February 2004 Medicaid Bulletin

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In This Issue . . .

All Providers:

All Providers Performing Laboratory Services:

Area Mental Health Centers:

Community Alternatives Program Providers:

Dental Providers:

Durable Medical Equipment Providers:

Health Check Providers:

Nursing Facility Providers:

Pharmacists:

Physicians:

Prescribers:

Attention: All Providers

Corrected 1099 Requests – Action Required by March 1, 2004

Providers receiving Medicaid payments of more than $600 annually receive a 1099 MISC tax form from EDS. The 1099 MISC tax form is generated as required by IRS guidelines. It will be mailed to each provider no later than January 31, 2004. The 1099 MISC tax form reflects the tax information on file with Medicaid as of the last Medicaid checkwrite cycle date, December 29, 2003.

If the tax name or tax identification number on the annual 1099 MISC you receive is incorrect, a correction to the 1099 MISC must be requested. This ensures that accurate tax information is on file with Medicaid and sent to the IRS annually. When the IRS receives incorrect information on your 1099 MISC, it may require backup withholding in the amount of 28 percent of future Medicaid payments. The IRS could require EDS to initiate and continue this withholding to obtain correct tax data.

A correction to the original 1099 MISC must be submitted to EDS by March 1, 2004 and must be accompanied by the following documentation:

Fax both documents to 919-816-4399, Attention: Corrected 1099 Request - Financial

Or

Mail both documents to:

EDS
Attention: Corrected 1099 Request - Financial
4905 Waters Edge Drive
Raleigh, NC 27606

A copy of the corrected 1099 MISC will be mailed to you for your records. All corrected 1099 MISC requests will be reported to the IRS. In some cases, additional information may be required to ensure that the tax information on file with Medicaid is accurate. Providers will be notified by mail of any additional action that may be required to complete the correction to their tax information.

IRS W-9 form

EDS, 1-800-688-6696 or 919-851-8888


Attention: All Providers

Referrals and Service Coordination for the Community Alternatives Program for Disabled Adults

The Community Alternatives Program for Disabled Adults (CAP/DA) provides a variety of home and community services as an alternative to nursing facility care. The program serves disabled adults and the elderly. Each county has designated a lead administrative agency to oversee the day-to-day operation of the program at the local level. In most counties, the lead agency is the entry point for the program and provides the case management for program participants. There are a few counties in which the lead agency has arranged for another agency to handle these functions. Each year the Division of Medical Assistance publishes a list of the local primary contacts for CAP/DA in the general Medicaid bulletin. The following list specifies the name, location, and phone number of the primary CAP/DA case management agency for each county. If the case management agency is not the lead agency, the name of the lead agency is shown in parentheses.

Providers of Medicaid home care services should refer to the list to coordinate any services that they provide to a CAP/DA client with the client’s CAP/DA case manager. The case managers need to be aware when home health services, personal care services, durable medical equipment, home infusion therapy, private duty nursing or hospice are being considered or provided to a CAP/DA client. A "CI" or "CS" in the CAP block of the Medicaid identification card identifies CAP/DA clients.

County

Lead Agency

City

Phone #

Alamance

Alamance County DSS

Burlington

(336) 229-3187

Alexander

Alexander County DSS

Taylorsville

(828) 632-1080

Alleghany

Alleghany Memorial Hospital

Sparta

(336) 372-4464

Anson

Anson Community Hospital

Wadesboro

(704) 695-3409

Ashe

Ashe Services for Aging, Inc.

West Jefferson

(336) 246-2461

Avery

Sloop CAP

Newland

(828) 733-1062

Beaufort

Beaufort County DSS

Washington

(252) 975-5500

Bertie

University Home Care – Cashie
(Lead Agency - East Carolina Health-Bertie)

Windsor

(252) 794-2622

Bladen

Bladen County Health Dept.

Elizabethtown

(910) 862-6221

Brunswick

Brunswick County DSS

Bolivia

(910) 253-2077

Buncombe

Buncombe County DSS

Asheville

(828) 250-5814

Burke

Burke County DSS

Morganton

(828) 439-2000

Cabarrus

Cabarrus County DSS

Kannapolis

(704) 920-1400

Caldwell

Caldwell County DSS

Lenoir

(828) 426-8200

Camden

Albemarle Regional Health Services

Elizabeth City

(252) 338-4066

Carteret

Carteret County DSS

Beaufort

(252) 728-3181

Caswell

Caswell County Health Dept.

Yanceyville

(336) 694-9592

Catawba

Catawba County DSS

Hickory

(828) 695-5600

Chatham

Chatham County Health Dept.

Pittsboro

(919) 542-8220

Cherokee

Murphy Medical Center

Andrews

(828) 321-4113

Chowan

Chowan Hospital Home Care

Edenton

(252) 482-6322

Clay

Clay County Health Dept.

Hayesville

(828) 389-1444

Cleveland

Cleveland Regional Medical Center
Care Solutions

Shelby

(704) 487-0968

Columbus

Columbus County Dept. of Aging

Whiteville

(910) 640-6602

Craven

Craven Regional Medical Center

New Bern

(252) 633-8182

Cumberland

Cape Fear Valley Health System, Inc.

Fayetteville

(910) 609-3400

Currituck

Albemarle Regional Health Services

Elizabeth City

(252) 338-4066

Dare

Dare County DSS

Manteo

(252) 475-5500

Davidson

Davidson County Senior Services

Lexington

(336) 236-3023

Davie

Davie County Hospital

Mocksville

(336) 751-8340

Duplin

Duplin Home Care & Hospice
(Lead Agency - Duplin General Hospital)

Kenansville

(910) 296-0819

Durham

Durham County DSS

Durham

(919) 560-8659

Edgecombe

Edgecombe Home Care & Hospice

Tarboro

(252) 641-7518

Forsyth

Senior Services, Inc.
(Lead Agency - Forsyth County Health Dept.)

Winston Salem

(336) 725-0907

Franklin

Franklin County DSS

Louisburg

(919) 496-5721

Gaston

Gaston County DSS

Gastonia

(704) 862-7540

Gates

Chowan Hospital Home Care
(Lead Agency - Gates County DSS)

Gatesville

(252) 357-1117

Graham

Graham County DSS.

Robbinsville

(828) 479-4201

Granville

Bayada Nurses, Inc.
(Lead Agency - Granville Medical Center)

Raleigh

(919) 676-7000

Greene

Greene County DSS

Snow Hill

(252) 747-5932

Guilford

Guilford County Health Dept.

Greensboro

(336) 641-3660

Halifax

Halifax County DSS

Halifax

(252) 536-6538

Harnett

Harnett County Dept. on Aging

Lillington

(910) 893-7596

Haywood

Haywood County Council on Aging

Waynesville

(828) 452-2370

Henderson

Margaret R. Pardee Hospital

Hendersonville

(828) 696-1000

Hertford

Hertford County DSS

Winton

(252) 358-7830

Hoke

Liberty Home Care
(Lead Agency – Hoke County DSS)

Raeford

(910) 875-8198

Hyde

Hyde County DSS

Swan Quarter

(252) 926-4199

Iredell

Iredell County DSS

Statesville

(704) 878-5086

Jackson

Harris Regional Hospital

Sylva

(828) 586-7410

Johnston

Johnston County DSS

Smithfield

(919) 989-5300

Jones

Jones County DSS

Trenton

(252) 448-2581

Lee

Lee County DSS

Sanford

(919) 718-4690

Lenoir

Lenoir Memorial Hospital

Kinston

(252) 522-7947

Lincoln

Lincoln County DSS

Lincolnton

(704) 732-1969

Macon

Macon County Public Health Center

Franklin

(828) 349-2081

Madison

Madison County Dept. of Community Services

Marshall

(828) 649-2722

Martin

Martin County DSS

Williamston

(252) 809-6403

McDowell

McDowell County DSS

Marion

(828) 652-3355

Mecklenburg

Mecklenburg County Health Dept.

Charlotte

(704) 336-4674

Mitchell

Mitchell County DSS

Bakersville

(828) 688-2175

Montgomery

Montgomery County DSS

Troy

(910) 576-6531

Moore

HealthKeeperz
(Lead Agency - Moore County DSS)

Pinehurst

(910) 255-0500

Nash

Nash County Health Dept.

Rocky Mount

(252) 446-1777

New Hanover

New Hanover Health Network

Wilmington

(910) 343-7711

Northampton

Northampton County DSS

Jackson

(252) 534-5811

Onslow

Onslow Council on Aging

Jacksonville

(910) 455-2747

Orange

Orange County DSS

Hillsborough

(919) 245-2882

Pamlico

Pamlico County Senior Services

Alliance

(252) 745-7196

Pasquotank

Albemarle Regional Health Services

Elizabeth City

(252) 338-4066

Pender

Pender Adult Services

Burgaw

(910) 259-9119

Perquimans

Albemarle Regional Health Services

Elizabeth City

(252) 338-4066

Person

Person County DSS

Roxboro

(336) 599-8361

Pitt

Pitt County DSS

Greenville

(252) 902-1111

Polk

St. Luke’s Hospital

Columbus

(828) 894-0564

Randolph

Randolph Hospital

Asheboro

(336) 625-5151

Richmond

Richmond County Health Dept.

Rockingham

(910) 997-8300

Robeson

Southeastern Regional Medical Center

Lumberton

(910) 618-9405

Rockingham

Rockingham County Council on Aging, Inc.

Reidsville

(336) 349-2343

Rowan

Rowan Regional Medical Center - CapCare

Salisbury

(704) 210-5626

Rutherford

Rutherford Hospital, Inc.

Forest City

(828) 245-3575

Sampson

Sampson County Dept. of Aging and In-Home Services

Clinton

(910) 592-4653

Scotland

HealthKeeperz
(Lead Agency - Scotland County Health Dept.)

Laurinburg

(910) 277-2484

Stanly

Stanly County DSS

Albemarle

(704) 982-6100

Stokes

Stokes County DSS

Danbury

(336) 593-2861

Surry

Surry County Friends of Seniors

Mount Airy

(336) 783-8500

Swain

Swain County Health Dept.

Bryson City

(828) 488-3792

Transylvania

Transylvania Community Hospital

Brevard

(828) 883-5254

Tyrrell

Tyrrell County DSS

Columbia

(252) 796-3421

Union

Union County DSS

Monroe

(704) 296-4300

Vance

Vance County DSS

Henderson

(252) 492-5001

Wake

Resources for Seniors, Inc.

Raleigh

(919) 872-7933

Warren

Warren County DSS

Warrenton

(252) 257-5974

Washington

Washington County Center for Human Services

Plymouth

(252) 793-4041

Watauga

Watauga County Project on Aging

Boone

(828) 265-8090

Wayne

Wayne Memorial Hospital, Inc.

Goldsboro

(919) 731-6314

Wilkes

Home Care of Wilkes Regional Medical Center

North Wilkesboro

(336) 903-7700

Wilson

WilMed Home Care

Wilson

(252) 399-8228

Yadkin

Yadkin County DSS

Yadkinville

(336) 679-3385

Yancey

Yancey County Health Dept.

Burnsville

(828) 682-7967

Barbara Schwab, CAP/DA Administrative Officer
DMA, 919-857-4021


Attention: All Providers

Refiling Denied 2003 New CPT Codes

The September 2003 general Medicaid bulletin lists the new 2003 CPT codes that are covered by N.C. Medicaid. These codes are now covered retroactively to date of service January 1, 2003. Claims that were filed for services performed between January 1, 2003 and February 28, 2003 that received a denial for EOB 9, "service not covered by the Medicaid program," may be refiled at this time as a new claim.

Providers who billed with and were paid for deleted 2002 CPT codes for dates of service January 1, 2003 through August 31, 2003, may request the payment to be recouped and be repaid for the new 2003 CPT codes using the Medicaid Claim Adjustment Request process. These requests are subject to the adjustment time limit guidelines.

EDS, 1-800-688-6696 or 919-851-8888


Attention: Physicians

Hospital Discharge Services – Billing Clarification

Refer to the following information when billing for hospital discharge services. These services include, as appropriate, final examinations, instructions for ongoing care, hospital stay information, and preparation of discharge records.

CPT code 99217 is used to report observation care discharge services provided to a patient when admission and discharge do not occur on the same date of service.

CPT codes 99234 through 99236 are used to report observation care or inpatient hospital care services provided to patients who are admitted and discharged on the same date of service.

CPT codes 99238 and 99239 are used to report all hospital discharge day management services provided to a patient (including newborns) on the day of hospital discharge when admission and discharge do not occur on the same date of service.

CPT code 99435 is used to report discharge services provided to newborns admitted and discharged on the same date of service.

The following CPT codes will not be reimbursed when billed with 99217 for the same date of service:

99234

99235

99236

99238

99239

99435

EDS, 1-800-699-6696 or 919-851-8888


Attention: Area Mental Health Centers and their Contract Agencies

HIPAA Code Conversion Clarification

The end-dating of the Y codes for community-based services (CBS) and the change to H codes did not change the service definition or the requirements for an order or authorization from the mental health center. It simply changed the code to be billed. Everything else remains the same.

The November 2003 Special Bulletin IV, HIPAA Code Conversions, incorrectly states the service limitation for CBS group services as 8 hours per day. The correct service limitation for CBS group service is 2Ύ consecutive hours, as indicated in the service records manual published by the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services. If more than 2Ύ consecutive hours of a group service is provided, it should be billed as day treatment.

Carol Robertson, Behavioral Health Services
DMA, 919-857-4020


Attention: Community Alternatives Program Providers

Recipient Eligibility Response System Update

As a result of the implementation of population group payer (POP) codes for recipients enrolled in the Community Alternatives Program (CAP), the 271 Eligibility Response transaction was updated effective January 1, 2004.

In addition to the 3-digit Medicaid Program Code, the 271 Eligibility Response returns the appropriate POP code for the requested recipient, if they are eligible for a POP group on the requested dates of service. This information is located in the Subscriber Eligibility or Benefit Information loop (2210C), in the SUBSCRIBER ELIGIBILITY OR BENEFIT INFORMATION (EB) segment, in the plan coverage description field (EB05), and the message text field (MSG01).

For information on this transaction, please refer to the June 2003 Special Bulletin II, HIPAA Update.

EDS, 1-800-688-6696 or 919-851-8888


Attention: All Providers

Medical Coverage Policies

The following new or amended medical coverage policies are now available on DMA’s website at http://www.ncdhhs.gov/dma/mp/index.htm:

These policies supersede previously published policies and procedures. Providers may contact EDS at 1-800-688-6696 or 919-851-8888 with billing questions.

Darlene Creech, Medical Policy Section
DMA, 919-857-4020


Attention: All Providers Performing Laboratory Services

Clinical Laboratory Improvements Amendment

Providers must enter the complete Clinical Laboratory Improvements Amendment (CLIA) certification number for the laboratory performing the service on the CMS-1500 claim form. The complete CLIA number is 10 characters in length with the third character an alpha and the other nine characters numeric (example: 34D1000000). Claims without the complete CLIA number will deny.

Where the CLIA number is entered on the claim depends on how the claim is filed.

EDS, 1-800-688-6696 or 919-851-8888


Attention: All Providers Performing Laboratory Services

Clinical Laboratory Improvements Amendment Certification Number Requirements

Effective June 1, 1998, the Clinical Laboratory Improvements Amendment (CLIA) requires that any provider performing laboratory tests have a CLIA certificate in order to receive reimbursement from federal programs. Providers must have their CLIA certificate number on file with the N.C. Medicaid program. The Division of Facility Services issues a CLIA certificate for each laboratory location. Providers with multiple locations must submit the certificate issued for the site where the lab services are rendered. Failure to have a CLIA number on file will result in denied claims. Return a completed form and a copy of your CLIA certificate to:

EDS
Provider Enrollment Unit
PO Box 300009
Raleigh, NC 27622

EDS, 1-800-688-6696 or 919-851-8888

CLIA Certification Information form


Attention: All Dental Providers

Conversion from CPT to CDT-4 Codes for Dental Services

To assure compliance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Medicaid program will no longer be able to accept dental claims with Current Procedural Terminology (CPT) codes filed on the American Dental Association (ADA) claim form. Federal regulations recognize only the Current Dental Terminology (CDT) code set published by the ADA as being HIPAA-compliant for dental claims. As a result, Medicaid is making the following changes to the dental program to assure continued coverage for the small percentage of oral health services that typically have been billed as covered CPT codes in any given year.

Changes in Procedure Codes Covered in the Dental Program
Effective with dates of service on or after February 1, 2004, the Medicaid Dental Program no longer covers CPT codes. Effective with dates of service on or after February 1, 2004, the dental procedure codes listed below have been added to the dental program. An indicator of "R" means that the service is considered routine and does not require prior approval. An indicator of "PA" means that prior approval is required.

CDT-4 Procedure Code

Description

Indicator

Reimbursement Rate

D7412

Excision of benign lesion, complicated

R

$ 230.00

D7413

Excision of malignant lesion up to 1.25 cm

R

182.20

D7414

Excision of malignant lesion greater than 1.25 cm

R

182.20

D7415

Excision of malignant lesion, complicated

R

230.00

D7465

Destruction of lesion(s) by physical or chemical method, by report

R

125.41

D7485

Surgical reduction of osseous tuberosity

R

234.47

D7560

Maxillary sinusotomy for removal of tooth fragment or foreign body

R

243.72

D7840

Condylectomy

R

879.99

D7850

Surgical discectomy, with or without implant

R

849.11

D7858

Joint reconstruction

PA

1,009.57

D7860

Arthrotomy

R

621.89

D7865

Arthroplasty

PA

1,055.64

D7870

Arthrocentesis

R

38.37

D7872

Arthroscopy – diagnosis, with or without biopsy

R

386.27

D7873

Arthroscopy – surgical: lavage and lysis of adhesions

R

434.90

D7940

Osteoplasty – for orthognathic deformities

PA

590.37

D7941

Osteotomy – mandibular rami

PA

1,047.15

D7943

Osteotomy – mandibular rami with bone graft; includes obtaining the graft

PA

1,115.28

D7944

Osteotomy – segmented or subapical – per sextant or quadrant

PA

881.19

D7945

Osteotomy – body of mandible

PA

1,094.72

D7946

LeFort I (maxilla – total)

PA

1,081.11

D7947

LeFort I (maxilla – segmented)

PA

815.20

D7948

LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) – without bone graft

PA

1,409.55

D7949

LeFort II or LeFort III – with bone graft

PA

1,946.33

D7950

Osseous, osteoperiosteal, or cartilage graft of the mandible or facial bones – autogenous or nonautogenous, by report

PA

893.38

D7960

Frenulectomy (frenectomy or frenotomy) – separate procedure

PA

149.71

D7972

Surgical reduction of fibrous tuberosity

R

175.37

D7991

Coronoidectomy

R

486.45

New Prior Approval Requirement for Code D7340
With the addition of coverage for code D7960, Medicaid no longer uses code D7340 to cover a labial or buccal frenectomy procedure. Code D7340 is used exclusively as defined in the CDT-4 manual, Vestibuloplasty – ridge extension (secondary epithelialization). As a result, the reimbursement rate has been adjusted (see below), and code D7340 requires prior approval effective with dates of service on or after February 1, 2004.

Revised Dental Reimbursement Rates
Effective with dates of service on or after February 1, 2004, reimbursement rates for the following dental procedure codes have been revised to be more consistent with rates paid for comparable procedures billed as CPT codes. With the exception of code D7340, the prior approval indicator remains unchanged from that published in the current Medical Coverage Policy #4A, Dental Services. An indicator of "R" means that the service is considered routine and does not require prior approval. An indicator of "PA" means that prior approval is required. The "EM" indicator designates an emergency service as defined in Medical Coverage Policy #4A, Dental Services.

CDT-4 Procedure Code

Description

Indicator

Reimbursement Rate

D0160

Detailed and extensive oral evaluation – problem focused, by report

R

$ 59.40

D0290

Posterior-anterior or lateral skull and facial bone survey film

R

31.43

D0320

Temporomandibular joint arthrogram, including injection

R

39.11

D7260

Oroantral fistula closure

R

398.87

D0160

Detailed and extensive oral evaluation – problem focused, by report

R

59.40

D0290

Posterior-anterior or lateral skull and facial bone survey film

R

31.43

D0320

Temporomandibular joint arthrogram, including injection

R

39.11

D7260

Oroantral fistula closure

R

398.87

D7286

Biopsy of oral tissue – soft (all others)

R

113.30

D7340

Vestibuloplasty – ridge extension (secondary epithelialization)

PA

548.59

D7350

Vestibuloplasty – ridge extension (including soft tissue grafts)

PA

1,016.32

D7410

Excision of benign lesion up to 1.25 cm

R

169.11

D7450

Removal of benign odontogenic cyst or tumor – lesion diameter up to 1.25 cm

R

370.61

D7451

Removal of benign odontogenic cyst or tumor – lesion diameter greater than 1.25 cm

R

370.61

D7460

Removal of benign nonodontogenic cyst or tumor – lesion diameter up to 1.25 cm

R

370.61

D7461

Removal of benign nonodontogenic cyst or tumor – lesion diameter greater than 1.25 cm

R

370.61

D7510

Incision and drainage of abscess – intraoral soft tissue

EM

152.62

D7520

Incision and drainage of abscess – extraoral soft tissue

EM

289.05

D7540

Removal of reaction producing foreign bodies, musculoskeletal system

EM

179.37

D7550

Partial ostectomy/sequestrectomy for removal of non-vital bone

EM

486.13

D7630

Mandible – open reduction (teeth immobilized, if present)

EM

677.24

D7640

Mandible – closed reduction (teeth immobilized, if present)

EM

388.90

D7680

Facial bones – complicated reduction with fixation and multiple surgical approaches

EM

804.38

D7730

Mandible – open reduction

EM

692.07

D7740

Mandible – closed reduction

EM

442.65

D7750

Malar and/or zygomatic arch – open reduction

EM

901.78

D7780

Facial bones – complicated reduction with fixation and multiple surgical approaches

EM

851.76

D7810

Open reduction of dislocation

EM

675.56

D7820

Closed reduction of dislocation

EM

81.20

D7910

Suture of recent small wounds up to 5 cm

EM

174.94

D7911

Complicated suture – up to 5 cm

EM

271.80

D7912

Complicated suture – greater than 5 cm

EM

337.33

D7920

Skin graft (identify defect covered, location and type of graft)

PA

468.94

D7980

Sialolithotomy

PA

319.17

D7981

Excision of salivary gland, by report

PA

441.43

D7982

Sialodochoplasty

PA

396.28

D7990

Emergency tracheotomy

EM

204.89

D9610

Therapeutic drug injection, by report

R

15.92

D9630

Other drugs and/or medicaments, by report

R

15.92

Revised Medical Coverage Policy for Dental Services
The changes described above have been incorporated into Medical Coverage Policy #4A, Dental Services. Revisions have been made primarily in sections 1.0 and 5.3 of that policy.

Ronald Venezie, DDS, MS, Dental Advisor
DMA, 919-857-4025


Attention: Nursing Facility Providers

A Reminder about Retroactive Prior Approval

It is the responsibility of the nursing facility to ensure that the initial FL2 request for prior approval is on file with EDS when a recipient is admitted to their facility.

Requests for approval of retroactive coverage for nursing facility services must be made to EDS if the coverage period is less than 90 days from the date of the initial FL2 request. The request may be made by telephone.

Requests for approval of retroactive coverage exceeding 90 days but less than 180 days from the initial FL2 request must be made to the Division of Medical Assistance. The request must be made in writing and include all pertinent medical justification for the dates of service requested.

DMA will not approve requests for retroactive coverage exceeding 180 days.

Linda Perry, R.N. Long-term Nurse Consultant
DMA, 919-857-4020


Attention: Durable Medical Equipment Providers

Addition of Code E0760, Ultrasonic Osteogenesis Stimulator to DME Fee Schedule

Effective with date of service February 1, 2004, ultrasonic osteogenesis stimulators were added to the Capped Rental category of the DME Fee Schedule. The code and maximum reimbursement rates are as follows:

Code

Description

Rental

New

Used

E0760

Osteogenesis stimulator, low intensity ultrasound, non-invasive

$ 297.33

$ 2,973.20

$ 2,229.90

Providers must bill their usual and customary rate. Prior approval is required. Medical necessity must be documented on the Certificate of Medical Necessity and Prior Approval form.

An ultrasonic osteogenesis stimulator (code E0760) is covered only if all of the following criteria are met:

  1. non-union of a fracture (ICD-9-CM codes listed below) documented by a minimum of two sets of radiographs obtained prior to starting treatment with the osteogenesis stimulator, separated by a minimum of 90 days, each including multiple views of the fracture site, and with a written interpretation by a physician stating that there has been no clinically significant evidence of fracture healing between the two sets of radiographs; and
  2. documented failure of at least one open surgical intervention for the treatment of the fracture; and
  3. fracture is not of the skull or vertebrae; and
  4. fracture is not tumor-related.

A non-union of a fracture other than the skull or vertebrae is described in ICD-9-CM code 733.82 plus the code for the fracture site. ICD-9-CM covered codes include the following:

Melody B. Yeargan, P.T., Medical Policy
DMA, 919-857-4020


Attention: All Health Check Providers

Developmental Screening and Surveillance

Did you know that about 16 percent of children have disabilities including speech and language delays, mental retardation, learning, and emotional/behavioral problems? Only 50 percent are detected prior to school entrance, which eliminates the possibility of early intervention. More than 20 years of research have proven that early intervention produces immediate and long-term benefits for children with disabilities, their families, and society.

Child development, a dynamic process, is often difficult to measure. Identifying children with developmental delays is important in the medical setting because a child’s primary care provider is generally the best-informed professional with whom families have regular contact over the first five years of the child’s life.

Developmental screening including mental, emotional, and behavioral is one of the many components of a complete Health Check visit. The AAP Committee on Children with Disabilities is recommending the use of standardized screening tests at well child visits.

So what standardized developmental screening tools are available and what is practical to use in the primary care practice? Primary care practices in North Carolina, within two different demonstration projects, have put standardized screening tools "to the test" and have successfully integrated developmental screening and surveillance into their office workflow. If you are interested in learning more about what is practical and what works contact Curtis Honeycutt, Health Check staff.

Angela Floyd, Health Check Program
DMA, 919-857-4022


Attention: Pharmacists and Prescribers

Cialis

Effective December 1, 2003, Cialis was added to the list of drugs for impotency covered by the N.C. Medicaid program. There is a limit of two units per month. The physician must document in his/her own handwriting "erectile dysfunction" on the face of the prescription. Impotence drugs for males 25 years of age and older do not require prior approval. For males under 25 years of age, the physician (or designee) must obtain prior approval from the Division of Medical Assistance. The prior approval request must include documentation for the medical necessity. Requests should be sent to the following address:

N.C. Division of Medical Assistance
Attention: Pharmacy Section
2501 Mail Service Center
Raleigh, NC 27699-2501

Fax: 919-715-1255

Sharman Leinwand, Medical Policy Section
DMA, 919-857-4020


Proposed Medical Coverage Policies

In accordance with Session Law 2003-284, proposed new or amended Medicaid medical coverage policies are available for review and comment on DMA’s website. To submit a comment related to a policy, refer to the instructions on the website. Providers without Internet access can submit written comments to the address listed below.

Darlene Creech
Division of Medical Assistance
Medical Policy Section
2501 Mail Service Center
Raleigh, NC 27699-2501

The initial comment period for each proposed policy is 45 days. An additional 15-day comment period will follow if a proposed policy is revised as a result of the initial comment period.


Checkwrite Schedule

February 3, 2004

March 2, 2004

April 6, 2004

February 10, 2004

March 9, 2004

April 13, 2004

February 17, 2004

March 16, 2004

April 20, 2004

March 25, 2004

May 5, 2004

 

Electronic Cut-Off Schedule

January 30, 2004

February 27, 2004

April 2, 2004

February 6, 2004

March 5, 2004

April 8, 2004

February 13, 2004

March 12, 2004

April 16, 2004

 

March 19, 2004

April 30, 2004

Electronic claims must be transmitted and completed by 5:00 p.m. on the cut-off date to be included in the next checkwrite. Any claims transmitted after 5:00 p.m. will be processed on the second checkwrite following the transmission date.


 

_____________________
 
_____________________
Gary M. Fuquay, Acting Director
 
Patricia MacTaggart
Division of Medical Assitance
 
Executive Director
Department of Health and Human Services
 
EDS

 

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