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

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.

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

• 2000 CPT Update, 1/00
• Accessing Hospice Participation Information on Automated Voice Response, 5/00
• Additional Medicaid Fair Handbooks Still Available, 3/00
• Basic Medicaid Seminar Schedule
  • 2/00
  • 3/00
• Changes to CPT 2000 Coverage, 3/00
• Corrected 1099 Requests-Action Required by March 15, 2000
  • 1/00
  • 2/00
• Directions to the DME and Basic Medicaid Seminars, 3/00
• Directions to the PASARR Seminars, 3/00
• Endoscopy CPT Base Codes and Their Related Procedures, 7/00
• Fee Schedules, Reimbursement Plans and Medicaid Bulletin Subscriptions, 5/00
• Forms Available on Website, 4/00
• Forms, 2/00
• Holiday Observance
  • 1/00
  • 3/00
  • 4/00
  • 5/00
  • 6/00
  • 7/00
• Implantable Contraceptive Capsules, 5/00
• Index of All 1999 General Bulletin Articles and Special Bulletins, 2/00
• Medicaid Adjustment Form, 2/00
• Medicaid Bulletins on DMA Website, 6/00
• Medicaid Managed Care HMO Risk Contract Update, 7/00
• Medicaid Resolution Inquiry, 4/00
• Medicaid Resolution Inquiry Form, 2/00
• Medicare Crossover Reference Request, 2/00
• North Carolina Electronic Claims Submission Software, 1/00
• Pap Smear Billing Changes, 5/00
• Preadmission Screening and Annual Resident Review Seminars, 3/00
• Preventive Medicine Services, 6/00
• Renovation of the MMIS System - ITME Project
  • 4/00
  • 6/00
• Resubmission vs. Filing Adjustment, 5/00
• Six Prescription Limit Override Form, 2/00
• Special W-9
  • 1/00
  • 2/00
• Sterilization Guidelines, 6/00
• Third Party Billing, 1/00
• Update on Year 2000 Activities, 1/00
• *Special Bulletin I: CPT Code Conversion, 5/00

Anesthesia Providers

• Individual Visits, 1/00
• Monitored Anesthesia Care and Diagnosis Editing, 6/00

Adult Care Home Providers

• Correction to Medicaid Special Bulletin - Number VII, December 1999, 3/00

Ambulance Providers

• Individual Visits, 3/00

CAP Providers and Case Managers

• Reimbursement Rate Increase
  • 1/00
  • 2/00

Carolina ACCESS Providers

• Billing Procedures When a Carolina ACCESS Medicaid Recipient has been in an Accident, 6/00
• Carolina ACCESS Expectations of Primary Care Providers, 7/00
• Changes Made Within Your Practice, 1/00

Chiropractor Providers

• Chiropractor Visits, 6/00

CRNA and Anesthesiologist Providers

• Individual Visits, 1/00

Durable Medical Equipment Providers

• Change in HCPCS Codes for Supplies for Use with Nebulizers and Suction Pumps, 4/00
• Coverage of Blood Glucose Monitors with Special Features, 1/00
• Coverage of Diabetic Supplies, 7/00
• Directions to the DME and Basic Medicaid Seminars, 3/00
• DME Seminar Schedules
  • 2/00
  • 3/00

Dental Providers

• Changes to the Dental Program Effective July 1, 2000, 7/00
• Dental Seminars, 3/00, pg. 16; 4/00
• Directions to the Dental Seminars, 4/00
• New Dental Claim Form and Code Updates for the Year 2000, 5/00
• Reimbursement Rate Increase, 1/00
• Sample of the 1999 ADA Claim Form
  • 5/00
  • 7/00

Dialysis Providers

• Dialysis Termination Dates, 1/00
• Dialysis Visits, 4/00

ECS Submitters

• Electronic Filing Tips, 3/00

FQHC/RHC Providers

• FQHC/RHC Visits, 7/00

Health Check Providers

• Directions to the Health Check Seminars, 2/00
• Health Check Billing Guide Error, 6/00
• Health Check Next Screening Date Changes, 3/00
• Health Check Seminars
  • 1/00
  • 2/00
• Rate Increase: Health Check, 3/00

Health Departments

• Dental Seminar Schedule, 4/00
• Directions to the Dental Seminars, 4/00
• Directions to the Health Department Seminars, 4/00
• Health Department Seminar Schedule, 4/00
• Medication Administration Codes, 5/00
• Physical and Occupational Therapy Evaluations, 6/00

Health Department Dental Staff

• Conversion from Clinic Visit Medicaid Billings to ADA Coded Billings, 7/00
• Dental Seminar Schedule, 4/00
• Directions to the Dental Seminars, 4/00

Home Health Providers

• Amendments to Home Medical Supply List, 1/00
• Correction to Billing Instructions for Skilled Nursing Visits - Eff. Feb. 1, 2000 Date of Service, 3/00
• Corrections to UB-92 Instructions in the October 1999 Revision of the Community Care Manual, 3/00
• Directions to the Home Health Seminars, 1/00
• HCPCS Codes for Skilled Nursing Providers, 5/00
• Home Health Seminar Schedule, 1/00

Home Infusion Therapy Providers

• Home Infusion Therapy Visits, 6/00

Hospice Providers

• Corrections to UB-92 Instructions in the October 1999 Revision of the Community Care Manual, 3/00
• Hospice Participation Information on Automated Voice Response System, 3/00
• Hospice Participation Reporting Requirements, 3/00
• Hospice Rates, 1/00
• FAQ's About the Hospice Participation Reporting Requirements, 5/00

Hospital Providers

• Ancillary Services Paid without Prior Authorization, 1/00
• Billing Sterilizations on UB-92, 6/00
• Directions to the Hospital Seminars, 6/00
• Hospital Seminar Schedule
  • 5/00
  • 6/00
• ICD-9 Procedure Code 47.09, 5/00
• Interpreter Signature on Sterilization Consent Form, 4/00
• Resident Supervision Requirements in Teaching Hospitals and Residency Programs, 6/00

Labs

• Reimbursement Rate Increase, 1/00

Local Education Agencies Providers

• Change of Documentation Requirements, 3/00

Mental Health/Substance Abuse Providers

• A New Health Benefit
  • 5/00
  • 6/00

Nursing Facility Providers

• Discharge of a Nursing Facility Resident, 5/00
• Nursing Facility Seminars, 7/00

OB/GYN Providers

• Directions to the OB/GYN Seminars, 5/00
• OB/GYN Seminars
  • 4/00
  • 5/00

Optical Providers

• Confirmation/Prior Approval Reminder, 6/00

Personal Care Service Providers

• Corrections to UB-92 Instructions in the October 1999 Revision of the Community Care Manual, 3/00
• Directions to the Personal Care Services Seminars, 7/00
• Personal Care Services Seminars
  • 6/00
  • 7/00
• Reimbursement Rate Increase, 1/00

Physicians

• Change to Injectable Drug List, 3/00
• Correction to Injectable Drug List, 5/00
• Coverage Criteria for Implantation of Patient-activated Cardiac Event Recorder, 4/00
• Injectable Drug Fee Change, 5/00
• Interpreter Signature on Sterilization Consent Form, 4/00
• Medication Administration Codes, 5/00
• Patient Demand Single or Multiple Event Recording CPT 93268, 7/00
• Physical and Occupational Therapy Evaluations, 6/00
• Reimbursement Rate: Physician Fees, 1/00
• Resident Supervision Requirements in Teaching Hospitals and Residency Programs, 6/00
• Update to Injectable Drug List
  • 4/00
  • 6/00

Prescribers

• Conversion from UPIN to DEA Number, 1/00
• DEA Number Form, 4/00
• DEA Number Required
  • 2/00
  • 4/00

Private Duty Nursing Providers

• Corrections to UB-92 Instructions in the October 1999 Revision of the Community Care Manual, 3/00

Psychiatric Hospital Providers

• Update on Continued Stay Review, 1/00

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:

• LCSWs can bill the following codes: 90801, 90802, 90804, 90806, 90810, 90812, 90814, 90816, 90818, 90821, 90823, 90826, 90828, 90845, 90846, 90847, 90849, 90853, 90857.
• CNSs can bill the following codes: 90801, 90802, 90804, 90806, 90808, 90810, 90812, 90814, 90816, 90818, 90821, 90823, 90826, 90828, 90846, 90849, 90853, 90857.
• The attending physician's provider number is used when filing claims.
• The prior approval process will follow the new preventive/early intervention mental health guidelines, which allows for 26 unmanaged visits.

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

Electronic Cut-Off Schedule

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.

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