CMS Manual System

1 CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 1150 Date: JANUARY 10, 2007 Change Request 5437 NOTE: Transmittal 1128, dated December 15, 2006, is rescinded and replaced with Transmittal 1150, dated January 10, 2007. The following codes were removed from the Non-Reportable List A4461, A4463, 77051, 77052, 77055, 77056, and 77057. All other information remains the same. SUBJECT: January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version I.

2 SUMMARY OF CHANGES: This instruction is to inform the fiscal intermediaries that the January 2007 Non-OPPS OCE specifications Version have been update with new additions, deletions, and changes. NEW / REVISED MATERIAL EFFECTIVE DATE: January 1, 2007 IMPLEMENTATION DATE: January 2, 2007 Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material. Any 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.

3 II. CHANGES IN Manual INSTRUCTIONS: (N/A if Manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D Chapter / Section / Subsection / Title N/A III. FUNDING: No additional funding will be provided by CMS; Contractor activities are to be carried out within their FY 2007 operating budgets. IV. ATTACHMENTS: Recurring Update Notification *Unless otherwise specified, the effective date is the date of service. Attachment - Recurring Update Notification Pub. 100-04 Transmittal: 1150 Date: January 10, 2007 Change Request: 5437 NOTE: Transmittal 1128, dated December 15, 2006, is rescinded and replaced with Transmittal 1150, dated January 10, 2007.

4 The following codes were removed from the Non-Reportable List A4461, A4463, 77051, 77052, 77055, 77056, and 77057. All other information remains the same. SUBJECT: January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version Effective Date: January 1, 2007 Implementation Date: January 2, 2007 I. GENERAL INFORMATION A. Background: The Non-OPPS OCE has been updated with any new additions, changes, and deletions to Healthcare Common Procedure Coding System /Current Procedural Terminology (HCPCS/CPT) codes.

5 This OCE is used to process bills from hospitals not paid under the OPPS. B. Policy: The following changes were made to version of the Non-OPPS OCE. Technical Modifications Replace the MS-DOS interactive user interface with a modified version of the 32 bit OCE/APC Windows GUI (see OCE/APC API/product specifications for the PC platform). Expand the size of the ASC payment group field from 1 byte to two bytes to accommodate the expanded number of ASC pricer groups. Replace ASC Payment Group numbers with ASC PRICER Group numbers in the OCE program and User Manual for the PC platform.

6 Clinical Specifications Overview OCE includes the following clinical changes: Addition, deletion and revision of HCPCS/CPT procedure codes Revised ASC payment group assignments Revised code lists for the Medicare Outpatient Code Edits Code Descriptions: Update the Code Description Database with the same codes and descriptions used for OPPS OCE o New HCPCS/CPT Procedure Codes, effective 1/1/07: HCPCS Description 00625 Anes spine tranthor w/o vent 00626 Anes, spine transthor w/vent 0162T Anal program gast neurostim 0163T Lumb artif diskectomy addl 0164T Remove lumb artif disc addl 0165T Revise lumb artif disc addl 0166T Tcath vsd close w/o bypass 0167T Tcath vsd close w bypass 0168T Rhinophototx light app bilat 0169T Place stereo cath brain 0170T Anorectal fistula plug rpr 0171T Lumbar spine proces distract 0172T Lumbar spine proces addl 0173T Iop monit io pressure 0174T Cad cxr with interp 0175T Cad cxr remote 0176T Aqu canal dilat w/o retent 0177T Aqu canal dilat w retent

7 0505F Hemodialysis plan doc'd 0507F Periton dialysis plan doc'd 1040F Dsm-IV info mdd doc'd 1050F History of mole changes 1055F Visual funct status assess 15002 Wnd prep, ch/inf, trk/arm/lg 15003 Wnd prep, ch/inf addl 100 cm 15004 Wnd prep ch/inf, f/n/hf/g 15005 Wnd prep, f/n/hf/g, addl cm 15731 Forehead flap w/vasc pedicle 15830 Exc skin abd 15847 Exc skin abd add-on 17311 Mohs, 1 stage, h/n/hf/g 17312 Mohs addl stage 17313 Mohs, 1 stage, t/a/l 17314 Mohs, addl stage, t/a/l 17315 Mohs surg, addl block 19105 Cryosurg ablate fa, each 19300 Removal of breast tissue 19301 Partical mastectomy 19302 P-mastectomy w/ln removal 19303 Mast, simple, complete 19304 Mast, subq 19305 Mast, radical 19306 Mast, rad, urban type 19307 Mast, mod rad 2019F Dilated macul exam done 2020F Dilated fundus eval done 2021F Dilat macul+exam done 2027F Optic nerve head eval done 2029F Complete phys skin exam done 2030F H2O stat doc'd, normal 2031F H2O stat doc'd, dehydrated 22526 Idet, single level 22527 Idet.

8 1 or more levels 22857 Lumbar artif diskectomy 22862 Revise lumbar artif disc 22865 Remove lumb artif disc 25109 Excise tendon forearm/wrist 25606 Treat fx distal radial 25607 Treat fx rad extra-articul 25608 Treat fx rad intra-articul 25609 Treat fx radial 3+ frag 27325 Neurectomy, hamstring 27326 Neurectomy, popliteal 28055 Neurectomy, foot 3044F HG a1c level < 3045F HG a1c level 3073F Pre-surg eye measures doc'd 3074F Syst bp < 130 mm hg 3075F Syst bp >=130-139 mm hg 3082F Kt/v < 3083F Kt/v >= and < 3084F Kt/v >= 3085F Suicide risk assessed 3088F Mdd, mild 3089F Mdd, moderate 3090F Mdd, severe; w/o psych 3091F MDD, severe; w/psych 3092F Mdd, in remission 3093F Doc new diag 1st/addl.

9 Mdd 3095F Central dexa results doc'd 3096F Central dexa ordered 32998 Perq rf ablate tx, pul tumor 33202 Insert epicard eltrd, open 33203 Insert epicard eltrd, endo 33254 Ablate atria, lmtd 33255 Ablate atria w/o bypass, ext 33256 Ablate atria w/bypass, exten 33265 Ablate atria w/bypass, endo 33266 Ablate atria w/o bypass endo 33675 Close mult vsd 33676 Close mult vsd w/resection 33677 Cl mult vsd w/rem pul band 33724 Repair venous anomaly 33726 Repair pul venous stenosis 35302 Rechanneling of artery 35303 Rechanneling of artery 35304 Rechanneling of artery 35305 Rechanneling of artery 35306 Rechanneling of artery 35537 Artery bypass graft 35538 Artery bypass graft 35539 Artery bypass graft 35540 Artery bypass graft 35637 Artery bypass graft 35638 Artery bypass graft 35883 Revise graft w/nonauto graft

10 35884 Revise graft w/vein 37210 Embolization uterine fibroid 4005F Pharm thx for op rx'd 4007F Antiox vit/min supp rx'd 4019F Doc recpt counsl vit d/calc+ 4051F Referred for an av fistula 4052F Hemodialysis via av fistula 4053F Hemodialysis via av graft 4054F Hemodialysis via catheter 4055F Pt. rcvng periton dialysis 4056F Approp. oral rehyd. recomm'd 4058F Ped gastro ed given, caregvr 4060F Psych svcs provided 4062F Pt referral psych doc'd 4064F Antidepressant rx 4065F Antipsychotic rx 4066F Ect provided 4067F Pt referral for ect doc'd 43647 Lap impl electrode, antrum 43648 Lap revise/remv eltrd antrum 43881 Impl/redo electrd.