CMS Releases Updated I/OCE Specifications

Version 12.2 of the Integrated Outpatient Code Editor (I/OCE) Specifications will be effective July 1. Changes include:

  • added, deleted, and revised APCs
  • added, deleted, and revised HCPCS Level II/CPT® procedure codes
  • changes to HCPCS Level II and APC status indicators
  • edit assignments
  • procedure/device and device/procedure pair changes

The I/OCE is used under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments; for community mental health centers; for all non-OPPS providers; for limited services when provided in a home health agency not under the Home Health Prospective Payment system, and; for hospice patients for the treatment of non-terminal illness.

APC 09267 Wilate Injection has been deleted and replaced by 01352 Wilate Injection (status indicator G). Seven additional APCs have been added, while two APC descriptors (09273 and 09280) have undergone minor revision.

More than 30 HCPCS Level II/CPT® codes have been added, effective July 1. Three HCPCS Level II codes (C9273, C9729, and S9075) will be deleted, and 10 CPT® codes are revised. Eight codes have been given new edit assignments (for example, CPT® 64613 Chemodenervation of muscle(s); neck muscle(s) (eg, for spasmodic torticollis, spasmodic dysphonia) has been removed from the conditional bilateral list).

Many of the changes are retroactive to Jan. 1, 2011, so be sure to check your past claims to determine if adjustments are required.

For a complete list of changes included in Version 12.2 of the I/OCE Specifications, see the Centers for Medicare & Medicaid Services (CMS) Transmittal 2224, Change Request (CR) 7439.


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