Release Newsletter

Version 2.27

April 2011

Institutional Change Summary

We are pleased to announce the release of PC-ACE Pro32 version 2.27. This upgrade contains several CMS Medicare Mandates and product enhancements effective 4/1/2011, including these highlighted changes:

¨ Emergency Update to CY 2011 Medicare Physician Fee Schedule (MPFS) Database – Removed termination dates for selected HCPCS codes

¨ Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS) – Added a new Institutional edit prohibiting the use of certain HCPCS codes on certain TOBs

ENCLOSED MATERIALS

· Pre-built PC-ACE Pro32 2.27 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers

· This Newsletter

CMS MEDICARE MANDATES

CR7079 - Annual Wellness Visit (AWV), Including Personalized Prevention Plan Services (PPPS)

ª Added a new Institutional edit prohibiting the use of HCPCS codes G0438 and G0439 on any other TOBS other than 12x, 13x, 22, 23x, 71x, 77x, and 85x

CR7182 - Additions to and Revisions of Existing G-Codes for the Reporting of Skilled Nursing Services and Skilled Therapy Services in the Home Health or Hospice Setting

ª Modified several institutional claim edits to support the new G-Codes G0157 thru G0164 defined for the reporting of Skilled Nursing Services and Skilled Therapy Services in the Home Health or Hospice setting

CR7300 - Emergency Update to CY 2011 Medicare Physician Fee Schedule (MPFS) Database

ª Removed the termination date on HCPCS codes L3660, L3670 and L3675

CR7299 - Addition/Deletion of HCPCS Codes -- Quarterly Update

ª Added HCPCS code "Q2040 - INCOBOTULINUMTOXIN A" (effective 4/1/2011)

ADDITIONAL CMS MANDATED CHANGES

CR7231 - FISS System Changes for the Elimination of Lump Sum Purchase Payment for Standard Power Wheelchairs Furnished on or After January 1, 2011, Due to the Affordable Care Act

ª Added an institutional claim edit which prohibits billing of standard power wheelchair HCPCS codes K0813, K0814, K0815, K0816, K0820 - K0829, K0830, K0831 and K0898 with DME purchase Revenue Codes 0292 or 0293 on Home Health claims (TOB = 32x/33x/34x ; effective 1/1/2011)

CR7319 - April Update to the CY 2011 Medicare Physician Fee Schedule Database (MPFSDB)

ª Terminated HCPCS codes 90470 and 90663 (effective 1/1/2011), and HCPCS codes Q1003, S2270, S2344, and S3905 (effective 4/1/2011)

Category III Codes Update (Source – AMA Website)

ª Added the following new codes (effective 7/1/2011):

· 0262T - IMPL.TJ PULM VLV EVASC APPR

· 0263T - IM B1 MRW CEL THER CMPL

· 0264T - IM B1 MRW CEL THER XCL HRVST

· 0265T - IM B1 MRW CEL THER HRVST ONL

· 0266T - IMPLT/RPL CRTD SNS DV TOTAL

· 0267T - IMPLT/RPL CRTD SNS DEV LEAD

· 0268T - IMPLT/RPL CRTD SNS DEV GEN

· 0269T - REV/REMVL CRTD SNS DEV TOTAL

· 0270T - REV/REMVL CRTD SNS DEV LEAD

· 0271T - REV/REMVL CRTD SNS DEV GEN

· 0272T - INTERROGATE CRTD SNS DEV

· 0273T - INTERROGATE CRTD SNS W/PGRMG

· 0274T - PERQ LAMOT/LAM CRV/THRC

· 0275T - PERQ LAMOT/LAM LUMBAR

Provider Taxonomy Code Quarterly Update (Source: WPC)

ª Updated the Provider Taxonomy Code reference file with the latest WPC published code set. Codes Added: 3 ; Codes Deleted/Terminated: 0 ; Codes Modified: 1. The new codes are: "174N00000X - Other Service Providers: Lactation Consultant, Non-RN", "174V00000X - Other Service Providers: Clinical Ethicist" and "204R00000X - Allopathic & Osteopathic Physicians: Electrodiagnostic Medicine" (effective 4/1/2011). The modified code is: 225000000X.

CR7128 - Payment Update and Common Working File (CWF) Editing for Influenza Virus Vaccine and Pneumococcal Vaccine Codes

ª Modified several existing influenza-related institutional claim edits to add influenza virus vaccine code 90662

ª Modified several existing pneumococcal-related institutional claim edits to add pneumococcal virus vaccine code 90670

HCPCS Update – C Codes (Source: CMS website)

ª Terminated HCPCS code C9278 effective 4/1/2011. This code is being replaced with Q2040.

ª Added new HCPCS codes (effective 4/1/2011):

· C9280 - INJECTION, ERIBULIN MESYLATE", "C9281 - INJECTION, PEGLOTICASE

· C9282 - INJ, CEFTAROLINE FOSAMIL

· C9729 - PERCUT LUMBAR LAMI"

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.