Integrated Outpatient Quarterly Release Files Version 20.0
HCPCS Codes Mapping Data Differences for IOCE Quarterly Release Files
Keywords
HCPCS Codes Mapping for IOCE
IOCE Quarterly Release Files V 20.0
HCPCS
HCPCS CPT
HCPCS Coding
HCPCS Coding System
HCPCS Age Restrictions
Healthcare Common Procedure Coding System
Hickpicks
Healthcare Common Procedure Coding System Mapping 2015 and 2019
This dataset contains information on ‘integrated’ Outpatient Code Editor (I/OCE) program processes claims for all outpatient institutional providers including hospitals that are subject to the Outpatient Prospective Payment System (OPPS) as well as hospitals that are NOT (Non-OPPS). This dataset contains HCPCS Codes differences between October, 2015 and January, 2019.
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Prior to OPPS, the software focused solely on editing claims without specifying any action to take when an edit occurred. It also did not compute any information for payment purposes. Claims will be identified as Outpatient Prospective Payment System ‘OPPS’ or ‘Non-OPPS’ by passing a flag to the OCE in the claim record, 1=OPPS, 2=Non-OPPS; a blank, zero, or any other value is defaulted to 1. These edits are updated quarterly and changes are communicated through Program Memorandum Transmittals. The OPPS functionality of the Integrated Outpatient Code Editor (I/OCE) software was developed for the implementation of the Medicare outpatient prospective payment system mandated by the 1997 Balanced Budget Act. CMS released the proposed OPPS rules using the Ambulatory Payment Classification (APC) system in the September 8, 1998 Federal Register. Final regulations were published in the April 7, 2000 Federal Register and the system became effective for Medicare on August 1, 2000.The APC-based OPPS developed by CMS is the outpatient equivalent of the inpatient, DRG-based PPS. The APC system establishes groups of covered services so that the services within each group are comparable clinically and with respect to the use of resources.
The OCE not only identifies individual errors but also indicates what actions should be taken and the reasons why these actions are necessary. In order to accommodate this functionality, the OCE is structured to return lists of edit numbers. This structure facilitates the linkage between the actions being taken, the reasons for the actions and the information on the claim (e.g., a specific diagnosis) that caused the action. In general, the OCE performs all functions that require specific reference to HCPCS codes, HCPCS modifiers and ICD-9-CM diagnosis codes. Since these coding systems are complex and annually updated, the centralization of the direct reference to these codes and modifiers in a single program will reduce effort and reduce the chance of inconsistent processing.
About this Dataset
Data Info
Date Created
2016-01-11
Last Modified
2019-10-01
Version
2019-10-01
Update Frequency
Quarterly
Temporal Coverage
2016-2019
Spatial Coverage
United States
Source
John Snow Labs; Centers of Medicare and Medicaid Services;
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
HCPCS Codes Mapping for IOCE, IOCE Quarterly Release Files V 20.0, HCPCS, HCPCS CPT, HCPCS Coding, HCPCS Coding System, HCPCS Age Restrictions, Healthcare Common Procedure Coding System, Hickpicks
Other Titles
Integrated Outpatient Quarterly Release Files Version 20.0, HCPCS Codes Mapping Data Differences for IOCE Quarterly Release Files
Data Fields
Name
Description
Type
Constraints
Type
Identifies the type of difference
string
-
HCPCS
Healthcare common procedure coding system
string
-
Ambulatory_Payment_Classification
Assignment for healthcare common procedure coding system
string
-
Status_Indicator
Status indicator for healthcare common procedure coding system
string
-
Payment_Indicator
Payment indicator code for healthcare common procedure coding system
integer
level : Nominal
Gender
Gender (1 = male, 2 = female)
string
-
Max_Units_Allowed
integer
level : Nominal
Questionable_Service
Questionable covered service (Edit 12)
integer
level : Nominal
Service_Not_Paid_By_Medicare
Service not paid by Medicare (Edit 13)
integer
level : Nominal
Not_Recognized_By_Medicare
Not recognized by Medicare for OPPS (Edit 28)
integer
level : Nominal
Is_Conditional_Bilateral
Conditional bilateral code
boolean
-
Is_Independent_Bilateral
Independent bilateral code
boolean
-
Inherent_Bilateral
integer
level : Nominal
Comprehensive
Numeric rank for primary comprehensive APC procedure
integer
level : Nominal
Component
Professional component = 0 & technical component = 1
integer
level : Nominal
Is_Activity_Therapy
Activity therapy in the nursing interventions classification, a nursing intervention defined as the prescription of and assistance with specific physical, cognitive, social, and spiritual activities to increase the range, frequency, or duration of an individual's
boolean
-
Is_Occupational_Therapy
Occupational therapy (OT) is the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities
boolean
-
NonCovered_Service
Non-covered service (Edit 9)
integer
level : Nominal
Not_Included_In_OPPS
Not included in OPPS (Edit 14)
integer
level : Nominal
Is_AddOn
Addon HCPCS codes if required
boolean
-
Vaccine
A vaccine is a biological preparation that provides active acquired immunity to a particular disease
integer
level : Nominal
Antigen
Antigen, substance that is capable of stimulating an immune response
integer
level : Nominal
Splint
A strip of rigid material used for supporting and immobilizing a broken bone when it has been set
integer
level : Nominal
Cast
Stretch fabric cast and splint covers of various designs/colours for people that want to keep their castor splint clean
integer
level : Nominal
Deductible_NA
Deductible not applicable
integer
level : Nominal
Blood_Service
Blood transfusion or exchange (Edit 43)
integer
level : Nominal
Blood_Product
Blood product (Edit 43)
integer
level : Nominal
PHP_Service
Code applicable for Partial Hospitalization logic
integer
level : Nominal
Description
HCPCS code description
string
-
Exclusive_Bilateral
Relating to two sides
integer
level : Nominal
Lab_Path
Laboratory/Pathology codes (Edit 15)
integer
level : Nominal
Sometimes_Therapy
Sometimes therapy” codes outside a therapy plan of care
integer
level : Nominal
Trauma_RevCode_Required
Trauma revenue code for HCPCS
integer
level : Nominal
Critical_Care_Requires_Trauma
Critical care code for HCPCS
integer
level : Nominal
STV_Packaged
Code packaged when S,T, or V procedure present
integer
level : Nominal
Separate_Procedure
Required separated procedure for reporting
integer
level : Nominal
Statutory_Exclusion
StatutoryExclusion code (Edit 50)
integer
level : Nominal
Hourly_Observation
Hourly observation services HCPCS code G0378
integer
level : Nominal
Direct_Admit_Obs
Directly admitted to observation codes
integer
level : Nominal
Not_Recognized_By_OPPS
Not recognized by Medicare for OPPS (Edit 28)
integer
level : Nominal
DME_Only
Bill to DMERC only (Edit 61)
integer
level : Nominal
Unclassified_Drug
Unclassified Drug (Edit 66)
integer
level : Nominal
Approval_Date
Approval date of HCPCS mapping
date
-
T_Packaged
Code packaged when T procedure present
integer
level : Nominal
Radio_Labeled_Product
Radiolabeled products required for nuclear medicine procedure
integer
level : Nominal
Nuclear_Medicine
Nuclear medicine procedure requires diagnostic radiopharmaceutical
integer
level : Nominal
Service_Not_Billable_FI
Service not billable by medicare
integer
level : Nominal
PHP_Sycho_Therapy
Psychotherapy talk therapy
integer
level : Nominal
All_PHP_Service
Code applicable for Partial Hospitalization logic
integer
level : Nominal
Daily_Mental_Health_Service
Code included in Daily Mental Health services cap
integer
level : Nominal
Red_Blood_Cells
Red blood cells (RBCs), also called erythrocytes, are the most common type of blood cell and the vertebrate's principal means of delivering oxygen (O2) to the body tissues—via blood flow through the circulatory system
integer
level : Nominal
Whole_Blood_Cells
Whole blood is made up of red blood cells, white blood cells, platelets, and blood plasma. ... The blood is typically combined with an anticoagulant and preservative during the collection process.
integer
level : Nominal
Critical_Care_Ancillary
Critical care ancillary service
integer
level : Nominal
Deductible_Coinsurance_NA
Deductible & coinsurance no applicable
integer
level : Nominal
Coinsurance_NA
Coinsurance no applicable
integer
level : Nominal
Skin_Substitute_Procedure
Code included as skin substitute application procedure
integer
level : Nominal
Skin_Substitute
Code included as skin substitute product
integer
level : Nominal
Comprehensive_APC_Exclusion
Numeric rank for primary comprehensive APC procedure
integer
level : Nominal
Device_Procedure
Code included as a device-dependent procedure (Edit 92)
integer
level : Nominal
Device
Code included as a device for a device-dependent procedure (Edit 92)
integer
level : Nominal
Skin_Substitute_Procedure_Low
Code included as a low cost skin substitute procedure (Edit 87)
integer
level : Nominal
Skin_Substitute_Low
Code included as a low cost skin substitute product (Edit 87)
integer
level : Nominal
Skin_Substitute_Procedure_High
Code included as a high cost skin substitute product (Edit 87)
integer
level : Nominal
Skin_Substitute_High
Code included as a high cost skin substitute product (Edit 87)
integer
level : Nominal
Lab_Service
Code included as a non-packaged laboratory service for bill type 14X
integer
level : Nominal
FQHC_Preventive
Code included as FQHC PPS preventive service for bill type 77X
integer
level : Nominal
FQHC_Influenza_Ppv
Code included as FQHC PPS influenza/PPV vaccine service for bill type 77X
integer
level : Nominal
FQHC_NonCovered
Code included as FQHC PPS non-covered service for bill type 77X
integer
level : Nominal
FQHC_Addon
Code included as FQHC PPS mental health add-on service code requiring primary procedure code for bill type 77X
integer
level : Nominal
FQHC_Primary
Code included as FQHC PPS primary procedure service code to be reported with mental health add-on service code for bill type 77X
integer
level : Nominal
Device_Procedure_Bypass
Code included as a device-dependent procedure (Edit 92)
integer
level : Nominal
SRS_Plan_And_Prep
Supplementary retirement scheme plan
integer
level : Nominal
NonStandard_CT_Scan
Modifier CT lets CMS know you're using non-standard equipment, and reduces your Medicare Part B payments
integer
level : Nominal
Cornea_Transplant
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue
integer
level : Nominal
Stereotactic_Radiosurgery
Stereotactic radiosurgery (SRS) is a non-surgical radiation therapy used to treat functional abnormalities and small tumors of the brain
integer
level : Nominal
Cornea_Tissue_Processing
This code includes tissue recovery, evaluation, medical review and laboratory tests for infectious disease, processing, and transportation
integer
level : Nominal
Advanced_Care_Planning
Advance care planning is a process that enables individuals to make plans about their future healthcare.
integer
level : Nominal
Annual_Wellness_Visit
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213,
integer
level : Nominal
Terminated_Device_Procedure
Termination device procedure indicates the mid-quarter date when a code or change becomes inactive
integer
level : Nominal
Pass_Through_Skin_Product
Pass thorough skin product codes
integer
level : Nominal
Negative_Pressure_Wound_Therapy
Negative-pressure wound therapy (NPWT) is a therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds and enhance healing of second- and third-degree burns
integer
level : Nominal
Film_XRay
Film Xray code
integer
level : Nominal
Allogeneic_Transplant
Allotransplant is the transplantation of cells, tissues, or organs, to a recipient from a genetically non-identical donor of the same species
integer
level : Nominal
FQHC_Chronic_Care
Federally Qualified Health Centers Chronic Care Management (CCM)