Release Newsletter
Version 2.13
July 2009
Institutional
Change Summary
We are pleased to announce the release of PC-ACE Pro32
version 2.13. This upgrade contains
several CMS Medicare Mandates and product enhancements effective 7/1/2009,
including these highlighted changes:
¨ CR6426 Instructions on Utilizing the 837 Institutional CAS Segments for MSP Part A Claims Edit added to prohibit use of CARC 225
ENCLOSED
Materials
¨ Pre-built PC-ACE Pro32 2.13 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
¨ This
Newsletter
CMS
Medicare Mandates
CR 6426 Instructions on Utilizing the 837
Institutional CAS Segments for MSP Part A Claims
ͺ Added an institutional claim edit prohibiting the use of CARC 225 on Medicare claims
CR 6477 - Addition/Deletion of HCPCS Codes -- Quarterly
Update
ͺ Added the following
HCPCS codes (effective 7/1/2009):
·
Q4115 - ALLOSKIN SKIN
SUB
·
Q4116 - ALLODERM SKIN
SUB
·
Q2023 - XYNTHA, INJ
ͺ Added the following
HCPCS modifiers (effective 7/1/2009):
·
PA - SURGERY, WRONG
BODY PART
·
PB - SURGERY, WRONG
PATIENT
·
PC - WRONG SURGERY ON
PATIENT
·
PI - PET TUMOR INIT TX
STRAT
·
PS - PET TUMOR SUBSQ
TX STRATEGY
ADDITIONAL CMS Mandated CHANGES
CR 6413 - April
2009 Integrated Outpatient Editor (I/OCE) Specifications Version 10.1
ͺ Terminated
HCPCS code "0085T - BREATH TEST HEART REJECT" effective
12/7/2008.
ͺ Added HCPCS
modifier "K8" effective 4/1/2009
ͺ Added a new Revenue
Code "0392 - BLOOD STORAGE"
ͺ Modified several institutional claim edits enforcing blood-handling rules to include Revenue Code 0392, as appropriate.
CR 6431 -
Billing Routine Cost of Clinical Trials
ͺ
Added an institutional claim edit requiring that diagnosis Code V70.7 be
present when HCPCS modifiers 'Q1' or 'QV' are present on Medicare claims with
service dates on or after 1/1/2008. This edit is effective 7/10/2009.
CR 6419 -
Surgery for Diabetes
ͺ
Added an institutional claim edit which disallows Medicare inpatient (TOB =
11x) bariatric surgeries for patients with a BMI < 35. This edit is
effective for discharges on or after February 12, 2009. These claims are
identified by the presence of one or more of the covered ICD-9 procedure codes
(43.89, 44.38, 44.39, 44.95, 45.51 or 45.91), a primary diagnosis of 278.01,
and a secondary diagnosis indicating T2DM (250.00, 250.02, 250.10, 250.12,
250.20, 250.22, 250.30, 250.32, 250.40, 250.42, 250.50, 250.52, 250.60, 250.62,
250.70, 250.72, 250.80, 250.82, 250.90 or 250.92), but do NOT contain one of
the ICD-9 diagnosis codes indicating a BMI ≥ 35 (V85.35, V85.36, V85.37,
V85.38, V85.39 or V85.4).
CR 6385 - New
Patient Discharge Status Code 21 to Define Discharges or Transfers to Court/Law
Enforcement
ͺ Added the new patient discharge status code "21 - Discharged/transferred to Court/Law Enforcement" valid for claims with discharge dates on or after 10/1/2009
CR 6440 -
Additional Data Collection on Hospice Claims
ͺ Modified an existing institutional claim edit to allow Revenue Codes 042x, 043x, 044x and 0569 to be billed on Hospice claims (TOBs 81x, 82x) with service dates on or after 10/1/2009. Additional changes per this mandate will be forthcoming in a future release.
CR 6411 -
Implementation of Health Care Claim Status Inquiry and Response (276/277)
Version 005010 - Part B Shared System Change
ͺ SDI will implement changes to support 5010 requirements over a period of several quarters beginning in the Q1 2009
CR 6399 - Implementation of Health Care Claim Status
Inquiry and Response (276/277) Version 005010 - DME Shared Systems
ͺ SDI will implement changes to support 5010 requirements over a period of several quarters beginning in the Q1 2009
CR6492 - July 2009 Update to the Hospital OPPS
ͺ Added
the following HCPCS codes (effective 7/1/2009):
·
0199T - PHYSIOLOGIC
TREMOR RECORD
·
0200T - PERQ SACRAL
AUGMT UNILAT INJ
·
0201T - PERQ SACRAL
AUGMT BILAT INJ
·
0202T - POST VERT
ARTHRPLST 1 LUMBAR
ͺ Numerous
other new HCPCS codes mentioned in this change request have already been added
to the product in a previous release.
CR6484
- July Update to the 2009 Medicare Physician Fee Schedule Database (MPFFSD)
ͺ
Terminated HCPCS Modifier "21 - PROLONGED E&M
SERVICES" effective 12/31/2008
July 2009 HCPCS Update (Source: CMS Website)
ͺ Added the following HCPCS codes (effective
7/1/2009):
·
C9250 - ARTISS FIBRIN
SEALANT
·
C9251 - INJ, C1
ESTERASE INHIBITOR
·
C9252 - INJECTION,
PLERIXAFOR
·
C9253 - INJECTION,
TEMOZOLOMIDE
·
C9360 - SURGIMEND,
NEONATAL
·
C9361 - NEUROMEND
NERVE WRAP
·
C9362 - IMPLNT,BON
VOID FILLER-STRIP
·
C9363 - INTEGRA
MESHED BIL WOUND MAT
·
C9364 - PORCINE
IMPLANT, PERMACOL
ͺ Modified the descriptions
for the following HCPCS codes:
·
C9358 - SURGIMEND,
FETAL
·
C9359 - IMPLNT,BON
VOID FILLER-PUTTY
Modifications in support of ansi (hipaa) ig compliance
Claim Adjustment Reason Code Reference File Update
Source: WPC Published Code Set
ͺ Updated the Claim Adjustment Reason Codes reference file with the latest WPC published code set. Codes Added: 2 ; Codes Deleted/Terminated: 0 ; Codes Modified: 3. The new codes are: "229 - Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X." and "230 - No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty." The modified codes are: 60, 156 and 187.
Claim Status Category Code and Claim Status Code
Reference File Update Source: WPC Published Code Set
ͺ Updated the
Claim Status Response Codes reference file with the latest WPC published code
set. Codes Added: 2 ; Codes
Deleted/Terminated: 0 ; Codes Modified: 6. The new status codes are: "693
- Amount must be greater than or equal to zero.", "694 - Amount must
not be equal to zero.", "695 - Entity's Country Subdivision Code."
and "696 - Claim Adjustment Group Code." The modified category codes
are: D0, P3 and P4. The modified status codes are: 104, 107 and 402.
Remittance Advice Remark Code Reference File
Update Source: WPC Published Code Set
ͺ Updated the Remittance Remarks Codes reference file with the latest WPC published code set. Codes Added: 3 ; Codes Deleted/Terminated: 0 ; Codes Modified: 5. The new codes are: "N516 - Records indicate a mismatch between the submitted NPI and EIN.", "N517 - Resubmit a new claim with the requested information." and "N518 - No separate payment for accessories when furnished for use with oxygen equipment." The modified codes are: MA46, M6, N109, N387 and N515.
C-Codes, April
2009 HCPCS Update (Source: CMS Website)
ͺ
Added a new HCPCS code effective 4/1/2009:
·
C9249 - INJ,
CERTOLIZUMAB PEGOL
UB-04: Version
3.00 Clarification/Errata/Updates (dated 2/18/2009)
ͺ Changed the description for Condition Code 42
to read "Continuing Care Not Related To Inpatient Hospitalization"
GENERAL PRODUCT ENHANCEMENTS
Institutional ANSI-835 Remittance Reports 4th Modifier
ͺ
Modified the institutional ANSI-835 remittance reports "Single Claim
Report" and "All Claims Report With Line Detail" to print the
fourth HCPCS modifier, when present.
CORRECTIONS TO CUSTOMER REPORTED PROBLEMS
Modification to the Patient List Report
ͺ Modified the Patient List report to properly display the primary Payer ID value. The value displayed in the report will now be determined in the following sequence: (a) The Payer ID value specified in the filter criteria, if any; (b) the institutional primary Payer ID, if specified on the patient record, or (c) the professional primary Payer ID value on the patient record.
ANSI-997 Report Utility Modification
ͺ Modified the ANSI-997 Report Utility to add support for repeating CTX01 elements (10 maximum) in the new ANSI-999 (5010) file format.
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 servers 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.