also want to review the specifications in the official instruction (CR 5522) issued to your intermediary, and note the highlighted sections, which also indicate changes from the prior release of the software. Some OCE/APC modifications in the release may also be retroactively added to prior releases. If so, the retroactive date appears in the “Effective Date” column in the above table.

Additional Information
The official instruction, CR5522, issued to your intermediary, RHHI, and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1198CP.pdf on the CMS Web site.

If you have any questions, please contact your Medicare intermediary, RHHI, or A/B MAC at their toll-free number, which may be found on the CMS Web site at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip .

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM5522
Related Change Request (CR) #: 5522
Related CR Release Date: March 9, 2007
Effective Date: April 1, 2007
Related CR Transmittal #: R1198CP
Implementation Date: April 2, 2007

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It’s Not Too Late to Give and Get the Flu Shot!
The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.pdf .