Quarterly OPPS and Integrated OCE Updates Released

by Judith L. Kares, JD

CMS recently released two July 2016 quarterly updates: Transmittal R3523, which is the July update to the OPPS, and Transmittal R3524CP, which is the related July update to the integrated outpatient code editor (I/OCE). Hospitals are strongly encouraged to review both of these updates to obtain important guidance on the billing, processing, and payment of inpatient and outpatient hospital services covered under Medicare Part B. The July OPPS update is a recurring update notification describing various changes in OPPS billing and payment policies generally effective for dates of service on and after July 1, 2016. The July I/OCE update contains related Healthcare Common Procedure Coding System (HCPCS), ambulatory payment classification (APC), HCPCS modifier and revenue code changes, deletions and additions identified in the OPPS update, as well as relevant instructions and specifications. In the remainder of this note, we will focus on key changes identified in the July OPPS quarterly update.

July OPPS update

In the July OPPS update, CMS identified key changes in the following areas:

• Billing instructions for intensity modulated radiation therapy (IMRT)
• Upper eyelid blepharoplasty and blepharoptosis repair
• Revised status indicators for pathology CPT codes
• Reporting for certain outpatient services similar to therapy services that are adjunctive to comprehensive APC (C-APC) procedures
• Category III CPT codes effective July 1
• Addition of C1713 and C1817 to the list of devices subject to the device intensive procedure edit
• Drugs, biologicals and radiopharmaceuticals

Please note that providers may resubmit claims that were impacted by adjustments to previous quarters’ payment files.

The following five drugs and biologicals have been granted OPPS pass-through status effective July 1:

• C9476
• C9477
• C9478
• C9479
• C9480

More specific information, including their descriptors and APC assignments, are set out in Table 3, Attachment A to the July update.

July I/OCE update

As noted above, the July I/OCE update contains HCPCS, APC, HCPCS modifier, and revenue code changes, deletions, and additions identified in the OPPS upddate, as well as related instructions and specifications. Transmittal R3524CP incorporates Attachment B to the July /IOCE update, listing these various code changes. It also provides a link to Attachment A to the July I/OCE update, which contains instructions and specifications for special processing logic for institutional services covered under Medicare Part B.  Although not yet released, Attachment A will soon be posted to the following CMS website: http://www.cms.gov/OutpatientCodeEdit/. Since the I/OCE is the processing system through which all Part B institutional claims are processed, hospitals are strongly encouraged to review the July I/OCE update, including both Attachments A and B, for more specific claims processing information.   

To view the complete, detailed article that appeared on Medicare Compliance Watch, click here.