Medicare contractors received updated instructions and specifications in December for the January 2012 Integrated Outpatient Code Editor (IOCE). They’ll use version 13.0 to edit claims paid under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, and for all non-OPPS providers; and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness.
The update includes a number of ambulatory payment classifications (APCs) and HCPCS Level II and CPT® code changes, most of which are effective Jan. 1, 2012, and all of which outpatient facilities should be aware.
APC Changes
There are 28 new APCs, 25 deleted APCs, 26 APCs with description changes, and 15 APCs with status indicator changes.
New APCs range from 00331 Combined abdomen and pelvis CT without contrast to 09366 EpiFix wound cover.
Deleted APCs begin with 00245 Level I cataract procedures without IOL insert and end with 09364 Porcine implant, Permacol.
Many of the description changes to APCs are meant to enhance specificity and some greatly change the meaning of the code. Here are a few examples:
| APC |
Old Description |
New Description |
| 00040 |
Percutaneous implantation of neurostimulator electrodes |
Level I implantation/revision/replacement of neurostimulator electrodes |
| 00061 |
Laminectomy, laparoscopy, or incision for implantation of neurostimulator electrodes |
Level II implantation/revision/replacement of neurostimulator electrodes |
| 00083 |
Coronary or non-coronary angioplasty and percutaneous valvuloplasty |
Coronary angioplasty, valvuloplasty, and level I endovascular revascularization of the lower extremity |
Other description changes have little or no effect. For example:
| APC |
Old Description |
New Description |
| 00831 |
Ifosfomide injection |
Ifosfamide injection |
| 09273 |
Sipleucel-T auto CD54+ |
Sipuleucel-T auto CD54+ |
| 09282 |
Injection, ceftaroline fosamil |
Inj, ceftaroline fosamil |
| 09284 |
Injection, ipilimumab |
Ipilimumab injection |
As for status indicator changes: With the exception of APC 00668, which went from ‘S’ to ‘T,’ APCs 01236, 01238, 01290, 01296, 01297, 09249, 09250, 09251, 09252, 09253, 09255, 09256, 09360, and 09363 went from a status indicator of ‘G’ to ‘K.’
Code Changes
Added to the January I/OCE are six HCPCS Level II ‘G’ codes for preventive screening services. The following codes are effective Oct. 1, 2011:
| HCPCS |
Code Description |
SI |
APC |
| G0442 |
Annual alcohol screen 15 min |
S |
00432 |
| G0443 |
Brief alcohol misuse counsel |
S |
00432 |
| G0444 |
Depression screen annual |
S |
00432 |
| G0445 |
High inten beh couns STD 30m |
S |
00432 |
| G0446 |
Intens behave ther cardio dx |
S |
00432 |
| G0447 |
Behavior counsel obesity 15m |
S |
00432 |
| |
|
|
|
|
Deleted from the IOCE, effective July 1, 2011 is HCPCS Level II code S3628 PAMG-1 rapid assay for ROM.
For the complete list of HCPCS Level II and CPT® procedure codes that are either added or deleted effective Jan. 1, 2011, and for description and status indicator changes and other code edits, please see the Centers for Medicare & Medicaid Services’ (CMS) Transmittal 2370.
December 30th, 2011
The annual updated version of the National Correct Coding Initiative (NCCI) policy manual for Medicare services will be effective Jan. 1, 2012, rather than Oct. 1, 2011. This manual will be posted on the NCCI website on or around Dec. 1, 2011.
CMS posts changes to each of its NCCI and Medically Unlikely Edit (MUE) edit files on a quarterly basis. Download a test file of Version 18.0, effective Jan. 1, 2012, from the National Correct Coding Initiative Edits Quarterly NCCI and MEU Version Update Changes page on the Centers for Medicare & Medicaid Services (CMS) website. The final file will be available “on or about” Nov. 17, according to CMS Transmittal 2322.
Visit the National Correct Coding Initiative Edits Overview page on the CMS website for more information about NCCI.
October 28th, 2011
Checking the National Correct Coding Initiative (NCCI) website regularly for allowable code combinations helps eliminate questions like the following, asked at the Oct. 6 NHIC, Corp. Mental Health Services Virtual Room/Teleconference:
“Can CPT 90862 be provided on the same day as individual therapy?”
(more…)
November 29th, 2010
Independent and provider-based home health agencies (HHAs) will soon need to be more diligent about certain information listed on claims when billing for services provided to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) has instructed regional home health intermediaries (RHHIs) to implement expanded edits beginning Jan. 1, 2011.
(more…)
September 10th, 2010
Beginning with the April 2010 update, the Centers for Medicare & Medicaid Services (CMS) now posts the National Correct Coding Initiative (NCCI) Edit files in Microsoft Excel 2007 and in text formats. Because Excel 2007 can support a larger number of rows, each code range is contained in one file as opposed to multiple files.
This should correct the incompatibility issues that some users experienced last quarter with the Excel 2003 files. Please be aware that Excel 2003 and earlier versions of the software have a maximum row count of 65,536. Some of the NCCI Edit files exceed the maximum row count. If you do not have Excel 2007, you should use the text format to import the data into an application that can support larger files.
More information on NCCI edits and download files are on the CMS website.
Source: NHIC, Corp. July 2010 J14 A/B MAC Resource
July 30th, 2010