MLN
Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare &
Medicaid Services) |
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Part A Information
MLN Matters Number: MM6080
Related Change Request (CR) #: 6080
Related CR Release Date: May 30, 2008
Effective Date: July 1, 2008
Related CR Transmittal #: R1523CP
Implementation Date: July 7, 2008
July 2008 Integrated
Outpatient Code Editor (I/OCE) Specifications Version 9.2
Provider Types Affected
Providers submitting claims to Medicare contractors
(fiscal intermediaries (FI), Regional Home Health Intermediaries
(RHHI), and/or Part A/B Medicare Administrative Contractors
(A/B MAC)) for outpatient services provided to Medicare beneficiaries
Provider Action Needed
This article is based on Change Request (CR) 6080 which provides
the Integrated OCE instructions and specifications for the
July, 2008, I/OCE that will be used for processing Outpatient
Prospective Payment System (OPPS) and Non-OPPS claims from
hospital outpatient departments, community mental health centers
(CMHC), and for all non-OPPS providers, and for limited services
when 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
Change Request (CR) 6080 informs providers and the fiscal
intermediaries (FI) and A/B MACs that the I/OCE is updated
for July 1, 2008. The I/OCE routes all institutional outpatient
claims (which includes non-OPPS through a single integrated
OCE eliminating the need to update, install, and maintain
two separate OCE software packages on a quarterly basis.
Claims with dates of service prior to July 1, 2007 are routed
through the non-integrated versions of the OCE software (OPPS
and non-OPPS OCE) that coincide with the versions in effect
for the date of service on the claim.
CR 6080 provides the I/OCE instructions and specifications
that will be utilized under the OPPS and Non-OPPS for hospital
outpatient departments, community mental health centers (CMHC),
and for all non-OPPS providers, and for limited services when
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. The I/OCE instructions
are attached to CR 6080 and will also be posted at http://www.cms.hhs.gov/OutpatientCodeEdit/
on the Centers for Medicare & Medicaid Services (CMS)
Web site.
CR 6080 also includes as an attachment with detailed lists
of the ambulatory payment classifications (APC), health care
common procedure coding systems (HCPCS), and Current Procedural
Terminology (CPT) code changes, additions, and deletions.
We will not repeat all of those changes in this article. However,
the key modifications of the OCE for the July 2008 release
(V9.2) are summarized in the table below.
In the table note that:
- Highlighted sections indicate change from the prior release
of the software; and
- Some I/OCE modifications in the release may also be retroactively
added to prior releases. If so, the retroactive date will
appear in the 'Effective Date' column.
| Effective Date |
Edit |
Summary of Change |
| 7/1/08 |
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 July 2008 release
will be 4/1/01).
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| 7/1/08 |
50 |
Change disposition for edit 50 to RTP (Return to Provider).
Note: The IOCE change to RTP this claim will no longer
trigger an initial determination. The provider should
bill statutorily excluded services as noncovered and affix
liability with the GY modifier (beneficiary liable).
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| 4/1/01 |
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Exclude denied or rejected lines from PHP (Partial Hospitalization
Program) processing and from Daily Mental Health assignment
criteria |
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Make HCPCS/APC/SI changes as specified by CMS |
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19, 20, 39, 40 |
Implement version 14.1 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). |
| 1/1/08 |
17 |
Remove codes 92621 and 92627 from the Inherently bilateral
list – change bilateral indicator to “0.” |
| 7/1/08 |
15 |
Change all max units to zero for all codes that currently
have max unit values other than zero. |
| 1/1/08 |
78 |
Update nuclear medicine/radiopharmaceutical edit requirements
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| 7/1/08 |
71/77 |
Update procedure/device edit requirements |
| 7/1/08 |
22 |
Add new modified CG (“Policy criteria applied”) to the
valid modifier list. |
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Documented some ‘general programming notes’ that were
in effect but not previously documented |
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Documented the exclusion of denied or reject lines from
composite criteria |
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Clarified the text in appendix D that includes some
non-type T procedures in bilateral procedure discounting. |
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Modify description for SI “H” – “Pass-through device
categories” |
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Modify description for SI “K” – Non pass-through drugs
and biologicals, therapeutic radiopharmaceutical, brachytherapy
sources, blood and blood products |
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Create a 508 Compliant version of the document (modify
as necessary) – for publication on CMS Web site |
Additional Information
The official instruction, CR 6080, issued to your FI, RHHI,
and A/B MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1523CP.pdf
on the CMS Web site.
If you have any questions, please contact your FI, RHHI,
or A/B MAC 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.
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