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Non-OPPS outpatient code editor includes new additions, deletions, and changes

HIM Connection, September 26, 2005

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CMS updated the nonoutpatient prospective payment system code editor (non-OPPS OCE) version 21.0 to add new codes and delete others, according to Transmittal 644 dated August 12.

The transmittal

• adds new valid diagnosis codes
• deletes certain diagnosis codes (and removes the edits to which they were assigned)
• revises various short code descriptions
• adds and deletes some HCPCS procedure codes
• specifies additions and deletions to the list of ASC procedures and payment groups
• outlines additions to the nonreportable procedure list

The transmittal details various diagnosis edit modifications effective October 1, including:

• Adding 15 new diagnosis codes for newborns only
• Adding one existing code for newborns only
• Adding one new diagnosis code to the list of pediatric diagnoses (ages 0-17)
• Adding four new diagnosis codes to the list of maternity diagnoses (ages 12-55)
• Adding 18 new diagnosis codes to the list of adult diagnoses (ages 12-24)
• Adding nine new diagnosis codes to the list of diagnoses allowed for females only
• Removing two diagnosis codes from the list of diagnoses allowed for males only

Although most of these changes take effect October 1, be sure to read the transmittal carefully because some of the changes have other effective dates.

For more information and to see a complete list of the codes that CMS removed, added, and changed, view Transmittal 644.

Editor's note: This article was adapted from JustCoding.com, published by HCPro, Inc.

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