Health Information Management

CMS updates I/OCE edit 84

APCs Insider, March 29, 2013

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

As part of the April update to the Integrated Outpatient Code Editor (I/OCE), CMS is revising the logic behind edit 84 (Claim lacks required primary code [return to provider]).

In the January release, CMS set up the edit with these five CPT add-on codes:
  • 33225, insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator [including upgrade to dual-chamber system] [list separately in addition to code for primary procedure]
  • 90785, psychotherapy, complex interactive
  • 90833, psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for the primary procedure)
  • 90836, psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for the primary procedure)
  • 90838, psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service (List separately in addition to the code for the primary procedure)
CMS added the four psychotherapy codes in January. These four codes were only supposed to trigger edit 84 on an outpatient hospital claim when they were billed with bill type 013x and condition code 41 or bill type 076x. For the first quarter of 2013, edit 84 worked fine for revenue code 076x, but would surface whenever bill type 013x was use, regardless of the condition code.
 
CMS corrected this problem for the April update.



Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular