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MLN Matters Number: MM5969 Related
Change Request (CR) #: 5969
Related CR Release Date: March 25, 2008 Effective
Date: April 1, 2008
Related
CR Transmittal #: R1483CP Implementation
Date: April 7, 2008
April 2008 Integrated Outpatient Code Editor (I/OCE) Specifications
Version 9.1
Provider Types Affected
All providers who submit institutional
outpatient claims (including non-OPPS hospitals) to Medicare Administrative
Contractors (A/B MAC), fiscal intermediaries (FI), or Regional Home Health
Intermediaries (RHHI) for services provided to Medicare beneficiaries
Impact on Providers
This article is
based on Change Request (CR) 5969 and notifies providers that I/OCE Specifications
Version 9.1, is effective April 1, 2008. Claims with dates of service prior
to July 1, 2007 are routed through the nonintegrated versions of the outpatient
code editor (OCE) software that coincide with the versions in effect for
the date of service on the claim.
Background
This article is based on
CR 5969 and informs providers that the I/OCE routes all institutional
outpatient claims (including non-outpatient prospective payment system hospital
claims) through a single integrated OCE eliminating the need to update,
install, and maintain two separate OCE software packages on a quarterly
basis. This
integration does not change the current logic that is applied to
outpatient bill types that already pass through the outpatient prospective
payment system (OPPS) OCE software. It
expands the software usage to include non-OPPS hospitals. The full
specifications for the I/OCE as well as detailed lists of the APC
(ambulatory payment classifications), HCPCS (health care common procedure
coding systems), CPT (Current Procedural Terminology) code changes, additions,
and deletions are attached to CR5969. The Web address for accessing CR5969
is in the Additional
Information section
of this article. Thus, we will not repeat all of those changes
in this article. However, the key changes in the Version 9.1 of
I/OCE are as follows:
Effective Date |
Edit |
Description of Change |
4/1/08 |
24 |
Modify the software to maintain/retain
28 prior quarters (seven years) of programs & codes in
each release. Remove older versions with each release.
(The earliest version date included in the April 2008
release will be 1/1/01). |
4/1/08
|
|
Modify appendix D of I/OCE Specifications
(attached to CR5969) to exempt codes with SI of “S” and “X” from
the conditional bilateral discounting. |
1/1/08
|
|
Change HCPCS APC to “0” in
the APC/ASC Return Buffer for all PH services on PHP claims. |
4/1/02 |
|
Add code 29086 to the list of
cast procedures (code list for Antigens, splints & Casts) |
1/1/08 |
|
Modify/correct list of codes
identified as partial hospitalization services for PHP claims |
1/1/08
|
|
Bypass edit 48 for rev code
0637. Assign edit 50 when submitted without a HCPCS code.
Apply to OPPS & Non-OPPS claims. |
Effective Date |
Edit |
Description of Change |
|
|
Make HCPCS/APC/SI changes as
specified by CMS |
|
19, 20, 39, 40
|
Implement version 14.0 of
the NCCI (National Correct Coding Initiative) file, removing
all code pairs which include Anesthesia (00100-01999), E&M
(92002-92014, 99201-99499), or MH (90804-90911). |
1/1/07 |
22 |
Add new (genetic testing) modifier
(8C) to the valid modifier list. |
|
|
Modify description of PHP code
lists in appendix C - to include all PH services in list
B, and make list A a subset of list B. |
1/1/08 |
78 |
Update nuclear medicine/radiopharmaceutical
edit requirements. |
1/1/08 |
71 |
Update procedure/device edit
requirements. |
1/1/08
|
|
Remove ASC procedure list – no
longer needed to identify claims to be processed as 83X TOB. |
|
|
Added explanatory paragraphs,
re antigens/splints/casts & CCI editing to the specifications
document. Add appendix N, for requested code listings. |
Additional Information
For complete details regarding
this CR please see the official instruction (CR5969) issued to
your Medicare FI, A/B MAC, or RHHI. That instruction may be viewed
by going to http://www.cms.hhs.gov/Transmittals/downloads/R1483CP.pdf  on
the Centers for Medicare & Medicaid Services (CMS) Web site.
To review the Outpatient Code Editor (OCE) website you may refer to: http://www.cms.hhs.gov/OutpatientCodeEdit/  on
the CMS Web site.
If you have questions, please contact your Medicare FI, A/B MAC, or RHHI
at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on
the CMS Web site.
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. CPT only copyright 2007 American Medical Association.
News Flash - The Hospital Outpatient Prospective Payment
System Fact Sheet (revised January 2008), which provides general
information about the Hospital Outpatient Prospective Payment System,
ambulatory payment classifications, and how payment rates are set, is now
available in print format from the Centers for Medicare & Medicaid Services
Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/ ,
scroll down to “Related Links Inside CMS” and select “MLN
Product Ordering Page.”
News Flash - It’s Not Too Late to Give and Get the
Flu Shot! In the U.S., the peak of flu season typically occurs
anywhere from late December through March; however, flu season can last
as late as May. Each office visit presents an opportunity for you to talk
with your patients about the importance of getting an annual flu shot and
a one time pneumococcal vaccination. Protect yourself, your patients, and
your family and friends by getting and giving the flu shot. Don’t
Get the Flu. Don’t Give the Flu. Get Vaccinated! Remember - Influenza
and pneumococcal vaccinations and their administration are covered Part
B benefits. Note that influenza and pneumococcal vaccines are NOT Part D
covered drugs. You and your staff can learn more about Medicare’s
coverage of adult immunizations and related provider education resources,
by reviewing Special Edition
MLN Matters article SE0748 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0748.pdf on
the CMS Web site.
Posted: 04/04/2007
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