I/OCE April Update: Modifier 33, New APCs for Outpatient Claims

The Centers for Medicare & Medicaid Services (CMS) announced, March 11, the release of the Integrated Outpatient Code Editor (I/OCE) Specifications Version 12.1. The I/OCE routes institutional outpatient claims through a single, integrated OCE. Version 12.1, effective April 1, includes code, ambulatory payment classification (APC) and status indicator changes, the addition of a new modifier, and more.

Institutional outpatient claims include:

  • Outpatient Prospective Payment System (OPPS) and non-OPPS for:
    • Hospital outpatient departments
    • Community mental health centers
    • All non-OPPS providers
  • Limited services, when provided:
    • In a home health agency not under the Home Health Prospective Payment System
    • To a hospice patient for the treatment of a non-terminal illness

Substantive changes in the April 1 update include:

  • Four APCs added to the I/OCE

APC 01351 Matristem wound matrix is effective retroactively to Jan. 1, 2011. APCs 09280 Injection, eribulin mesylate, 09281 Injection, pegloticase, and 09282 Injection, ceftaroline fosamil are effective as of April 1.

  • The removal of CPT® code 88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure) from the female procedures list, effective Jan. 1, 2011.
  • The addition of modifier 33

Look for more information regarding this new modifier in the May 2011 issue of AAPC’s Coding Edge.

  • HCPCS Level II outpatient code additions
  • HCPCS/CPT® code deletions
  • Status indicator changes

For more information about these code additions/deletions and revised status indicators, read the article “April 1 OPPS Update Brings New Services, Retroactive Payment Corrections” in this issue of EdgeBlast.

For complete details, see CMS Transmittal 2172 and MLN Matters® article MM7344.

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