Updated IOCE Includes Substantial Changes

Medicare contractors received updated instructions and specifications in December for the January 2012 Integrated Outpatient Code Editor (IOCE). They’ll use version 13.0 to edit claims paid under the Outpatient Prospective Payment System (OPPS) and non-OPPS for hospital outpatient departments, community mental health centers, and for all non-OPPS providers; and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness.

The update includes a number of ambulatory payment classifications (APCs) and HCPCS Level II and CPT® code changes, most of which are effective Jan. 1, 2012, and all of which outpatient facilities should be aware.

APC Changes

There are 28 new APCs, 25 deleted APCs, 26 APCs with description changes, and 15 APCs with status indicator changes.

New APCs range from 00331 Combined abdomen and pelvis CT without contrast to 09366 EpiFix wound cover.

Deleted APCs begin with 00245 Level I cataract procedures without IOL insert and end with 09364 Porcine implant, Permacol.

Many of the description changes to APCs are meant to enhance specificity and some greatly change the meaning of the code. Here are a few examples:

APC Old Description New Description
00040 Percutaneous implantation of neurostimulator electrodes Level I implantation/revision/replacement of neurostimulator electrodes
00061 Laminectomy, laparoscopy, or incision for implantation of neurostimulator electrodes Level II implantation/revision/replacement of neurostimulator electrodes
00083 Coronary or non-coronary angioplasty and percutaneous valvuloplasty Coronary angioplasty, valvuloplasty, and level I endovascular revascularization of the lower extremity

Other description changes have little or no effect. For example:

APC Old Description New Description
00831 Ifosfomide injection Ifosfamide injection
09273 Sipleucel-T auto CD54+ Sipuleucel-T auto CD54+
09282 Injection, ceftaroline fosamil Inj, ceftaroline fosamil
09284 Injection, ipilimumab Ipilimumab injection

As for status indicator changes: With the exception of APC 00668, which went from ‘S’ to ‘T,’ APCs 01236, 01238, 01290, 01296, 01297, 09249, 09250, 09251, 09252, 09253, 09255, 09256, 09360, and 09363 went from a status indicator of ‘G’ to ‘K.’

Code Changes

Added to the January I/OCE are six HCPCS Level II ‘G’ codes for preventive screening services. The following codes are effective Oct. 1, 2011:

HCPCS Code Description SI APC
G0442 Annual alcohol screen 15 min S 00432
G0443 Brief alcohol misuse counsel S 00432
G0444 Depression screen annual S 00432
G0445 High inten beh couns STD 30m S 00432
G0446 Intens behave ther cardio dx S 00432
G0447 Behavior counsel obesity 15m S 00432

Deleted from the IOCE, effective July 1, 2011 is HCPCS Level II code S3628 PAMG-1 rapid assay for ROM.

For the complete list of HCPCS Level II and CPT® procedure codes that are either added or deleted effective Jan. 1, 2011, and for description and status indicator changes and other code edits, please see the Centers for Medicare & Medicaid Services’ (CMS) Transmittal 2370.


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