Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1971 Date: MAY 21, 2010

Transcription

1 anual ystem Pub edicare laims Processing epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 1971 ate: Y 21, 2010 hange equest 6930 UBJT: Quarterly Update to orrect oding nitiative () dits, ersion 16.2, ffective July 1, UY O NG: This is the normal update to the procedure to procedure edits. The attached ecurring Update Notification applies to hapter 23, ection T T: *July 1, 2010 PLNTTON T: July 6, 2010 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the newrevised information only, and not the entire table of contents.. NG N NUL NTUTON: (N if manual is not updated) =, N=N, =LT- N N PT TON UBTON TTL N. UNNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) andor arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.. TTNT: ecurring Update Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment ecurring Update Notification Pub Transmittal: 1971 ate: ay 21, 2010 hange equest: 6930 UBJT: Quarterly Update to orrect oding nitiative () dits, ersion 16.2, ffective July 1, 2010 ffective ate: July 1, 2010 mplementation ate: July 6, GNL NOTON. Background: The enters for edicare & edicaid ervices developed the National orrect oding nitiative to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. The latest package of edits, ersion 16.2, effective July 1, 2010, will be available via the ata enter (). test file will be available on or about ay 4, 2010, and a final file will be available on or about ay 18, ersion 16.2 will include all previous versions and updates from January 1, 1996, to the present and will be organized in two tables: olumn olumn 2 orrect oding dits and utually xclusive ode () dits. B. Policy: The coding policies developed are based on coding conventions defined in the merican edical ssociation s urrent Procedural Terminology manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice and review of current coding practice.. BUN QUNT TBL Use hall" to denote a mandatory requirement Number equirement esponsibility (place an in each hared- ystem OT B aintainers The regional office correct coding initiative representatives (O ) should access the file from the in the same manner they downloaded the previous versions. The filenames for the regions are: Test ile: O

3 Number equirement esponsibility (place an in each hared- ystem OT B aintainers U00.@B12372.LL.T.TT U00.@B12372.LL.PT.TT inal ile: U00.@B12372.LL.T.NL U00.@B12372.LL.PT.NL ontractors shall use the specific job control language in order to access ersion 16.2 through the Network ata over and load the files into the system. The filenames for the contractors are: Test ile: U00.@B12372.N.T.TT U00.@B12372.N.PT.TT inal ile: U00.@B12372.N.T.NL U00.@B12372.N.PT.NL The adds, deletes, and modifier indicator change lists will be forthcoming via electronic mail on or about ay 26, The O representative shall forward this listing to the contractors ontractors shall maintain the and file formats contained in Pub , edicare laims Processing, hapter 23, ection ontractors shall not search their files to either retract payment or to retroactively pay claims ontractors shall adjust claims if they are brought to their attention f contractors foresee any problems with loading the files, they should load the files 2-3 days prior to the effective date (including weekends). O

4 . PO UTON TBL Numbe r equirement provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. esponsibility (place an in each hared- ystem OT B aintainers ontractors shall post this article, or a direct link to this article, on their eb site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly.. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. -ef equireme nt Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: N. ONTT Pre-mplementation ontact(s): al llen, , aleria.llen@cms.hhs.gov Post-mplementation ontact(s): al llen, , aleria.llen@cms.hhs.gov

5 . UNNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), andor arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s), include the following statement: The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of ork. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.