July Outpatient Editor Update Includes NCCI Changes

July 2012 updates to the Integrated Outpatient Code Editor (I/OCE), the Centers for Medicare & Medicaid Services’ (CMS) system for filing and adjudicating claims paid under the Outpatient Prospective Payment System (OPPS), include a change to bring it in line with correct coding guidelines. The OCE is used for outpatient services in hospitals and ambulatory surgical centers (ASCs).

The changes include:

• Effective Oct. 1, 2011, Medicare will apply payment adjustment flag (PAF) 9 (deductible/co-insurance not applicable) to any claim lines when modifier Q3 Live kidney donor surgery and related services is present on the line.

• Effective Oct. 1, 2005, the I/OCE deactivates edits described as mutually exclusive to earliest non-archived version. (Mutually exclusive National Correct Coding Initiative (NCCI) edits retroactively merged with code 1/code 2 edits.)

• Effective April 1, 2012, the following skin substitute codes are added to the skin substitute logic:
  • C9368 Grafix core, per square centimeter
  • C9369 Grafix prime, per square centimeter
  • Q4123 Alloskin RT, per square centimeter
  • Q4125 Arthroflex, per square centimeter
  • Q4128 FlexHD or Allopatch HD, per square centimeter
  • Q4129 Unite biomatrix, per square centimeter

• Effective July 1, 2012, implement version 18.2 of the NCCI (as modified for applicable institutional providers).

• Effective Jan. 1, 2012, the list of primary procedures reportable with add-on code 33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system) is updated to remove 33222 Revision or relocation of skin pocket for pacemaker, and add the following:
  • 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system
  • 33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system
  • 33263 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; dual lead system
  • 33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; multiple lead system

• Effective July 1, 2012, the I/OCE will update the device code used for edit 85, replacing deleted code C9732 Insertion of ocular telescope prosthetic including removal of crystalline lens with new code 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens.

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