August 2000 North Carolina Medicaid Bulletin

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Providers are responsible for informing their billing agency for information in this bulletin
In This Issue

All Providers

Durable Medical Equipment (DME) Providers:

Family Practice Providers:

Home Health Providers:

Independent Practitioners:

Mental Health/Substance Abuse Providers:

Nursing Facility Providers:


Attention: All Providers

Forms

As a result of requests from providers, frequently used forms will be printed in the General Bulletin on a periodic basis. This month find forms for Health Insurance Information Referral (DMA-2057), Electronic Funds Transfer, Provider Certification for Signature on File, and Pharmacy Adjustment Request. These forms are printed on white paper in the center of this bulletin and may be duplicated for your convenience. Please watch future bulletins for other forms.

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



Attention: All Providers

Endoscopy CPT Base Codes and Their Related Procedures

This article is being reprinted because the opening paragraph was inadvertently deleted from the original article printed in the July Medicaid Bulletin.

The following table represents a current and updated list of base and related endoscopy codes as designated in the Resource Based Relative Value System (RBRVS). The effective date of two new groups "31 and 32" is 01/01/2000. Groups "28 and 29" have been end-dated effective 04/01/2000. This list replaces the list published in the May 1999 Medicaid Bulletin.

Scopy Base and Related Code Group
Group
Base code
Related Codes
Comments
1 29815 29819-29823, 29825-29826  
2 29830 29834-29838  
3 29840 29843-29847  
4 29860 29861-29863  
5 29870 29871, 29874-29877, 29879-29887  
6 31505 31510-31513  
7 31525 31527-31530, 31535, 31540, 31560, 31570  
8 31526 31531, 31536, 31541, 31561, 31571  
9 31622 31625, 31625-31631, 31635, 31640-31641, 31645  
10 43200 43202, 43204-43205, 43215-43217, 43219-43220, 43226-43228  
11 43235 43239, 43241, 43243-43247, 43249-43251, 43255, 43258-43259  
12 43260 43261-43265, 43267-43269, 43271-43272  
13 44360 44361, 44363-44366, 44369, 44372-44373   
14 44376 44377-44378   
15 44388 44389-44394  
16 45300 45303, 45305, 45307-45309, 45315, 45317, 45320-45321  
17 45330 45331-45334, 45337-45339  
18 45378 45379-45380, 45382-45385  
19 46600 46604, 46606, 46608, 46610-46612, 46614-46615  
20 47552 47553-47556  
21 50551 50555, 50557, 50559, 50561   
22 50570 50572, 50574-50576, 50578, 50580   
23 50951 50953, 50955, 50957, 50959, 50961   
24 50970 50974, 50976   
25 52000 52250, 52260, 52265, 52270, 52275-52277, 52281, 52283, 52285, 52290, 52300, 52305, 52310, 52315, 52317-52318, 52282  
26 52005 52320, 52325, 52327, 52330, 52332, 52334   
27 52335 52336-52339  
28 56300 56301-56309, 56311, 56343-56344, 56314 End-dated 04/01/00 due to 2000 CPT updates
29 56350 56351-56356 End-dated 04/01/00 due to 2000 CPT updates
30 57452 57454, 57460  
31 49320 38570, 49321-49323, 58550, 58551, 58660-58662, 58670, 58671 Effective 01/01/00, new family of codes for 2000 based on RBRVS 
32 58555 58558-58563 Effective 01/01/00, new family of codes for 2000 based on RBRVS 

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


Attention: All Providers

Denied Managed Care Claims

EDS is now assisting providers with all denied claims issues including problems related to Carolina ACCESS (CA). The local Managed Care Representative (MCR) will no longer receive CA denied claims information. If assistance is needed in attaining help from EDS, your MCR is available to facilitate a meeting between your practice and the appropriate staff at EDS. Providers can request assistance directly from EDS by calling 1-800-688-6696.

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


Attention: Durable Medical Equipment (DME), Home Health Providers

Coverage of Diabetic Supplies

This article is being republished because "Home Health Providers" was erroneously omitted from the attention line in the July Medicaid Bulletin.

This article is being published subsequent to inquiries from Medicaid recipients about Medicaid coverage and access of diabetic supplies.

Both DME and Home Health providers may furnish the following diabetic supplies to Medicaid recipients:
 
CODE
DESCRIPTION
A4253
Blood glucose test strips for use with monitor
A4258
Spring-powered device for lancet
A4259
Lancets
W4651
Blood glucose test strips (visual strips)
W4667
Insulin syringe with needle, 1 cc or smaller
W4675
Urine test strips for combination ketones and glucose
W4676
Urine test strips or tablets for ketones
W4677
Urine test strips or tablets for glucose

In addition, DME providers may furnish the following diabetic supplies to Medicaid recipients:
 
CODE
DESCRIPTION
W4018
Dial-a-dose insulin delivery device
W4063
Needle for use with dial-a-dose system

DME providers should refer to Section 6 of the North Carolina Medicaid Durable Medical Equipment Manual, March 1, 1999 Reprint and to the September 1998 Medicaid Bulletin article, "Coverage of Diabetic Equipment and Supplies" for complete instructions for providing diabetic supplies.

Home health providers should refer to Section 5.1.6 of the North Carolina Medicaid Community Care Manual, October 1999 Revision for complete instructions for providing medical supplies.

Dot Ling, Medical Policy
DMA, 919-857-4021

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


Attention: All Providers

Index of all 2000 General Bulletin Articles and Special Bulletins

All Providers

Anesthesia Providers

Adult Care Home Providers

Ambulance Providers

CAP Providers and Case Managers

Carolina ACCESS Providers

Chiropractor Providers

CRNA and Anesthesiologist Providers

Durable Medical Equipment Providers

Dental Providers

Dialysis Providers

ECS Submitters

FQHC/RHC Providers

Health Check Providers

Health Departments

Health Department Dental Staff

Home Health Providers

Home Infusion Therapy Providers

Hospice Providers

Hospital Providers

Labs

Local Education Agencies Providers

Mental Health/Substance Abuse Providers

Nursing Facility Providers

OB/GYN Providers

Optical Providers

Personal Care Service Providers

Physicians

Prescribers

Private Duty Nursing Providers

Psychiatric Hospital Providers


Attention: All Providers

Modifier 25 and Minor Procedures

Modifier 25 appended to an Evaluation and Management (E/M) procedure code denotes the E/M visit as a significant and separately identifiable service performed by the same physician on the same day as a minor procedure.

A minor procedure is a procedure or service with 0 to 10 days follow up and includes not only operative procedures but also procedures or services such as 59025 (fetal non-stress test) and 93000 (Electrocardiogram).

Following are examples of billing modifier 25 appropriately.

Example #1:

The provider has a scheduled appointment to perform a fetal non-stress test. At the same appointment the recipient complains of an earache and sore throat. The provider will append modifier 25 to the E/M visit for the earache and sore throat indicating a service was performed that was significant and separately identifiable from the fetal non-stress test.

Example #2:

The provider has a scheduled appointment to perform an Electrocardiogram. At the same appointment the recipient complains of a red and painful toe. The provider will append modifier 25 to the E/M visit for the toe indicating a service was performed that was significant and separately identifiable from the Electrocardiogram.

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


Attention: All Mental Health/Substance Abuse Providers

Incident to Policy for Licensed Clinical Social Workers and Clinical Nurse Specialists

Effective August 1, 2000, the Division of Medical Assistance (DMA) has expanded the "incident to service" policy to include Licensed Clinical Social Workers (LCSW) and Clinical Nurse Specialists (CNS) who are masters level registered nurses with psychiatric certification in providing mental health/substance abuse services. The LCSW and CNS must be an employee of the supervising physician, physician group practice, or of the legal entity that employs the physician who provides direct personal supervision. Please refer to the July 1997 North Carolina Medicaid Bulletin article concerning the incident to service policy.

Billing guidelines:

Please note that this article is not directly related to DMA's plan to allow the direct enrollment of LCSWs, CNSs, and psychologists. Information related to direct enrollment will follow in a later issue of the Medicaid Bulletin.

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


Attention: Mental Health Providers

Individual Visits

EDS is offering individual provider visits for Mental Health providers. Please complete and return the form below. An EDS Provider Representative will contact you to schedule a visit and discuss the type of issues to be addressed.

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


Attention: Family Practice Providers

Individual Visits

EDS is offering individual provider visits for Family Practice providers. Please complete and return the form below. An EDS Provider Representative will contact you to schedule a visit and discuss the type of issues to be addressed.

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


Attention: Independent Practitioners

Independent Practitioner Seminars

Independent Practitioner seminars are scheduled for October, 2000. The September Medicaid Bulletin will have the registration form and a list of site locations for the seminars. Please list any issues you would like addressed at the seminars.

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


Attention: Nursing Facility Providers

Nursing Facility Seminar Schedule

Seminars for nursing facility providers are scheduled for September, 2000. These seminars will focus on nursing facility guidelines and policies, prior approval, FL2 completion, UB-92 instructions, and denial resolution.

Please select the most convenient site and return the completed registration form to EDS as soon as possible. Seminars begin at 10:00 a.m. and end at 1:00 p.m. Providers are encouraged to arrive by 9:45 a.m. to complete registration. Due to limited seating, preregistration is required. Providers not registered are welcome to attend if reserved space is adequate to accommodate.  Return the Nursing Facility Seminar Registration Form to:

                Provider Services
                EDS
                P.O. Box 300009
                Raleigh, NC 27622

Note: Providers should bring their June 2000 issue of the Nursing Facility manual to the workshop for reference. Additional manuals will be available for purchase at $6.00. If you plan to purchase a manual at the workshop please bring a three-ring binder.
 

Directions
 
Wednesday, September 6, 2000
Four Points Sheraton
5032 Market Street
Wilmington, NC
Tuesday, September 12, 2000
Blue Ridge Community College
College Drive
Flat Rock, NC
Auditorium
Thursday, September 14, 2000
Ramada Inn
3050 University Parkway
Winston-Salem, NC
Tuesday, September 19, 2000
Holiday Inn Conference Center
530 Jake Alexander Blvd., S.
Salisbury, NC
Thursday, September 28, 2000
WakeMed 
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza
 



Directions to the Nursing Facility Seminars

WILMINGTON, NORTH CAROLINA

FOUR POINTS SHERATON

I-40 East into Wilmington to Highway 17 - just off I-40. Turn left onto Market Street. The Four Points Sheraton is located approximately ½ mile on the left.

FLAT ROCK, NORTH CAROLINA

BLUE RIDGE COMMUNITY COLLEGE

I-40 to Asheville. Head East on I-26 to Exit 22. Turn right and take the next right. At the large Blue Ridge Community College sign turn left. The college is located on the right. Pass the main entrance to the college and turn right into the college entrance past the pond. The parking lot is on the left. Auditorium entrance is located to the right of the main entrance to the Patton Building.

WINSTON-SALEM, NORTH CAROLINA

RAMADA INN PLAZA

I-40 Business to Cherry Street Exit. Continue on Cherry Street for approximately 2 to 3 miles. Turn left at the IHOP Restaurant. The Ramada Inn Plaza is located on the right.

SALISBURY, NORTH CAROLINA

HOLIDAY INN CONFERENCE CENTER

Traveling South on I-85:  Take Exit 75 and turn right on Jake Alexander Blvd.

Traveling North on I-85: Take Exit 75 and turn left on Jake Alexander Blvd. Travel approximately ½ mile. The Holiday Inn is located on the right.
 
  RALEIGH, NORTH CAROLINA

WAKEMED MEI CONFERENCE CENTER

Directions to the Parking Lot:
Take the I-440 Raleigh Beltline to New Bern Avenue, Exit 13A (New Bern Avenue, Downtown). Travel toward WakeMed. Turn left onto Sunnybrook Road and park at the East Square Medical Plaza which is a short walk to the conference facility. Parking is not allowed in the parking lot in front of the Conference Center. Vehicles will be towed if not parked in the East Square Medical Plaza parking lot located at 23 Sunnybrook Road.

Directions to the Conference Center from Parking Lot:
Cross Sunnybrook Road and follow sidewalk access up to Wake County Health Department. Walk across the Health Department parking lot and ascend steps (with blue handrail) to MEI Conference Center. Entrance doors at left.


Checkwrite Schedule

August 8, 2000
September 6, 2000
October 10, 2000
August 15, 2000
September 12, 2000
October 17, 2000
August 24, 2000
September 19, 2000
October 26, 2000
September 28, 2000

 

Electronic Cut-Off Schedule

August 4, 2000
September 1, 2000
October 6, 2000
August 11, 2000
September 8, 2000
October 13, 2000
August 18, 2000
September 15, 2000
October 20, 2000
September 22, 2000


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.

 



Paul R. Perruzzi, Director John W. Tsikerdanos
Division of Medical Assitance Executive Director
Department of Health and Human Services EDS

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