CMS Manual System

CMS Manual System

Pub 100-04 Medicare Claims Processing

Transmittal 1150

Department of Health & Human Services (DHHS)

Centers for Medicare & Medicaid Services (CMS)

Date: JANUARY 10, 2007 Change Request 5437

NOTE: Transmittal 1128, dated December 15, 2006, is rescinded and replaced with Transmittal 1150, dated January 10, 2007. The following codes were removed from the Non-Reportable List A4461, A4463, 77051, 77052, 77055, 77056, and 77057. All other information remains the same.

SUBJECT: January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1

I. SUMMARY OF CHANGES: This instruction is to inform the fiscal intermediaries that the January 2007 Non-OPPS OCE specifications Version 22.1 have been update with new additions, deletions, and changes.

NEW / REVISED MATERIAL EFFECTIVE DATE: January 1, 2007 IMPLEMENTATION DATE: January 2, 2007

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D N/A

Chapter / Section / Subsection / Title

III. FUNDING: No additional funding will be provided by CMS; Contractor activities are to be carried out within their FY 2007 operating budgets. IV. ATTACHMENTS: Recurring Update Notification

*Unless otherwise specified, the effective date is the date of service.

Attachment - Recurring Update Notification

Pub. 100-04 Transmittal: 1150 Date: January 10, 2007

Change Request: 5437

NOTE: Transmittal 1128, dated December 15, 2006, is rescinded and replaced with Transmittal 1150, dated January 10, 2007. The following codes were removed from the Non-Reportable List A4461, A4463, 77051, 77052, 77055, 77056, and 77057. All other information remains the same.

SUBJECT: January 2007 Non-Outpatient Prospective Payment System (Non-OPPS) Outpatient Code Editor (OCE) Specifications Version 22.1

Effective Date: January 1, 2007

Implementation Date: January 2, 2007

I. GENERAL INFORMATION

A. Background: The Non-OPPS OCE has been updated with any new additions, changes, and deletions to Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes. This OCE is used to process bills from hospitals not paid under the OPPS.

B. Policy: The following changes were made to version 21.3 of the Non-OPPS OCE. ? Technical Modifications

? Replace the MS-DOS interactive user interface with a modified version of the 32 bit OCE/APC Windows GUI (see OCE/APC API/product specifications for the PC platform).

? Expand the size of the ASC payment group field from 1 byte to two bytes to accommodate the expanded number of ASC pricer groups.

? Replace ASC Payment Group numbers with ASC PRICER Group numbers in the OCE program and User manual for the PC platform.

? Clinical Specifications Overview OCE v22.1 includes the following clinical changes: ? Addition, deletion and revision of HCPCS/CPT procedure codes ? Revised ASC payment group assignments ? Revised code lists for the Medicare Outpatient Code Edits

? Code Descriptions: ? Update the Code Description Database with the same codes and descriptions used for OPPS OCE v8.0 o New HCPCS/CPT Procedure Codes, effective 1/1/07: HCPCS Description 00625 Anes spine tranthor w/o vent 00626 Anes, spine transthor w/vent 0162T Anal program gast neurostim 0163T Lumb artif diskectomy addl 0164T Remove lumb artif disc addl 0165T Revise lumb artif disc addl 0166T Tcath vsd close w/o bypass 0167T Tcath vsd close w bypass 0168T Rhinophototx light app bilat 0169T Place stereo cath brain 0170T Anorectal fistula plug rpr

0171T 0172T 0173T 0174T 0175T 0176T 0177T 0505F 0507F 1040F 1050F 1055F 15002 15003 15004 15005 15731 15830 15847 17311 17312 17313 17314 17315 19105 19300 19301 19302 19303 19304 19305 19306 19307 2019F 2020F 2021F 2027F 2029F 2030F 2031F 22526 22527 22857 22862 22865 25109 25606 25607 25608

Lumbar spine proces distract Lumbar spine proces addl Iop monit io pressure Cad cxr with interp Cad cxr remote Aqu canal dilat w/o retent Aqu canal dilat w retent Hemodialysis plan doc'd Periton dialysis plan doc'd Dsm-IV info mdd doc'd History of mole changes Visual funct status assess Wnd prep, ch/inf, trk/arm/lg Wnd prep, ch/inf addl 100 cm Wnd prep ch/inf, f/n/hf/g Wnd prep, f/n/hf/g, addl cm Forehead flap w/vasc pedicle Exc skin abd Exc skin abd add-on Mohs, 1 stage, h/n/hf/g Mohs addl stage Mohs, 1 stage, t/a/l Mohs, addl stage, t/a/l Mohs surg, addl block Cryosurg ablate fa, each Removal of breast tissue Partical mastectomy P-mastectomy w/ln removal Mast, simple, complete Mast, subq Mast, radical Mast, rad, urban type Mast, mod rad Dilated macul exam done Dilated fundus eval done Dilat macul+exam done Optic nerve head eval done Complete phys skin exam done H2O stat doc'd, normal H2O stat doc'd, dehydrated Idet, single level Idet, 1 or more levels Lumbar artif diskectomy Revise lumbar artif disc Remove lumb artif disc Excise tendon forearm/wrist Treat fx distal radial Treat fx rad extra-articul Treat fx rad intra-articul

25609 27325 27326 28055 3044F 3045F 3073F 3074F 3075F 3082F 3083F 3084F 3085F 3088F 3089F 3090F 3091F 3092F 3093F 3095F 3096F 32998 33202 33203 33254 33255 33256 33265 33266 33675 33676 33677 33724 33726 35302 35303 35304 35305 35306 35537 35538 35539 35540 35637 35638 35883 35884 37210 4005F

Treat fx radial 3+ frag Neurectomy, hamstring Neurectomy, popliteal Neurectomy, foot HG a1c level < 7.0% HG a1c level 7.0-9.0% Pre-surg eye measures doc'd Syst bp < 130 mm hg Syst bp >=130-139 mm hg Kt/v = 1.2 and = 1.7 Suicide risk assessed Mdd, mild Mdd, moderate Mdd, severe; w/o psych MDD, severe; w/psych Mdd, in remission Doc new diag 1st/addl. mdd Central dexa results doc'd Central dexa ordered Perq rf ablate tx, pul tumor Insert epicard eltrd, open Insert epicard eltrd, endo Ablate atria, lmtd Ablate atria w/o bypass, ext Ablate atria w/bypass, exten Ablate atria w/bypass, endo Ablate atria w/o bypass endo Close mult vsd Close mult vsd w/resection Cl mult vsd w/rem pul band Repair venous anomaly Repair pul venous stenosis Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Revise graft w/nonauto graft Revise graft w/vein Embolization uterine fibroid Pharm thx for op rx'd

4007F 4019F 4051F 4052F 4053F 4054F 4055F 4056F 4058F 4060F 4062F 4064F 4065F 4066F 4067F 43647 43648 43881 43882 44157 44158 47719 48105 48548 49324 49325 49326 49402 49435 49436 5005F 5010F 5015F 54865 55875 55876 56442 57296 57558 58541 58542 58543 58544 58548 58957 58958 64910 64911 67346

Antiox vit/min supp rx'd Doc recpt counsl vit d/calc+ Referred for an av fistula Hemodialysis via av fistula Hemodialysis via av graft Hemodialysis via catheter Pt. rcvng periton dialysis Approp. oral rehyd. recomm'd Ped gastro ed given, caregvr Psych svcs provided Pt referral psych doc'd Antidepressant rx Antipsychotic rx Ect provided Pt referral for ect doc'd Lap impl electrode, antrum Lap revise/remv eltrd antrum Impl/redo electrd, antrum Revise/remove electrd antrum Colectomy w/ileoanal anast Colectomy w/neo-rectum pouch Fusion of bile duct cyst Resect/debride pancreas Fuse pancreas and bowel Lap insertion perm ip cath Lap revision perm ip cath Lap w/omentopexy add-on Remove foreign body, adbomen Insert subq exten to ip cath Embedded ip cath exit-site Pt counsld on exam for moles Macul+fndngs to dr mng dm Doc fx & test/txmnt for op Explore epididymis Transperi needle place, pros Place rt device/marker, pros Hymenotomy Revise vag graft, open abd D&c of cervical stump Lsh, uterus 250 g or less Lsh w/t/o ut 250 g or less Lsh uterus above 250 g Lsh w/t/o uterus above 250 g Lap radical hyst Resect recurrent gyn mal Resect recur gyn mal w/lym Nerve repair w/allograft Neurorraphy w/vein autograft Biopsy, eye muscle

70554 70555 72291 72292 76776 76813 76814 76998 77001 77002 77003 77011 77012 77013 77014 77021 77022 77031 77032 77051 77052 77053 77054 77055 77056 77057 77058 77059 77071 77072 77073 77074 77075 77076 77077 77078 77079 77080 77081 77082 77083 77084 77371 77372 77373 77435 82107 83698 83913

Fmri brain by tech Fmri brain by phys/psych Perq vertebroplasty, fluor Perq vertebroplasty, ct Us exam k transpl w/doppler Ob us nuchal meas, 1 gest Ob us nuchal meas, add-on Us guide, intraop Fluoroguide for vein device Needle localization by xray Fluoroguide for spine inject Ct scan for localization Ct scan for needle biopsy Ct guide for tissue ablation Ct scan for therapy guide Mr guidance for needle place Mri for tissue ablation Stereotact guide for brst bx Guidance for needle, breast Computer dx mammogram add-on Comp screen mammogram add-on X-ray of mammary duct X-ray of mammary ducts Mammogram, one breast Mammogram, both breasts Mammogram, screening Mri, one breast Mri, both breasts X-ray stress view X-rays for bone age X-rays, bone length studies X-rays, bone survey, limited X-rays, bone survey complete X-rays, bone survey, infant Joint survey, single view Ct bone density, axial Ct bone density, peripheral Dxa bone density, axial Dxa bone density/peripheral Dxa bone density, vert fx Radiographic absorptiometry Magnetic image, bone marrow Srs, multisource Srs, linear based Sbrt delivery Sbrt management Alpha-fetoprotein l3 Assay lipoprotein pla2 Molecular, rna stabilization

86788 86789 87305 87498 87640 87641 87653 87808 91111 92025 92640 94002 94003 94004 94005 94610 94644 94645 94774 94775 94776 94777 95012 96020 96040 96904 99363 99364 A4461 A4463 A4559 A4600 A4601 A8000 A8001 A8002 A8003 A8004 A9279 A9527 A9568 C1821 C9232 C9233 C9234 C9235 C9350 C9351 D0145

West nile virus ab, igm West nile virus antibody Aspergillus ag, eia Enterovirus, dna, amp probe Staph a, dna, amp probe Mr-staph, dna, amp probe Strep b, dna, amp probe Trichomonas assay w/optic Esophageal capsule endoscopy Corneal topography Aud brainstem implt programg Vent mgmt inpat, init day Vent mgmt inpat, subq day Vent mgmt nf per day Home vent mgmt supervision Surfactant admin thru tube Cbt, 1st hour Cbt, each addl hour Ped home apnea rec, compl Ped home apnea rec, hk-up Ped home apnea rec, downld Ped home apnea rec, report Exhaled nitric oxide meas Functional brain mapping Genetic counseling, 30 min Whole body photography Anticoag mgmt, init Anticoag mgmt, subseq Surgicl dress hold non-reuse Surgical dress holder reuse Coupling gel or paste Sleeve, inter limb comp dev Lith ion batt, non-pros use Soft protect helmet prefab Hard protect helmet prefab Soft protect helmet custom Hard protect helmet custom Repl soft interface, helmet Monitoring feature/deviceNOC Iodine I-125 sodium iodide Technetium tc99m arcitumomab Interspinous implant Injection, idursulfase Injection, ranibizumab Inj, alglucosidase alfa Injection, panitumumab Porous collagen tube per cm Acellular derm tissue percm2 Oral evaluation, pt < 3yrs

D0273 D0360 D0362 D0363 D0486 D1206 D1555 D4230 D4231 D6012 D6091 D6092 D6093 D7292 D7293 D7294 D7951 D7998 D8693 D9120 D9612 E0676 E0936 E2373 E2374 E2375 E2376 E2377 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2393 E2394 E2395 E2396 G0377 G0380 G0381 G0382 G0383

Bitewings - three films Cone beam ct Cone beam, two dimensional Cone beam, three dimensional Accession of brush biopsy Topical fluoride varnish Remove fix space maintainer Ana crown exp 4 or> per quad Ana crown exp 1-3 per quad Endosteal implant Repl semi/precision attach Recement supp crown Recement supp part denture Screw retained plate Temp anchorage dev w flap Temp anchorage dev w/o flap Sinus aug w bone/bone sup Intraoral place of fix dev Rebond/cement/repair retain Fix partial denture section Thera par drugs 2 or > admin Inter limb compress dev NOS CPM device, other than knee Hand/chin ctrl spec joystick Hand/chin ctrl std joystick Non-expandable controller Expandable controller, repl Expandable controller, initl Pneum drive wheel tire Tube, pneum wheel drive tire Insert, pneum wheel drive Pneumatic caster tire Tube, pneumatic caster tire Foam filled drive wheel tire Foam filled caster tire Foam drive wheel tire Foam caster tire Solid drive wheel tire Solid caster tire Solid caster tire, integrate Valve, pneumatic tire tube Drive wheel excludes tire Caster wheel excludes tire Caster fork Administra Part D vaccine Lev 1 hosp type B ED visit Lev 2 hosp type B ED visit Lev 3 hosp type B ED visit Lev 4 hosp type B ED visit

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