Others titles
- Integrated Outpatient Quarterly Release Files Version 17.0, Release, January, 2016
- HCPCS Codes Mapping Data Differences for IOCE Quarterly Release Files.
Keywords
- HCPCS Codes Mapping for IOCE
- IOCE Quarterly Release Files V 17.0
- Medical Billing
- Billing Cost
- HCPCS CPT
- HCPCS Coding
- HCPCS Coding System
- HCPCS Age Restrictions
- Healthcare Common Procedure Coding System
- Hickpicks
Healthcare Common Procedure Coding System Mapping Quarterly Files
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 the Healthcare Common Procedure Coding System (HCPCS) Codes Mapping Quarterly Files between October, 2015 and January 2016.
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Description
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 |
2016-01 to 2018-01 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers of Medicare and Medicaid Services (cms.gov); |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | HCPCS Codes Mapping for IOCE, IOCE Quarterly Release Files V 17.0, Medical Billing, Billing Cost, HCPCS CPT, HCPCS Coding, HCPCS Coding System, HCPCS Age Restrictions, Healthcare Common Procedure Coding System, Hickpicks |
Other Titles | Integrated Outpatient Quarterly Release Files Version 17.0, Release, January, 2016, 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_Code | Gender Code 0 = not applicable, 1 = male, 2 = female | integer | level : Nominal |
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) | integer | level : Nominal |
Version_Compared | Valid Versions Comparison to the latest Version | integer | level : Nominal |
Begin_Date | Effective date of “VER” | date | - |
Data Preview
Type | HCPCS | Ambulatory Payment Classification | Status Indicator | Payment Indicator | Gender Code | Max Units Allowed | Questionable Service | Service Not Paid By Medicare | Not Recognized By Medicare | Is Conditional Bilateral | Is Independent Bilateral | Inherent Bilateral | Comprehensive | Component | Is Activity Therapy | Is Occupational Therapy | NonCovered Service | Not Included In OPPS | Is AddOn | Vaccine | Antigen | Splint | Cast | Deductible NA | Blood Service | Blood Product | PHP Service | Description | Exclusive Bilateral | Lab Path | Sometimes Therapy | Trauma RevCode Required | Critical Care Requires Trauma | STV Packaged | Separate Procedure | Statutory Exclusion | Hourly Observation | Direct Admit Obs | Not Recognized By OPPS | DME Only | Unclassified Drug | Approval Date | T Packaged | Radio Labeled Product | Nuclear Medicine | Service Not Billable FI | PHP Sycho Therapy | All PHP Service | Daily Mental Health Service | Red Blood Cells | Whole Blood Cells | Critical Care Ancillary | Deductible Coinsurance NA | Coinsurance NA | Skin Substitute Procedure | Skin Substitute | Comprehensive APC Exclusion | Device Procedure | Device | Skin Substitute Procedure Low | Skin Substitute Low | Skin Substitute Procedure High | Skin Substitute High | Lab Service | FQHC Preventive | FQHC Influenza Ppv | FQHC NonCovered | FQHC Addon | FQHC Primary | Device Procedure Bypass | SRS Plan And Prep | NonStandard CT Scan | Cornea Transplant | Stereotactic Radiosurgery | Cornea Tissue Processing | Advanced Care Planning | Annual Wellness Visit | Terminated Device Procedure | Pass Through Skin Product | Negative Pressure Wound Therapy | Film XRay | Allogeneic Transplant | FQHC Chronic Care | Version Compared | Begin Date |
Addition | 0105U | 0 | Q4 | 3 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Neph ckd mult eclia tum nec | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0106U | 0 | Q4 | 3 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Gstr emptg 7 timed brth spec | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0107U | 0 | Q4 | 3 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | C diff tox ag detcj ia stool | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0108U | 0 | Q4 | 3 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Gi barrett esoph 9 prtn bmrk | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0109U | 0 | A | 2 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Id aspergillus dna 4 species | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0110U | 0 | Q4 | 3 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Rx mntr 1+oral onc rx&sbsts | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0111U | 0 | A | 2 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Onc colon ca kras&nras alys | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0112U | 0 | A | 2 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Iadi 16s&18s rrna genes | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0113U | 0 | A | 2 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Onc prst8 pca3&tmprss2-erg | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |
Addition | 0114U | 0 | A | 2 | 0 | 0 | 0 | 0 | 0 | False | False | 0 | 0 | 0 | False | False | 0 | 0 | False | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Gi barretts esoph vim&ccna1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1900-01-01 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 77 | 2019-10-01 |