June 2001 NC Medicaid Bulletin title image

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In This Issue.. 

All Providers

Developmental Evaluation Centers:

Federally Qualified Health Centers:

Health Departments:

Hospital Providers:

Mental Health Providers:

Personal Care Services Providers:

Physicians:

Rural Health Clinics:


 


Attention: Hospitals
Medicare Ambulance Crossover Billing

Medicaid requires hospital-based ambulances to have a separate ambulance provider number (see general Medicaid bulletin, April 1997). However, hospital-based ambulance providers should refrain from billing ambulance crossover services on paper whenever possible as a separate claim to Medicaid.

When hospital-based crossover claims are received by Medicaid via tape from Medicare, the Medicaid payment is remitted to the hospital provider number. When a hospital then submits a paper claim for the same ambulance service, duplicate payment may occur. Hospitals are required to refund the duplicate payment. To prevent this, hospitals must continue to bill ambulance services for regular Medicaid recipients (blue Medicaid identification card) using the hospital's ambulance provider number, but refrain from billing Medicare crossover ambulance services for dually eligible recipients on paper claims.
 

Janet Tudor, Medical Policy Section
DMA, 919-857-4020


Attention: Physicians
Rho (D) Immune Globulin for Intravenous Use (CPT Code 90386) - Billing Guidelines

The N.C. Medicaid program covers Rho (D) immune globulin (RhlgIV), human, for intravenous use, CPT code 90386. This product is given for the treatment of idiopathic thrombocytopenic purpura (ITP) and for the suppression of Rh isoimmunization.

Dosages may vary considerably, depending on the diagnosis. For example, for the treatment of ITP, the dosage may range from 125 to 300 international units (IU) per kilogram (kg) of body weight. To suppress Rh isoimmunization, the dosage usually ranges from 600 IU to 1500 IU.

Effective with date of processing, July 1, 2001, the unit of coverage for CPT 90386 is 1 unit = 100 international units (IU). Providers should indicate the number of units given in block 24G on the HCFA-1500 claim form by rounding up to the next higher number, if necessary. Listed below are two examples of how to bill for CPT code 90386.

Diagnosis Dosage Units Billed in Block 24G of the HCFA-1500
Rh isoimmunization 1500 IU 15
ITP 8491 IU 85

The maximum reimbursement rate is $20.00 per each 100 international units (IU) of Rho (D) immune globulin for dates of processing July 1, 2001 and after.
 

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


Attention: Mental Health Providers
Credentialing Update for Direct-Enrolled Licensed Clinical Social Workers

Medicaid began direct enrollment of Licensed Clinical Social Workers (LCSWs) effective February 1, 2001. The credentials necessary for LCSWs to enroll are:

Because LCSWs who enrolled with Medicare prior to July 1, 2000 were not required to have an MSW, Medicaid will waive this requirement for these LCSWs who apply for enrollment with Medicaid. However, all other LCSWs must meet the requirements for enrollment with Medicaid as indicated above.
 

Darlene Pilkington, Provider Services
DMA, 919-857-4017


Attention: Health Departments, Developmental Evaluation Centers, Federally Qualified Health Centers, and Rural Health Clinics
Use of Codes Y2351 and Y2041

Effective with date of service July 1,2001, CPT codes 97802 and 97803 (see description below) must be used when billing for medical nutrition therapy for pregnant women and children birth through 20 years of age. State-created codes Y2351 and Y2041 will be end-dated with dates of service June 30, 2001 and will no longer be accepted.
 

97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes

97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
 

This material is excerpted from the American Medical Association Current Procedural Terminology 2001. CPT codes, descriptions, and other data only are copyright 2000 by the American Medical Association. All rights reserved.

The following guidelines replace those published in the Technical Manual for Maternity Care Coordination, May 1999; the Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) workshop handout, August 1998; and any other materials from other sources. Please note that these codes apply to services to pregnant women and individuals from birth through age 20. When billing, remember that:

V22.0
V22.1
V22.2
V23.0
V23.1
V23.2
V23.2
V23.4
V23.5
V23.7
V23.81
V23.82
V23.83
V23.84
V23.89
V23.9


Service Provider
Medical nutrition therapy MUST be provided by:

Time spent providing medical nutrition therapy billed to Medicaid may not be charged to the WIC Program.
 

Service Eligibility
Pregnant and Postpartum Women
In order to receive medical nutrition therapy reimbursement, the recipient must:

Children and Adolescents
In order to receive medical nutrition therapy, a child must:


Service Description
Pregnant and Postpartum Women
This service is appropriate for women whose pregnancies are threatened by chronic, episodic or acute conditions for which nutrition therapy is a critical component of medical management, and for postpartum women who need follow-up for these conditions or who develop such conditions early in the postpartum period. The service requires consultation with a patient having a specific disease or requiring a diagnostic nutrition assessment, and may be provided throughout the pregnancy and until the end of the month in which the 60th postpartum day occurs.

Children and Adolescents
This service is appropriate for the treatment of children and adolescents with chronic, episodic or acute conditions for which nutrition therapy is a critical component of medical management or with preventable conditions for which nutrition/diet is the primary therapy.

All Recipients
For both women and children, the nutrition service may include the following components:

  1. a review of medical management and an evaluation of medical and psychosocial history, and treatment plan, as they impact nutrition interventions
  2. a diagnostic nutritional assessment which may include:
  3. development of an individualized nutrition care plan, which may include:
  4. counseling on nutritional/dietary management of nutrition-related medical conditions
  5. consultation with primary care provider
Components 2, 3, and 4 are critical to medical nutrition therapy. The provider must complete at least two of these in order for the service to be billed to Medicaid. In addition, all individuals categorically eligible for the WIC Program must be referred to the WIC Program for routine nutrition education and food supplements.

Medical nutrition therapy must be a face-to-face encounter with an individual or their caretaker. Group classes/instruction (i.e., weight management or diabetes education) are not billable medical nutrition therapy services.
 

Documentation of Services
A clinical record for each recipient of Medicaid-reimbursed medical nutrition therapy must be maintained. For health departments, this documentation will be part of the client's medical record. Documentation must include, at a minimum, the date of service, presenting problem, summary of the required nutrition service components, and the signature of the qualified nutritionist providing the service. Medicaid requires that records of medical nutrition counseling must be maintained for a minimum of five years.
 

Billing for Medical Nutrition Therapy
FQHCs and RHCs must bill using their provider number and the alpha suffix "C." All agencies must bill the same fee for all recipients who receive the same service. If a recipient is covered by a private insurance as well as by Medicaid, the third party insurance should be billed first.
 

Coordination with Other Programs
WIC Program Services
For agencies that also administer a WIC Program, the nutrition education contacts required by the WIC Program must be provided prior to billing Medicaid for medical nutrition therapy. The staff time utilized to provide a Medicaid-reimbursable nutrition service may not be charged to WIC Program funds. A WIC referral must be initiated for all categorically eligible clients.

Care Coordination
Dietitians/nutritionists providing medical nutrition therapy must refer eligible clients to the Maternity Care Coordination or Child Service Coordination programs as indicated.


Referral Criteria for Pregnant and Postpartum Women
Pregnant or postpartum women who have one or more of the following high-risk indicators should be referred to a qualified provider of medical nutrition therapy services:


Referral Criteria for Children and Adolescents
Referral to a qualified provider may be made for any medical condition requiring nutrition intervention, including but not limited to:


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


Attention: Personal Care Services Providers
Personal Care Services Seminars

Personal Care Services (PCS) seminars are scheduled for August 2001. The July general 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. Return Personal Care Services Seminar Issues form to:
 

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

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


 

Checkwrite Schedule

June 12, 2001
July 10, 2001
August 7, 2001
June 19, 2001
July 17, 2001
August 14, 2001
June 28, 2001
July 26, 2001
August 23, 2001

 

Electronic Cut-Off Schedule

June 8, 2001
July 6, 2001
August 3, 2001
June 15, 2001
July 13, 2001
August 10, 2001
June 22, 2001
July 20, 2001
August 17, 2001

 

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 Christopher T. Deelsnyder, CE
Division of Medical Assitance Administrative Process Management
Department of Health and Human Services EDS
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