Q&A: Separate procedure list resources

Q. Could you please let me know where I can find resources to help me understand the separate procedure exception for inpatient-only procedures?

A. According to the IOCE Specifications, Special Processing Conditions, an inpatient-only procedure on CMS’ separate procedure list is “bypassed” when performed incidental to any other surgical procedure with Status Indicator T. Essentially, the inpatient-only code identified as a separate procedure is rejected and the claim is processed according to the usual OPPS rules. The separate procedure list is available in the IOCE Quarterly Data Files available on the OCE homepage.

An easy way to find this link as well as other frequently used CMS websites, is to use Revenue Cycle Advisor’s Helpful Links page. Scroll down to the “Medicare Related Sites – Hospital” section and click on “OCE Specifications” link. Open the IOCE Quarterly Data Files. Next, open the EXCEL file called “Q_CD_HcpcsMap”. If a “1” is indicated in column “Q,” this inpatient-only procedure code has been identified as a separate procedure and the edit will be bypassed when this particular HCPCS is billed on an outpatient claim with another “T” procedure code. This file has been downloaded and manipulated to identify only those HCPCS codes on the separate procedure list and for your convenience the January 2017 separate procedure list is attached.

Note that the separate procedure list is a specific list created by CMS for bypassing IOCE edits in certain circumstances. The separate procedure is the inpatient-only HCPCS code identified by status indicator C and is not referring to the surgical procedure identified by status indicator T. The list is not based on a HCPCS code description or other instruction in the CPT® manual.

Editor’s note: This question was answered by Debbie Mackaman, RHIA, CPCO, CCDS, an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and lead instructor for the Critical Access Hospital Version and Rural Health Clinic Version.

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