January 2002 NC Medicaid Bulletin title image

In This Issue..

All Providers: Adult Care Home Providers: Ambulance Services Providers: Carolina ACCESS Primary Care Providers: Dialysis Treatment Facilities: Home Health Agencies: Hospice Providers:


Hospital Providers:


Mecklenburg County Providers:


Nurse Practitioners:


Personal Care Services Providers:


Physicians:


Prescribers:


Private Duty Nursing Providers:


Attention: All Providers

Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Tuesday, January 1, 2002 in observance of New Year's Day, and on Monday, January 21, 2002 in observance of Dr. Martin Luther King, Jr.'s Birthday.
 

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


Attention: All Providers

Current Procedural Terminology Update for 2002

The annual review of the 2002 Current Procedural Terminology (CPT) codes has not been completed. The codes that are covered for 2001 must be utilized until the Division of Medical Assistance provides further directions for filing the 2002 codes. Providers will be notified concerning coverage of new codes in future general Medicaid bulletins.
 

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


Attention: Adult Care Home Providers

Reimbursement Rate Increase for Adult Care Home Providers

Effective with date of service October 1, 2001, the per diem rates paid by the N.C. Medicaid program for Adult Care Home personal care services are:
 
Description Revenue Code HCPCS Code Maximum
Reimbursement
Rate
Basic ACH/PC (Facility Beds 1 to 30) 
599 
W8251 
$ 13.03 
Basic ACH/PC (Facility Beds 31 and above) 
599 
W8258 
14.43 
Therapeutic Leave (TL) (Facility Beds 1 to 30) 
183 
W8251 
13.03 
Therapeutic Leave (TL) (Facility Beds 31 and above) 
183 
W8258 
14.43 
Enhanced ACH/PC (Eating) 
599 
W8256 
10.33 
Enhanced ACH/PC (Toileting) 
599 
W8257 
3.69 
Enhanced ACH/PC (Eating and Toileting) 
599 
W8259 
14.02 
Enhanced ACH/PC (Ambulation/Locomotion) 
599 
W8255 
2.64 

The transportation rate (RC 229) has increased to $.60 per Medicaid resident per day. Providers must bill their usual and customary charges. Adjustments will not be made to previously processed claims.
 

Jackie Burnette, Financial Operations
DMA, 919-857-4015


Attention: Hospital Providers

Reimbursement Rates for Lower Level of Care, Ventilator Dependent Care, and Swing Bed

Effective with date of service October 1, 2001, the hospital lower level of care, ventilator dependent care, and swing bed rates per patient day are:
 
Level of Care Maximum Reimbursement Rate
Intermediate Care 
$ 96.22 
Skilled Nursing Care 
126.36 
Ventilator Dependent Care 
359.70 

Adjustments will not be made to previously processed claims.
 

Carolyn Brown, Financial Operations
DMA, 919-857-4015


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. This year's list shows 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 with the client's CAP/DA case manager any services that they provide to a CAP/DA client. CAP/DA 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.

CAP/DA Lead Agency List
 
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) 757-1180 
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  District Memorial Hospital  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) 633-8240 
Cumberland  Cape Fear Valley Health System, Inc.  Fayetteville  (910) 829-1720 
Currituck  Albemarle Regional Health Services  Elizabeth City  (252) 338-4066 
Dare  Dare County DSS  Manteo  (252) 473-1471 
Davidson  Davidson County Senior Services  Thomasville  (336) 474-2754 
Davie  Davie County Hospital  Mocksville  (336) 751-8340 
Duplin  Duplin Home Care and Hospice 
(Lead Agency - Duplin General Hospital) 
Kenansville  (910) 296-0819 
Durham  Durham County DSS  Durham  (919) 560-8659 
Edgecombe  Edgecombe Home Care and 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 Health Dept.  Robbinsville  (828) 479-4201 
Granville  Granville Medical Center  Oxford  (919) 690-3242 
Greene  Greene County DSS  Snow Hill  (252) 747-5932 
Guilford  Guilford County Health Dept.  Greensboro (336) 641-3331 
Halifax  Halifax County DSS  Halifax  (252) 536-6537 
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  Duke / St Joseph Home Health 
(Lead Agency - Hoke County DSS) 
Raeford  (910) 875-8198 
Hyde  Hyde County DSS  Swan Quarter  (252) 926-3371 
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 DSS  Franklin  (828) 349-2124 
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) 336-4700 
Mitchell  Mitchell County DSS  Bakersville  (828) 688-2175 
Montgomery  Montgomery County DSS  Troy  (910) 576-6531 
Moore  FirstHealth Home Care 
(Lead Agency - Moore County DSS) 
West End  (910) 295-2211 
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) 413-1101 
Polk  St. Luke's Hospital  Columbus  (828) 894-0564 
Randolph  Randolph Hospital  Asheboro  (336) 625-5151 
Richmond  FirstHealth Richmond  Rockingham  (910) 997-5800 
Robeson  Southeastern Regional Medical Center  Lumberton  (910) 618-9405 
Rockingham  Rockingham County Council on Aging, Inc.  Reidsville  (336) 349-2343 
Rowan  CapCare Rowan Regional Medical Center  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  Scotland Home Health 
(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) 401-8500 
Swain  Swain County Health Dept.  Bryson City  (828) 488-3792 
Transylvania  Transylvania Community Hospital  Brevard  (828) 883-5473 
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: Prescribers

Synagis Policy Revision

Synagis is a covered benefit reimbursable through the pharmacy program for FY 2001/2002. It has been approved for the prevention of respiratory syncytial virus (RSV) infections in high-risk children determined eligible by age and risk factors at the beginning of the RSV season. The drug is approved for administration once monthly during RSV season, which has been identified in North Carolina as October 1, 2001 through March 31, 2002 and will be reimbursable only during that period.

The following guidelines and procedures should be used in determining appropriate candidates for Synagis. Eligibility guidelines are based on the 1998 American Academy of Pediatrics recommendations as published in Pediatrics.

  1. Chronic Lung Disease and Less Than Two Years of Age - Synagis prophylaxis should be considered for infants and children younger than two years of age with chronic lung disease (CLD) who have required medical therapy for their CLD within six months before the anticipated RSV season.
  2. History of Premature Birth - Infants born at 32 weeks gestation or earlier, without CLD, may benefit from RSV prophylaxis.

  3. a. Infants born at 28 weeks of gestation or earlier may benefit from RSV prophylaxis up to 12 months of age.

    b. Infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to six months of age.

    c. Infants born from 32 to 35 weeks of gestation with additional risk factors may be considered for prophylaxis up to six months of age. Risk factors include underlying conditions that predispose to respiratory complication (e.g., neurologic disease in very low birth weight infants), number of young siblings, child care center attendance, exposure to tobacco smoke in the home, anticipated cardiac surgery, and distance to and availability of hospital care for severe respiratory illness.

  1. Synagis is not recommended for children with cyanotic congenital heart disease.
When prescribing Synagis, the physician is required to write in his or her own handwriting on the face of the prescription: the birth weight, gestational age, and date of birth of the child.
 

Sharman Leinwand, MPH, RPH, Pharmacy Program Manager
DMA, 919-857-4034


Attention: Ambulance Services Providers

Reimbursement Rate Increase for Ambulance Services

Effective with date of service July 1, 2001, the maximum reimbursement rates for ambulance services were increased.
 
Procedure Code Description Maximum Reimbursement Rate
A0320 
Ambulance service, BLS, non-emergency transport 
$ 63.72 
A0322 
Ambulance service, BLS, emergency transport 
63.72 
A0324 
Ambulance service, ALS, non-emergency transport, base rate one way 
63.72 
A0326 
Ambulance service, ALS, non-emergency, special services rendered 
83.61 
A0330 
Ambulance service, ALS, emergency transport 
112.51 
A0380 
BLS ground mileage, outside base area, one way 
2.10 
A0390 
ALS ground mileage, outside base area, one way 
2.10 
A0090 
Non-emergency mileage outside base area, one way 
2.10 
Y0001 
Non-emergency transport round trip 
70.47 
Y0002 
State-to-state placement, base rate one way, prior approval required 
63.72 
A0040 
Helicopter, lift off 
422.91 
Y0050 
Helicopter, nautical mile 
11.26 
Y0060 
Fixed wing, lift off 
422.91 
Y0070 
Fixed wing, per nautical mile 
3.52 
Y0003 
Fixed wing, lift off, state-to-state placement, prior approval require 
422.91
Y0004 
Helicopter, lift off, state-to-state placement, prior approval required 
422.91 

Providers are reminded to bill their usual and customary charges. Adjustments will not be made to previously processed claims.
 

Janet Choplin, Financial Operations
DMA, 919-857-4015


Attention: Physicians, Nurse Practitioners, and Dialysis Treatment Facilities

Ferrlecit (Sodium Ferric Gluconate Complex, HCPCS Code J2915, 625 mg.) Coverage Criteria

Effective with date of service July 1, 2001, the N.C. Medicaid program covers Ferrlecit (sodium ferric gluconate complex in sucrose injection, 62.5 mg.) for the treatment of patients with iron deficiency anemia who are undergoing chronic hemodialysis. Dialysis treatment facilities will be reimbursed for Ferrlecit in addition to the dialysis composite rate. Administration supply costs are included in the dialysis composite rate. Providers must bill their usual and customary charges. The maximum reimbursement rate for Ferrlecit is $38.70 per unit.

Ferrlecit is covered for recipients under the following conditions:

Billing Requirements for Physicians: Example:
 
21
Diagnosis
24A
Date(s) of Service
24B
Place of Service
24D
Procedures, Services or Supplies
24F
Charges
24G
Days or Units
585 
280.8 
08142001 
11 
J2915 

Note: Physicians cannot bill an Evaluation and Management code in addition to an injection administration code, CPT 90782. This drug should be added to the list of injectable drugs published in the November 2000 general Medicaid bulletin.

Billing Requirements for Dialysis Treatment Facilities:

Example:
 
42
Rev Code
43
Description
44
HCPCS/Rate
45
Serv Date
46
Serv Units
47
Total Charges
250 
Ferrlecit 
62.5 mg. 
J2915 
08142001 

 
 
67
Prin Diag Cd
68
Code
69
Code
70
Code
71
Code
72
Code
73
Code
74
Code
75
Code
585 
280.1 

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


Attention: All Providers

Medicaid Identification Cards

In June 2001, to increase efficiency and improve security, Medicaid recipients were issued blue Medicaid identification (MID) cards printed on laser paper. Effective January 2002, the pink MID card, received by most Medicaid-eligible pregnant women, and the buff (or brown) MID card, received by Medicare-Aid recipients, will also be produced on laser paper.

The new MID cards will be printed on 8.5" x 11" watermarked laser paper. The lighter weight paper is more pliable and will be perforated, allowing the recipient to detach the card. However, the card is still valid if it is not detached. The new cards also include a postal bar code, which is expected to improve delivery.

There is no change to the way recipients will use the MID cards. On occasion, Medicaid recipients may receive blue, pink or buff cards printed on the heavier stock paper. These cards are still valid.
 

Andy Wilson, Medicaid Eligibility Unit
DMA, 919-857-4019


Attention: Hospice Providers

Reimbursement Rate Increase for Hospice Services

Effective with date of service January 1, 2002, the maximum allowable rate for the following hospice services increased. The hospice rates are as follows:
 
    Routine Home Care Continuous Home Care Inpatient Respite Care General Inpatient Care  Hospice Intermediate R & B Hospice Skilled 
R & B
Metropolitan Statistical Area  SC  RC 651 
Daily 
RC 652 
Hourly 
(1) 
RC 655 
Daily 
(2) (3) (4) 
RC 656 
Daily 
(3) (4) 
RC 658 
Daily 
(5) 
RC 659 
Daily 
(5) 
Asheville 
39 
$ 97.28 
$ 23.65 
$ 103.77 
$ 432.94 
$ 93.64 
$ 124.44 
Charlotte 
41 
101.38 
24.64 
107.29 
449.91 
93.64 
124.44 
Fayetteville 
42 
94.37 
22.94 
101.28 
420.91 
93.64 
124.44 
Greensboro/ 
Winston-Salem/ 
High Point 
43 
98.42 
23.92
104.75 
437.67 
93.64 
124.44 
Hickory 
44 
98.98 
24.06 
105.23 
439.99 
93.64 
124.44 
Jacksonville 
45 
89.58 
21.77 
97.18 
401.07 
93.64 
124.44 
Raleigh/Durham 
46 
102.21 
24.84 
108.00 
453.36 
93.64 
124.44 
Wilmington 
47 
103.42 
25.14 
109.04 
458.38 
93.64 
124.44 
Rural 
53 
92.84 
22.57 
99.97 
414.56 
93.64 
124.44 
Goldsboro 
105 
93.17 
22.65 
100.25 
415.92 
93.64 
124.44 
Greenville 
106 
101.88 
24.76 
107.72 
452.00 
93.64 
124.44 
Norfolk 
Currituck County 
107 
93.96 
22.84 
100.94 
419.23 
93.64 
124.44 
Rocky Mount 
108 
96.16 
23.37 
102.82 
428.33 
93.64 
124.44 

Note: Providers must bill their usual and customary charges. Adjustments will not be made to previously processed claims.

Key to Hospice Rate Table:

SC = Specialty Code
RC = Revenue Code

  1. A minimum of eight hours of continuous home care per day must be provided.
  2. There is a maximum of five consecutive days including the date of admission but not the date of discharge for inpatient respite care. Bill for the sixth and any subsequent days at the routine home care rate.
  3. Payments to a hospice for inpatient care are limited in relation to all Medicaid payments to the agency for hospice care. During the 12-month period beginning November 1 of each year and ending October 31, the aggregate number of inpatient respite and general inpatient days may not exceed 20 percent of the aggregate total number of days of hospice care provided during the same time period for all the hospice's Medicaid patients. Hospice care provided for patients with acquired immune deficiency syndrome (AIDS) is excluded in calculating the inpatient care limit. The hospice refunds any overpayments to Medicaid.
  4. Date of Discharge: For the day of discharge from an inpatient unit, the appropriate home care rate must be billed instead of the inpatient care rate unless the recipient expires while an inpatient. When the recipient is discharged as deceased, the inpatient rate (general or respite) is billed for the discharge date.
  5. When a Medicare/Medicaid recipient is in a nursing facility, Medicare is billed for routine or continuous home care, as appropriate, and Medicaid is billed for the appropriate long-term care rate. When a Medicaid only hospice recipient is in a nursing facility, the hospice may bill for the appropriate long-term care (SNF/ICF) rate in addition to the home care rate provided in revenue code 651 or 652. See section 8.15.1, page 8-12, of the N.C. Medicaid Community Care Manual for details.
     
Debbie Barnes, Financial Operations
DMA, 919-857-4015


Attention: All Providers

Medicare Crossovers

The N.C. Medicaid program collaborates with several Medicare carriers to negotiate and execute Trading Partner Agreements, which establish a crossover relationship between Medicaid and a particular Medicare carriers. The agreement enables Medicare claims for recipients who also have Medicaid coverage secondary to Medicare to cross over to Medicaid for payment.

In order to process these crossover claims, providers must submit a Medicare Crossover Reference Request form, which allows EDS to cross reference the provider's Medicare number with their Medicaid number and process the claim. Without this information, EDS cannot identify the provider's Medicaid number and cannot process Medicare crossover claims.

Providers must complete the Medicare Crossover Reference Request form if they file Medicare claims with any of the Medicare carriers listed on the form to ensure that the claim will cross over to Medicaid for payment.

Medicare Crossover Reference Request form

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


Attention: All Providers

Breast and Cervical Cancer Control Program Guidelines

The federal Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) gave States the option to provide full Medicaid benefits to women who: The N.C. General Assembly approved funding for this option in Senate Bill 1005. The NCBCCCP operates through local health departments, some community health centers, and other medical facilities that are contracted to participate as screening providers and coordinators for the program.

Effective January 1, 2002, NCBCCCP screening providers will complete a Medicaid eligibility application for women who have been screened through the NCBCCCP and found to need treatment for either breast or cervical cancer or pre-cancerous conditions.

Providers may refer women who meet the criteria listed above to their local health department to be screened under the NCBCCCP. The NCBCCCP screening program has specific age and income requirements. Contact the local health department for these requirements.

The period of Medicaid eligibility is based on the individual's course of treatment for cancer established by a statement from her physician. The certification period ends when the course of treatment ends. Women in this new coverage group will receive a blue Medicaid identification card, which entitles them to all Medicaid covered services during the breast or cervical cancer treatment period.
 

Denise Rogers, Medicaid Eligibility Unit
DMA, 919-857-4019


Attention: Mecklenburg County Providers

Managed Care Update

Effective February 1, 2002, Carolina ACCESS/ACCESS II will be a managed care enrollment option for Medicaid recipients in Mecklenburg County. This option will be offered in addition to the two health maintenance organizations, United Healthcare and Southcare, currently providing Medicaid services in Mecklenburg County.
 

Julia McCollum, Managed Care Section
Darryl Frazier, Managed Care Section
DMA, 919-857-4022


Attention: Hospital Providers

ICD-9-CM Diagnosis Codes - Additions and Changes

The following list of ICD-9-CM diagnosis codes are new or have been revised by federal mandate. These codes are listed in the August 1, 2001 Federal Register, pages 400063 through 400066, and are effective on date of service October 1, 2001.

New Diagnosis Codes
 
Code Description
256.31 
Premature menopause 
256.39 
Other ovarian failure 
277.7 
Dysmetabolic Syndrome X 
464.00 
Acute laryngitis, without mention of obstruction 
464.01 
Acute laryngitis, with obstruction 
464.50 
Unspecified supraglottitis, without mention of obstruction 
464.51 
Unspecified supraglottitis, with obstruction 
521.00 
Unspecified dental caries 
521.01 
Dental caries limited to enamel 
521.02 
Dental caries extending into dentine 
521.03 
Dental caries extending into pulp 
521.04 
Arrested dental caries 
521.05 
Odontoclasia 
521.09 
Other dental caries 
525.10 
Unspecified acquired absence of teeth 
525.11 
Loss of teeth due to trauma 
525.12 
Loss of teeth due to periodontal disease 
525.13 
Loss of teeth due to caries 
525.19 
Other loss of teeth 
530.12 
Acute esophagitis 
564.00 
Unspecified constipation 
564.01 
Slow transit constipation 
564.02 
Outlet dysfunction constipation 
564.09 
Other constipation 
602.3 
Dysplasia of prostate 
608.82 
Hematospermia 
608.87 
Retrograde ejaculation 
692.76 
Sunburn of second degree 
692.77 
Sunburn of third degree 
718.70 
Developmental dislocation of joint, site unspecified 
718.71 
Developmental dislocation of joint, shoulder region 
718.72 
Developmental dislocation of joint, upper arm 
718.73 
Developmental dislocation of joint, forearm 
718.74 
Developmental dislocation of joint, hand 
718.75 
Developmental dislocation of joint, pelvic region and thigh 
718.76 
Developmental dislocation of joint, lower leg 
718.77 
Developmental dislocation joint, ankle and foot 
718.78 
Developmental dislocation of joint, other specified sites 
718.79 
Developmental dislocation of joint, multiple sites 
733.93 
Stress fracture of tibia or fibula 
733.94 
Stress fracture of the metatarsals 
733.95 
Stress fracture of other bone 
772.10 
Intraventricular hemorrhage, unspecified grade 
772.11 
Intraventricular hemorrhage, Grade I 
772.12 
Intraventricular hemorrhage, Grade II 
772.13 
Intraventricular hemorrhage, Grade III 
772.14 
Intraventricular hemorrhage, Grade IV 
779.7 
Perventricular leukomalacia 
793.80 
Unspecified abnormal mammogram 
793.81 
Mammographic microcalcification 
793.89 
Other abnormal findings on radiological examination breast 
840.7 
Superior glenoid labrum lesions (SLAP) 
997.71 
Vascular complications of mesenteric artery 
997.72 
Vascular complications of renal artery 
997.79 
Vascular complications of other vessels 
V10.53 
Personal history of malignant neoplasm, renal pelvis 
V45.84 
Dental restoration status 
V49.82 
Dental sealant status 
V83.01 
Asymptomatic hemophilia A carrier 
V83.02 
Symptomatic hemophilia A carrier 

Codes Requiring Further Subdivision

The following diagnosis codes have been further subdivided with new codes found in the above table. Therefore, effective with date of service October 1, 2001, these codes should not be used.
 
Code
Description
256.3 
Other ovarian failure 
464.0 
Acute laryngitis 
521.0 
Dental caries 
525.1 
Loss of teeth due to accident, extraction, or local periodontal disease 
564.0 
Constipation 
772.1 
Intraventricular hemorrhage 
793.8 
Nonspecific abnormal findings on radiological and other examinations of body structure, breast 

Revised Diagnosis Code Titles
 
Code Current Description Revised Description 
411.81 
Coronary occlusion without myocardial infarction  Acute coronary occlusion without myocardial infarction 
493.00 
Extrinsic asthma without mention of status asthmaticus  Extrinsic asthma without mention of status asthmaticus or acute exacerbation or unspecified 
493.10 
Intrinsic asthma without mention of status asthmaticus  Intrinsic asthma without mention of status asthmaticus or acute exacerbation or unspecified 
493.20 
Chronic obstructive asthma without mention of status asthmaticus  Chronic obstructive asthma without mention of status asthmaticus or acute exacerbation or unspecified 
493.90 
Asthma, unspecified without mention of status asthmaticus  Asthma, unspecified without mention of status asthmaticus or acute exacerbation or unspecified 
V70.7 
Examination for normal comparison or control in clinical research  Examination of participant in clinical trial 

Ann H. Kimbrell, R.N., Institutional Services
DMA, 919-857-4022


Attention: Personal Care Services Providers and Home Health Agencies

Questions and Answers Regarding Personal Care Services (in Private Residences)

The following questions were asked during the August 2001 workshops for agencies providing Personal Care Services (PCS) in private residences. This article is part of a continuing effort to educate providers regarding Medicaid guidelines for providing services in the home.
  1. Is there a limit on the amount of time that the aide can spend on "incidental services" such as meal preparation and housekeeping?

  2. No, but remember that PCS is based on the client's need for personal care, not home management, and the purpose of each visit must be to meet the client's personal care needs. Guidelines do not address the amount of time that can be spent on incidental services. The incidental services covered under PCS are housekeeping and home management tasks essential, though secondary, to the personal care needs of the patient. The time allotted on the PCS plan of care for all the personal care and home management tasks to be accomplished during a visit must be reasonable and necessary to complete the tasks. The plan of care must document the specific tasks and the total time needed to complete all of the tasks on a given day. Daily records must be kept to support the services provided. Appropriate revisions to the plan of care must be made to reflect any permanent change in amount of time or task.
     

  3. Is meal preparation considered an "incidental service" or a "personal care" service? It is listed under "Personal Care" in section 30 of the DMA 3000 but under "Home Management" on page 6-3 of the N.C. Medicaid Community Care Manual.

  4. Preparation of "simple meals" is considered an "incidental" housekeeping and home management task, as indicated on page 6-3 of the N.C. Medicaid Community Care Manual. The meal preparation could qualify as a Level III Personal Care task if the physician orders a specific diet requiring careful menu planning or specialized preparation. Aides performing menu planning and preparation of more complex diets must meet the N.C. Board of Nursing's competency requirements and be registered as a Nurse Aide I or II in the N.C. Nurse Aide Registry with the Division of Facility Services (DFS).
     

  5. What does "medically stable" mean?

  6. "Medically stable" means that the patient's medical condition is at maintenance level and without constant changes that would require monitoring and evaluation. Keep in mind that PCS is a paraprofessional service and does not include skilled medical care.
     

  7. Is bathing or assistance with bathing a requirement to get PCS services?

  8. Medicaid guidelines do not indicate the need for a specific personal care task as a requirement for services. PCS guidelines indicate that the patient must need at least one of the In-Home Aide Level II or III Personal Care tasks listed on pages 6-2 and 6-3 of the N.C. Medicaid Community Care Manual, due to a medical condition, to be appropriate for the program. Keep in mind that PCS must be the most cost-effective and appropriate form of care and should not replace other care available.
     

  9. Please review levels of care that require a certified versus a non-certified aide.

  10. The qualifications of the aide needed are determined by the tasks identified and in accordance with rules set forth by the N.C. Board of Nursing. The tasks included under PCS correspond to personal care tasks in the "In-Home Aide Level II and Level III Personal Care" of the DHHS In-Home Aide Service Plan. Aides performing Level III Personal Care tasks must meet the N.C. Board of Nursing's competency requirements and be registered as a Nurse Aide I or II in the N.C. Nurse Aide Registry with DFS. Level II Personal Care tasks can be performed by an aide meeting in-home aide qualifications in the Home Care Licensure Rules. A full explanation of these requirements is covered on pages 6-2 and 6-3 of the N.C. Medicaid Community Care Manual.
     

  11. Please provide clarification and updated guidelines for dually eligibleMedicare/Medicaid patients getting skilled services under the Medicare Prospective Payment System (PPS).
  12. The response to this question is deleted from the electronic version of the bulletin due to a legal action.

     

  13. As a PCS provider, what do I need to know about an "open episode" and how does it affect my provision of PCS?
  14. The response to this question is deleted from the electronic version of the bulletin due to a legal action.

     

  15. Will the PCS plan of care need to match the Home Health plan of care if services are resumed after Medicare-covered skilled service ends? Will Medicaid question the amount of time spent by the PCS aide verses the Home Health aide?

    The response to this question is deleted from the electronic version of the bulletin due to a legal action.


Adelle Kingsberry, Hospice/PCS Program Consultant
DMA, 919-857-4021


Attention: Carolina ACCESS Primary Care Providers

Carolina ACCESS Primary Care Provider Manual Available Online

The revised Carolina ACCESS Primary Care Provider Manual is now available on DMA's website. Providers without Internet access should contact their Regional Managed Care Consultant for assistance. Please refer to the below list.

Regional Managed Care Consultants
 
Jerry Law
252-321-1806
Rosemary Long
919-477-3362
Lisa Gibson
919-319-0301
Julia McCollum
919-857-4219
Daryl Frazier
919-857-4233
Lisa Catron
828-683-8812
Beaufort  Bladen  Alamance  Chatham  Cabarrus  Alexander 
Bertie  Brunswick  Anson  Durham  Gaston  Alleghany 
Camden  Carteret Caswell  Franklin  Iredell  Ashe 
Chowan  Columbus  Davie  Granville  Lincoln  Avery 
Currituck  Craven  Davidson  Orange  Mecklenburg  Buncombe 
Dare  Cumberland  Forsyth  Vance  Union  Burke 
Edgecombe  Duplin  Guilford  Wake    Caldwell 
Gates  Greene  Lee      Catawba 
Halifax  Harnett  Montgomery      Cherokee 
Hertford  Hoke  Moore     Clay 
Hyde  Johnston  Person      Cleveland 
Martin  Jones  Randolph      Graham 
Nash  Lenoir  Richmond      Haywood 
Northhampton  New Hanover  Rockingham      Henderson 
Pasquotank  Onslow  Rowan      Jackson 
Perquimans  Pamlico  Stanley      Macon 
Pitt  Pender  Stokes      Madison 
Terrell  Robeson  Surry      McDowell 
Warren  Sampson  Yadkin      Mitchell 
Washington  Scotland        Polk 
  Wayne        Rutherford 
  Wilson        Swain 
          Transylvania 
          Watauga 
          Wilkes 
          Yancey 

Laurie Giles, Managed Care Section
DMA, 919-857-4022


Attention: All Providers

Index to General and Special Medicaid Bulletins for 2001


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


Attention: All Providers

Electronic Funds Transfer Form - Fax Number Change for Submittals

Providers are instructed to use the following fax number when submitting Electronic Funds Transfer (EFT) forms to the EDS Financial Unit: 919-816-4399.

EDS offers EFT as an alternative to paper check issuance. Providers are required to complete and submit an EFT form to initiate the automatic deposit process. Providers must also complete and submit a new EFT form if they change banks or bank accounts.

A deposit slip or voided check confirming the account number and bank transit number must be attached to the EFT form. Completed forms may be mailed to EDS at the address listed below or they may be faxed to the EDS Financial Unit.

EDS
Attention: Financial Unit
P.O. Box 300011
Raleigh, NC 27622

Note: There is an interim time period of two checkwrites during which providers will receive a paper check before automatic deposit begins or resumes to a new bank account. The top left corner of the last page of the provider's Remittance and Status Report will indicate EFT number rather than check number when automatic deposit begins or resumes.

Electronic Funds Transfer form
 

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


Attention: All Providers

Corrected 1099 Requests - Action Required by March 1, 2002

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, 2002. The 1099 MISC tax form will reflect the tax information on file with Medicaid as of the last Medicaid checkwrite cycle date, December 27, 2001.

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 30.5 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, 2002 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
P.O. Box 300011
Raleigh, NC 27622
Attention: Corrected 1099 Request - Financial

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.
 

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


Attention: Home Health, Personal Care Services, and Private Duty Nursing Providers

Written Confirmation of Verbal Orders

This article is deleted from the electronic version of the bulletin due to a legal action.
 

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


Attention: Personal Care Services Providers (excluding Adult Care Homes)

Personal Care Services Seminars

Personal Care Services (PCS) seminars are scheduled for March 2002. The February 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 PCS 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


January 15, 2002 
February 12, 2002 
March 5, 2002 
January 23, 2002 
February 19, 2002 
March 12, 2002 
January 30, 2002 
February 27, 2002 
March 19, 2002 
March 28, 2002 

Electronic Cut-Off Schedule


January 11, 2002 
February 8, 2002 
March 1, 2002 
January 18, 2002 
February 15, 2002 
March 8, 2002 
January 25, 2002 
February 22, 2002 
March 15, 2002 
March 22, 2002 

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.



 
 
______________________ _______________________
Nina M. Yeager, Director Ricky Pope
Division of Medical Assitance Executive Director
Department of Health and Human Services  EDS

 
 
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