Release Newsletter

Version 1.94

JULY 2008

Professional Change Summary

We are pleased to announce the release of PC-ACE Pro32 version 1.94. This upgrade contains several CMS Medicare Mandates and product enhancements effective 7/1/2008, including these highlighted changes:

ENCLOSED Materials

¨ Pre-built PC-ACE Pro32 1.94 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers

¨ This Newsletter

CMS Medicare Mandates

CR5980 – April Update to the 2008 Medicare Physician Fee Schedule Database

ª Terminated HCPCS code G0377 effective 12/31/2007

CR5999 - April 2008 Update of the Hospital OPPS

ª Added HCPCS codes effective 4/1/2008:

§ C9241 - INJECTION, DORIPENEM

ª Revised the following HCPCS descriptions effective 4/1/2008:

§ C8921 from "COMP TRANSTHO ECHO W/CONTR" to "TTE W OR W/O FOL W/CONT, COM"

§ C8922 from "LIMIT TRANSTHO ECHO W/CONTR" to "TTE W OR W/O FOL W/CONT, F/U"

§ C8923 from "2D COM TRANSTHO ECHO W/CONTR" to "2D TTE W OR W/O FOLW/CON,CO"

§ C8924 from "2D LIM TRANSTHO ECHO W/CONTR" to "2D TTE W OR W/O FOL W/CON,FU"

§ C8925 from "2D TEE W/CONTRAST, INT/REPT" to "2D TEE W OR W/O FOL W/CON,IN"

§ C8926 from "CONG TEE W/CONTR, INT/REPT" from "TEE W OR W/O FOL W/CONT,CONG"

§ C8927 from "TEE W/CONTRAST; MONITOR" to "TEE W OR W/O FOL W/CONT, MON"

§ C8928 from "2D TRANSTHO W/CONTR; STRESS" to "TEE W OR W/O FOL W/CON,STRES"

CR5981 - New HCPCS Codes for April 2008 Update

ª Added a new Professional claim edit prohibiting the use of HCPCS codes J7602, J7603, J1751, and J1752 on Medicare claims (eff 4/1/2008)

ª Replaced an existing Professional claim edit previously modified per CR5713 such that it now requires HCPCS codes J1566, J1568, J1569, J1561, J1572 and/or Q4097 when billing preadministration-related services (G0332) associated with IVIG administrations (effective 4/1/2008)

CR5969 – April 2008 Integrated Outpatient Code Editor (I/OCE) Specifications 9.1

ª Added new HCPCS codes effective 4/1/2008

§ 01213 - VWF COMPLEX, NOT HUMATE-P

§ 09241 - INJECTION, DORIPENEM

§ C9241 - INJECTION, DORIPENEM

ª Added new Modifier effective 1/1/2007:

§ 8C - GENERIC TESTING

CR6087 - July Update to the 2008 Medicare Physician Fee Schedule Database (MPFSDB)

ª Added new HCPCS code effective 3/13/2008

§ G0398 - HOME SLEEP TEST/TYPE 2 PORTA

§ G0399 - HOME SLEEP TEST/TYPE 3 PORTA

§ G0400 - HOME SLEEP TEST/TYPE 4 PORTA

CR6084 - Laboratory NCD Edit Software Changes for July2008

ª Modified the HCPCS code description for 86701 to "Antibody; HIV-1"

ª Modified the HCPCS code description for 86702 to "Antibody; HIV-2"

ª Modified the HCPCS code description for 86703 to "Antibody;HIV-1/2, Single Asy"

Modifications in Support of ANSI (HIPAA) IG Compliance

G Codes, July 2008 - Source: CMS Website

ª Added new HCPCS codes effective 3/13/2008:

§ G0398 - HOME SLEEP TEST/TYPE II PORTA

§ G0399 - HOME SLEEP TEST/TYPE III PORTA

§ G0400 - HOME SLEEP TEST/TYPE IV PORTA

C Codes, April 2008 (updated 3/25/2008) - Source: CMS Website

ª Added a new HCPCS code effective 4/1/2008:

§ C9241 - INJECTION, DORIPENEM

C Codes, July 2008 (updated 6/3/2008) – Source: CMS Website

ª Added new HCPCS codes effective 7/1/2008:

§ C9242 - INJECTION, FOSAPREPITANT

§ C9356 - TENOGLIDE TENDON PROT, CM2

§ C9357 - FLOWABLE WOUND MATRIX, 1 CC

§ C9358 - SURGIMEND, 0.5CM2

Other HCPCS Update – Source: CMS Website

ª Added a new Modifier code effective 7/1/2008:

§ CG - POLICY CRITERIA APPLIED

Update to the Category III Codes – Source: AMA Website

ª Added new codes effective 7/1/2008:

§ 3351F - NEG SCRN DEP SYMP BY DEPTOOL

§ 3352F - NO SIG DEP SYMP BY DEP TOO

§ 3353F - MILD-MOD DEP SYMP BY DEPTOOL

§ 3354F - CLIN SIG DEP SYM BY DEP TOOL

Professional Claim Import Module Update

ª Modified the Professional Claim Import Module to support NPI lookups from the Physician and Facility reference files when importing from NSF format files. The claim-level Referring Physician and Service Facility, as well as the line-level Referring Provider, Ordering Provider, Supervising Provider and Purchased Services Provider are supported by this new lookup feature. A lookup attempt from the Physician or Facility reference file as appropriate will be made automatically when only the entity's Legacy ID is available in the NSF file. If a unique match is made to the Legacy ID, the NPI on the matching record will be automatically loaded to the claim. This enhancement will allow Stage 3 NPI compliance without requiring the user to modify their NSF file.

Professional Claim Print Module Update

ª Modified the Professional Claim Print Module to print both the UPIN and NPI identifiers when available for supporting physicians referenced on Ambulance (AMB), Podiatry (POD), and Physical Therapy (LPT) claim attachments

Installing the Upgrade

Perform a full PC-ACE Pro32 database backup before installing the upgrade. To install the upgrade, run the attached PCACEUP.EXE file using Windows Explorer or equivalent, and follow the simple upgrade wizard steps. When prompted, enter the upgrade password provided by your software supplier. For

networked instructions, it is recommended (but not required) that the update be run from the server’s console.

IMPORTANT: The recommended database backup is for safety purposes only, and should NOT be restored after successfully installing the update. The update program preserves all existing claims and reference file settings.