Health Information Management

Prepare for October OPPS OCE update

APCs Insider, September 16, 2005

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Prepare for October OPPS OCE update

QUESTION: I have heard that the October OPPS OCE (outpatient code editor) is out and that it contains some changes our hospital should be aware of. How should we prepare?

ANSWER: The October OPPS OCE contains seven significant changes. Click here: http://www.cms.hhs.gov/Manuals/pm_trans/R664CP.pdf to read the transmittal.

Here is a summary:

1. Additional transmission of modifiers. The OCE will allow you to transmit up to four modifiers. Currently OPPS only allows two.

2. Expansion of procedures that require mandatory devices. Procedures that require a mandatory C code for the devices will be returned to the provider (RTP) unless providers report the device with the procedure. Effective October 1, 2005, CMS will expand the device edit list to apply to more procedure codes for which the use of the device is essential to performing the procedure.

Review all procedures that require a C code device. CMS indicated some procedures may require more than one device, and therefore more than one C code. The procedure will be returned to the provider if you don't report both C codes. This includes procedures performed in the OR, cardiac catheter lab, and interventional radiology.

Review the excel spreadsheet click here: http://www.cms.hhs.gov/providers/hopps/default.asp. Click on the link for "October 2005 Proposed Device Code Edits" to read a complete list of procedures that require mandatory device coding. The link is near the bottom of the page.

3. No cost device billing clarification. CMS will require hospitals to report no cost devices with a $1.00 charge. Do not report these with a zero dollar charge.

4. New C code C9725: Placement of an endorectal intracavity applicator for high intensity brachytherapy.

5. New C code C2637: Brachytherapy source (Ytterbium -169 per source).

6. Review the drugs and biologicals category for updates.

7. Elimination of "exclusively bilateral list." Effective October 1, 2005, the presence or absence of modifier -50 on certain bilateral codes will not trigger edits 16 and 17. Note that providers should continue to use modifier -50 after the implementation date to identify separate and distinct procedures that are bilateral, and CMS will determine the appropriate payment for the procedure.



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