Transcription of 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 51 Date: DECEMBER 19, 2003 CHANGE REQUEST 3027 I. SUMMARY OF CHANGES: January medicare Outpatient Code Editor (OCE) Specifications Version For Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System (OPPS) NEW/REVISED MATERIAL - EFFECTIVE DATE: Various dates as described in the instruction *IMPLEMENTATION DATE: January 5, 2004 Disclaimer for Manual changes only: The revision date and transmittal number apply only to red italicized material.
2 Any other material was previously published and remains unchanged. II. CHANGES IN Manual INSTRUCTIONS: (N/A if Manual not updated.) (R = REVISED, N = NEW, D = DELETED (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE N/A *III. FUNDING: These instructions should be implemented within your current operating budget. IV. ATTACHMENTS: Business Requirements Manual Instruction Confidential Requirements One-Time Notification X Recurring Update Notification * medicare contractors only Recurring Update Notification Pub.)
3 100-04 Transmittal: 51 Date: December 19, 2003 Change Request 3027 SUBJECT: January medicare Outpatient Code Editor (OCE) Specifications Version For Bills From Hospitals That Are Not Paid Under the Outpatient Prospective Payment System (OPPS) I. GENERAL INFORMATION A. Background: This Change Request (CR) informs you that the OCE has been updated with new additions, changes, and deletions to Healthcare Common Procedure Coding System /Current Procedural Terminology, Fourth Edition (HCPCS/CPT-4) codes.
4 CMS sent detailed information about these changes in separate communications. See Program Memorandum AB-03-140, dated September 12, 2003. This OCE is used to process bills from hospitals not paid under the OPPS. B. Policy: The following are changes made to version of the non-OPPS OCE: The new HCPCS/CPT codes as described in Appendix A have been added to the list of valid codes for the non-OPPS OCE. The HCPCS/CPT codes listed in Appendices B and C have been deleted from the non- OPPS OCE. The following ASC procedure codes have been added to the list of ASC procedures and payment groups, effective January 1, 2004: Code Payment Group 1.
5 36555 1 2. 36556 1 3. 36557 2 4. 36558 2 5. 36560 3 6. 36561 3 7. 36563 3 8.
6 36565 3 9. 36566 3 10. 36568 1 11. 36569 1 12. 36570 3 13. 36571 3 214. 36575 2 15.
7 36576 2 16. 36578 2 17. 36580 1 18. 36581 2 19. 36582 3 20. 36583 3 21. 36584 1 22.
8 36585 3 23. 36589 1 24. 36590 1 The following new procedure codes have been added to the list of procedures for Females Only, effective January 1, 2004: 1. 57425 Laparoscopy, surg, colpopexy 2. 59070 Transabdom amnioinfus w/ us 3. 59072 Umbilical cord occlud w/ us 4. 59074 Fetal fluid drainage w/ us 5.
9 59076 Fetal shunt placement, w/ us 6. 59897 Fetal invas px w/ us The following codes have been added to the list of Non-Covered procedures, effective January 1, 2004: 1. A9280 2. J7303 3. V5362 4. V5363 5. V5364 The following codes have been removed from the list of Non-Covered procedures, effective January 1, 2001: 1. E0740 2. E0760 The following code has been removed from the list of Non-Covered procedures, effective January 1, 2004: 1. G0282 The codes as described in Appendix D have been added to the list of Non-Reportable procedures.
10 3 The codes as described in Appendix E which are billable only to the DMERC have been added to the list of Non-Reportable procedures. The following code has been removed from the list of Non-Reportable procedures, effective January 1, 2003: 1. G0257 C. Provider Education: Intermediaries shall inform affected providers by posting either a summary or relevant portions of this document on their Web site within two weeks of receiving this instruction. Also, intermediaries shall publish this same information in their next regularly scheduled bulletin.
