Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2468 Date: May 11, 2012

Transcription

1 anual ystem Pub edicare laims Processing Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 2468 Date: ay 11, 2012 hange equest 7841 UBJET: July 2012 ntegrated Outpatient ode Editor (/OE) pecifications Version UY OF HNGE: This notification provides the ntegrated OE instructions and specifications for the ntegrated OE that will be utilized under the OPP and Non-OPP for hospital outpatient departments, community mental health centers, and for all non-opp providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment ystem or to a hospice patient for the treatment of a non-terminal illness. This ecurring Update Notification applies to hapter 4, ection EFFETVE DTE: July 1, 2012 PLEENTTON DTE: July 2, 2012 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D HPTE / ETON / UBETON / TTLE N/. FUNDNG: For Fiscal ntermediaries (Fs), egional Home Health ntermediaries (HHs) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

2 V. TTHENT: ecurring Update Notification *Unless otherwise specified, the effective date is the date of service.

3 ttachment ecurring Update Notification Pub Transmittal: 2468 Date: ay 11, 2012 hange equest: 7841 UBJET: July 2012 ntegrated Outpatient ode Editor (/OE) pecifications Version 13.2 Effective Date: July 1, 2012 mplementation Date: July 2, GENEL NFOTON. Background: This instruction informs the Fiscal ntermediaries (Fs), /B s, HHs and the Fiscal ntermediary hared ystem (F) that the /OE was updated for July 1, The /OE routes all institutional outpatient claims (which includes non-opp hospital claims) through a single integrated OE which eliminates the need to update, install, and maintain two separate OE software packages on a quarterly basis. B. Policy: This notification provides the ntegrated OE instructions and specifications for the ntegrated OE that will be utilized under the OPP and Non-OPP for hospital outpatient departments, community mental health centers, all non-opp providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment ystem or to a hospice patient for the treatment of a nonterminal illness. The /OE specifications will be posted to the Website and can be found at BUNE EQUEENT TBLE Number equirement esponsibility (place an X in each applicable column) / D F hared- ystem OTHE B E aintainers The hared ystem aintainer shall install the ntegrated OE (/OE) into their systems edicare contractors shall identify the /OE specifications on the Website at E H H F X X X X X V W F. POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column)

4 provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. / B D E F E H H X X X hared- ystem aintainers F V W F OTHE V. UPPOTNG NFOTON. For any recommendations and supporting information associated with listed requirements, use the box below: X-ef equirement Number N/ ecommendations or other supporting information: B. For all other recommendations and supporting information, use this space: 5344, Transmittal 1107: Notification of an ntegrated Outpatient ode Editor (OE) for the July 2007 elease V. ONTT Pre-mplementation ontact(s): Yvonne Young at yvonne.young@cms.hhs.gov or nita ntkowiak at nita.ntkowiak2@cms.hhs.gov For Policy related questions contact arina Kushnirova at marina.kushnirova@cms.hhs.gov Post-mplementation ontact(s): ontact your ontracting Officer s epresentative (O) or ontractor anager, as applicable. V. FUNDNG

5 . For Fiscal ntermediaries (Fs), egional Home Health ntermediaries (HHs) and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. B. For edicare dministrative ontractors (s): The edicare dministrative ontractor () is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as changes to the tatement of Work (OW). The contractor is not obligated to incur costs in excess of the amounts specified in your contract unless and until specifically authorized by the contracting officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the contracting officer, in writing or by , and request formal directions regarding continued performance requirements. TTHENT: ummary of Data hanges ppendix ummary of odifications

6 ppendix ummary of odifications The modifications of the OE for the July 2012 release (V13.2) are summarized in the table below. eaders should also read through the entire document and note the highlighted sections, which also indicate changes from the prior release of the software. ome OE modifications in the update may also be retroactively added to prior releases. f so, the retroactive date will appear in the 'Effective Date' column. # Type Effective Edits odification Date ffected 1. Logic 7/1/12 24 odify the software to maintain 28 prior quarters (7 years) of programs in each release. emove older versions with each release. (The earliest version date included in this July 2012 release will be 10/1/ Logic 10/1/11 - pply Payment djustment Flag PF 9 (Deductible/o-insurance not applicable) to any claim lines when modifier Q3 is present on the line 3. Logic 10/1/05 19, 39 Deactivate edits described as mutually exclusive retroactive to earliest non-archived version. (utually exclusive N edits retroactively merged with code1/code2 edits). 4. Logic 4/1/12 - dd skin substitute codes 9368, 9369, Q4123, Q4125, Q4128 & Q4129 to the skin substitute logic. 5. ontent 7/1/12 - ake HP/P/ changes as specified by (data change files). 6. ontent 7/1/12 20, 40 mplement version 18.2 of the N (as modified for applicable institutional providers). [ll edits combined in a single file, in code1/code2 format; mutually exclusive pairs no longer differentiated]. 7. ontent 1/1/12 71, 77 Update procedure/device and device/procedure edit requirements. 8. ontent 1/1/12 84 Update the list of primary procedures reportable with dd-on code 33225: emove dd 33228, 33229, & ontent 7/1/12 85 Update the device code used for edit 85 replace deleted code 9732 with new code 0308T. 10. Doc 7/1/12 - reate 508-compliant versions of the specifications & ummary of Data hanges documents for publication on the web site. 11. Other 7/1/12 - Deliver quarterly software updates & all related documentation and files to users via electronic means.

7

8 FNL ummary of Data hanges ntegrated OE v 13.2 Effective July 1,

9 Table of ontents PT codes, descriptions, and material only are opyright 2011 merican edical ssociation. ll ights eserved. No fee schedules, basic units, relative values, or related listings are included in PT. The assumes no liability for the data contained herein. pplicable F/DF restrictions apply to government use. DEFNTON... 3 P HNGE... 4 dded Ps... 4 Deleted Ps... 4 P Description hanges... 4 HP/PT POEDUE ODE HNGE... 5 dded HP/PT Procedure odes... 5 Deleted HP/PT Procedure odes... 6 HP Description hanges... 6 HP hanges- P, tatus ndicator and/or Edit ssignments... 6 Edit ssignments... 7 Procedure/ Device Pair hanges... 7 Device/Procedure Pair hanges... 7 dd-on/primary Procedure Pair hanges... 8 kin ubstitute Product hanges

10 DEFNTON blank in a field indicates no change The old column describes the attribute prior to the change being made in the current update, which is indicated in the new column. f the effective date of the change is the same as the effective date of the new update, old describes the attribute up to the last day of the previous quarter. f the effective date is retroactive, then old describes the attribute for the same date in the previous release of the software. Unassigned, Pre-defined or Placeholder in P or HP descriptions indicates that the P or HP code is inactive. When the P or HP code is activated, it becomes valid for use in the OE, and a new description appears in the new description column, with the appropriate effective date. ctivation Date (ctivdate) indicates the mid-quarter date of FD approval for a drug, or the mid-quarter date of a new or changed code resulting from a National overage Determination (ND). The ctivation Date is the date the code becomes valid for use in the OE. f the ctivation Date is blank, then the effective date takes precedence. Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. code is not valid for use in the OE after its termination date. For codes with of Q1, Q2, and Q3, the P assignment is the standard P to which the code would be assigned if it is paid separately. 3

11 P HNGE dded Ps The following P(s) were added to the OE, effective P PDesc tatusndicator nthrax vaccine sc or im K inocycline hydrochloride K Nabilone oral K Thiethylperazine maleate K lloskin K rthroflex K Flexhd or allopatch hd K Unite biomatrix K The following P(s) were added to the OE, effective P PDesc tatusndicator Human fibrinogen conc inj K flibercept injection G mported Lipodox inj K Grafix core G Grafix prime G Deleted Ps The following P(s) were deleted from the OE, effective P PDesc nj heparin sodium per 10 u nj heparin sodium per 1000u The following P(s) were deleted from the OE, effective P PDesc Human fibrinogen conc inj njection, aflibercept P Description hanges The following P(s) had description changes, effective P Old Description New Description nj, bupivicaine liposome nj, bupivacaine liposome 4

12 The following P(s) had description changes, effective P Old Description New Description Doxorubicin hcl liposome inj Doxil injection HP/PT POEDUE ODE HNGE dded HP/PT Procedure odes The following new HP/PT code(s) were added to the OE, effective HP odedesc P Edit ctivdate TermDate G8907 Pt doc no events on discharg G8908 Pt doc w burn prior to D/ G8909 Pt doc no burn prior to D/ G8910 Pt doc to have fall in G8911 Pt doc no fall in G8912 Pt doc with wrong event G8913 Pt doc no wrong event G8914 Pt trans to hosp post D/ G8915 Pt not trans to hosp at D/ G8916 Pt w V B given on time G8917 Pt w V B not given on time G8918 Pt w/o preop order V B pro The following new HP/PT code(s) were added to the OE, effective HP odedesc P Edit ctivdate TermDate 0302T car ischm mntrng sys compl T T car ischm mntrng sys eltrd T T car ischm mntrng sys device T T car ischm mntrng prgrm eval T car ischm mntrng interr eva T mvl icar ischm mntrng dvce T T nsj ocular telescope prosth T Grafix core G Grafix prime G Q2034 griflu vaccine L Q2045 Human fibrinogen conc inj K Q2046 flibercept injection G Q2047 Peginesatide injection Q2048 Doxil injection K Q2049 mported Lipodox inj K ometasone sinus implant E

13 Deleted HP/PT Procedure odes The following HP/PT code(s) were deleted from the OE, effective HP odedesc 9291 njection, aflibercept 9732 nsert ocular telescope pros HP Description hanges The following code descriptions were changed, effective HP Old Description New Description Harvest allogenic stem cells Harvest allogeneic stem cell nsert uteri tandems/ovoids nsert uteri tandem/ovoids /membane diffuse capacity 0 diffuse capacity The following code descriptions were changed, effective HP Old Description New Description 9290 nj, bupivicaine liposome nj, bupivacaine liposome The following code descriptions were changed, effective HP Old Description New Description 0206T emote algorithm analys ecg Pptr dbs alys car elec dta HP hanges- P, tatus ndicator and/or Edit ssignments The following code(s) had an P and/or and/or edit change, effective ** blank in the field indicates no change. HP odedesc Old P New P Old New Old Edit New Edit G9148 edical Home Level N/ 72 G9149 edical Home Level N/ 72 G9150 edical Home Level N/ 72 G9151 PP demo tate N/ 72 G9152 PP demo community N/ 72 G9153 PP demo physician N/ 72 The following code(s) had an P and/or and/or edit change, effective ** blank in the field indicates no change. HP odedesc Old P New P Old New Old Edit New Edit J1642 nj heparin sodium per 10 u K N J1644 nj heparin sodium per 1000u K N 6

14 The following code(s) had an P and/or and/or edit change, effective ** blank in the field indicates no change. HP odedesc Old P New P Old New Old Edit New Edit nthrax vaccine sc or im E K 9 N/ J2265 inocycline hydrochloride E K 9 N/ J8650 Nabilone oral E K 9 N/ Q0174 Thiethylperazine maleate10mg E K 9 N/ Q4123 lloskin E K 9 N/ Q4125 rthroflex E K 9 N/ Q4128 Flexhd or allopatch hd E K 9 N/ Q4129 Unite biomatrix E K 9 N/ The following code(s) had an P and/or and/or edit change, effective ** blank in the field indicates no change. HP odedesc Old P New P Old New Old Edit New Edit J1680 Human fibrinogen conc inj K E N/ 28 J9001 Doxorubicin hcl liposome inj K E N/ 28 Edit ssignments The following code(s) were removed from the independent bilateral list, effective HP The following code(s) were added to the inherently bilateral list, effective HP Procedure/ Device Pair hanges The following procedure/device code pair requirements were added, effective Proc Device Device/Procedure Pair hanges The following device/procedure code pair requirements were added, effective Device Proc

15 dd-on/primary Procedure Pair hanges The following add-on/primary procedure pair requirements were added, effective ddon Primary The following add-on/primary procedure pair requirements were removed, effective ddon Primary kin ubstitute Product hanges The following code(s) were added to the skin substitute product list, effective HP Q4123 Q4125 Q4128 Q4129 The following code(s) were added to the skin substitute product list, effective HP