Health Information Management

New OCE does more than edit

APCs Insider, August 27, 2003

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August 22, 2003
Vol. 4, No. 33


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Keith Siddel,
MBA, PhD (c),
president, CEO
HRM, Hospital Resource Management

Andrea Clark
Health Revenue Assurance Associates

Cheryl D'Amato,
director, health information management
HSS, Inc.

Julie Downey,
ambulatory coding coordinator, HIM
University Colorado Hospital

Carole Gammarino,

Julia R. Palmer
president, Health Information Management Division

Valerie Rinkle, MPA,
revenue cycle director
Asante Health System




New OCE does more than edit

In order to handle claims with service dates that span more than one calendar day, the October OCE version V4.3 will process claims with multiple days of services, and provide additional information about errors.

The original OCE focused only on the presence or absence of specific edits and did not suggest any solution to the edits. It was structured to return a set of flags for each diagnosis and procedure to specify the presence or absence of individual edits. The revised OCE identifies individual errors, points out ways to fix them, and explains why these actions are necessary, according to PM A-03-069, published August 8, 2003.

The revised OCE needs to be installed by October 1, 2003. CMS will issue it before then, unless a notice of further delay is announced.

Starting with unprocessed claims with dates of service on or after August 1, 2000, the following bill types must be processed through the revised OCE:

  • All outpatient hospital Part B bills (bill types 12X, 13X, or 14X)

  • Community mental health center bills (bill type 76X)

  • Home health agency and comprehensive outpatient rehabilitation facility bills containing HCPCS codes for reporting antigens, hepatitis B vaccines, splints, and casts, such as bill types 34X or 75X

  • All bills containing a condition code 07, "treatment of non-terminal illness - hospice," that include HCPCS codes for reporting antigens, hepatitis B vaccines, splints and casts.

All other outpatient bill types with dates of service April 1, 2002, and later, (22X, 23X, 24X, 32X, 33X, 71X, 72X, 73X, 74X, 81X or 82X) should also be processed, as well as outpatient bill types 34X and 75X that contain services other than those listed above with dates of service April 1, 2002 and later.

Do not send claims from Indian Health Service hospitals, critical access hospitals (CAHs), hospitals located in American Samoa, Guam, Saipan, and the state of Maryland, or the Virgin Islands with dates of service January 1, 2002, and later, and claims from hospitals that furnish only inpatient Part B services with dates of service January 1, 2002, and later. They are all excluded from OPPS.

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TODAY'S TOPIC: Eye flush is included in E/M facility code

Question: A patient was seen in the ED after he spilled chemicals into his eye. The ED physician irrigated the eye with more than three liters of saline.

Can we assign CPT code 65205 for removal of foreign body (chemicals being the foreign body) or would the procedure be included in the facility E/M code?

Answer: The irrigation of the eye is included in the facility E/M visit code. CPT code 65205, "removal of superficial foreign body, external eye, conjunctival, superficial," is not appropriate in this instance because the eye is being flushed and no foreign body is actually being removed.

Although the CPT Assistant and Coder's Desk Reference do not define a foreign body, in practice it is considered as a solid object, such as a splinter of metal or wood. The descriptor for 65205 alludes to this, as it states, "The physician picks the foreign body or mineral deposit from the conjunctiva with the side of the beveled edge of a needle (e.g., 65205). A small incision may be required to remove an embedded foreign body (e.g., 65210)."

TIP OF THE WEEK: Explain the effects of poor documentation to physicians

Coding and Compliance Feature Article of the Month: Use official coding guidelines for general rules, create facility-specific guidelines for consistency

Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.

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