June 2000 NC Medicaid Bulletin

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

All Providers:

Anesthesia Providers:

Carolina ACCESS Primary Care Physicians:

Chiropractor Providers:

Health Departments:

Health Check Providers:

Home Infusion Therapy (HIT) Providers:

Hospital Providers:

Mental Health/Substance Abuse Providers:

Optical Providers:

Personal Care Service (PCS) Providers:

Physicians:


Attention: All Providers
Holiday Observance

The Division of Medical Assistance (DMA) and EDS will be closed on Tuesday, July 4, 2000, in observance of Independence Day.


EDS, 1-800-688-6696 or 919-851-8888  



Attention: All Providers
Sterilization Guidelines

The North Carolina Medicaid program is bound by stringent federal guidelines in regard to coverage of sterilization procedures. Federal funding is available for an individual to be sterilized only if the following guidelines contained in 42 CFR 441.253 are met:

  1. The individual is at least 21 years old at the time the sterilization consent is obtained.
  2. The individual is not a mentally incompetent individual.
  3. At least 30 days, but not more than 180 days have passed between the date of informed consent and the date of the sterilization except under the following circumstances:

  4. Premature delivery - Informed consent must be given at least 30 days before the expected date of delivery and at least 72 hours must have passed since the informed consent was given
    Emergency abdominal surgery - At least 72 hours must have passed since the informed consent was given
  5. The individual has voluntarily given informed consent in accordance with all the requirements prescribed in 42 CFR 441.257 and 441.258. The individual must be:

The sterilization consent form is a federally mandated document. The form must be on file with the fiscal agent and all federal regulations pertaining to the completion of the form must be satisfied prior to payment of a sterilization claim. The consent form must be Health and Human Services and State approved.

The sterilization consent form is a three-copy form. The pink copy should be given to the recipient for their records, the physician should retain the yellow copy, and the white copy should be submitted to EDS. Consent forms may be obtained by calling EDS at 1-800-688-6696.

Local health departments may also obtain consent forms from the Department of Health and Human Services at:

N.C. DHHS
Women's Preventive Health Branch
P.O. Box 29597
Raleigh, NC 27626-0597
COURIER # 56-20-11


If the recipient name on the claim and the name on the sterilization consent form is different, a signed name change statement that verifies the recipient whose name appears on the claim and consent are the same person, must be included (refer to example below).

Reminders

North Carolina Medicaid will not pay for sterilization reversals. If a judicial court orders a sterilization for a recipient who is a ward of the county and is mentally incompetent, the county is responsible for reimbursement for the sterilization.

Name Change Statement (Example)
 
Elvis County Health Department
1 Graceland Drive
Hound Dog, NC 22222
 
Medicaid ID Number: 912345678S


 To Whom It May Concern:

Mary Smith has changed her name to Mary Jones.

Dr. Elvis (Signature of representative at providers office is required) 

  Diagnosis and Procedure Codes for Elective Sterilization

The following codes are the only codes to be considered specifically for the purpose of elective sterilization:

Sterilization Abbreviations

The following abbreviations are acceptable on the sterilization consent form as a description of the type of sterilization procedure:

HCFA clarification has also been given to use "tubal banding", although it is not widely used.
 
Guide for Completion of Sterilization Consent Form

Following is the list of fields included in the Federal consent form requirements for sterilization. All areas are required to be completed except area 9 (race). Fields in bold print cannot be altered. This guide will assist in correct completion of consent forms and should help to decrease the number of denials related to errors in completing the form.

  1. Person or facility who provided information concerning sterilization
  2. Type of sterilization procedure to be performed
  3. Recipient date of birth (must be at least 21 years of age when the consent form is signed)
  4. Name of recipient as it appears on the Medicaid ID card
  5. The full name of the physician scheduled to do the surgery (abbreviations, initials, or "doctor on call" are unacceptable). May use "Physician on call of Jones OB GYN clinic"
  6. Type of sterilization procedure to be performed
  7. Recipient's signature (must be dated) cannot be altered, traced over, or corrected
  8. Date the consent form was signed (the date of the recipient's signature must be at least 30 days prior to the date of the sterilization). The 30 day count begins the day following the recipient's signature date
  9. Race and ethnicity (not required)
  10. Language in which the form was read to the recipient, if an interpreter was used
  11. Signature of the interpreter
  12. Signature date of the interpreter (same as # 8 and # 16)
  13. Name of recipient
  14. Name of sterilization procedure
  15. Signature of person witnessing consent (must be dated see # 16)
  16. Date (this date must be the same as the recipient signature date) Note: the doctor can also be the witness
  17. The full name and address of the facility, include street name and number, city, state, and zip code where the consent was obtained and witnessed
  18. Name of recipient
  19. Actual date of sterilization
  20. Type of sterilization procedure performed
  21. The box is to be checked if the delivery was premature (write the recipient's expected delivery date in the space provided)
  22. The box is to be checked if emergency abdominal surgery was performed
  23. Physician signature must be legible or name must be printed below the signature. (A signature stamp may be used)
  24. Date must be on or after the date of service
Blank Consent Form

Consent Form Completion Tips

Interpreter Signature on Sterilization Consent Form

When telephone interpreter services are needed to complete the sterilization consent form for non-English speaking Medicaid recipients, the interpreter's signature, date of the interpreter's service, and the language used are required on the sterilization consent form. In lieu of getting the interpreter's signature on the sterilization consent form at the time the service is provided, the interpreter who explains the procedure by telephone may fax or mail the attestation of their interpreter services. Criteria for the faxed or mailed attestation are as follows:


Submitting Sterilization Consents Without a Claim

Sterilization consent forms may be submitted separately from the claim. The elimination of claim attachments allows electronic submission of claims.

When submitting a sterilization consent form separately from the claim, follow the instructions below:

Upon receipt, EDS will review the consent to ensure adherence to federally mandated guidelines. Reviewed results will be entered into the EDS system.
(Physicians and Health Departments) (Hospitals)
EDS EDS
PO Box 30968 PO Box 300010
Raleigh, NC 27622  Raleigh, NC 27622 
EDS, 1-800-688-6696 or 919-851-8888  
 



Attention: Hospital Providers
Billing Sterilizations on UB-92

The North Carolina Medicaid program is regulated by stringent Federal guidelines concerning sterilizations. A valid consent form must be on file with EDS in order to allow a claim to be paid. When submitting a UB-92 claim form, list all charges with the appropriate revenue code in Form Locator 47 (total charges).

When a sterilization procedure is performed and there is not a valid consent on file, all charges related to the sterilization procedure must be entered in Form Locator 48, "non-covered charges." Amounts indicated in Form Locator 48 will be deducted from the allowable payment. If these charges are not listed correctly under Form Locator 48, the entire claim will be denied.

A statement must be entered in Form Locator 84 stating the "non-covered charges are for sterilization." Medicaid requires that all procedures provided to a recipient be listed under Form Locators 80 and 81, including the non-covered procedure codes.

Sample UB-92 Form

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



Attention: All Providers
Medicaid Bulletins on DMA Website


The Medicaid Bulletin is now available on the DMA website. To access:

  1. Go to http://www.ncdhhs.gov/dma/
  2. Click on "Medicaid Bulletins"
  3. Find the desired month and click on the desired version (HTML or PDF). HTML provides links to the specific article, forms, etc. and PDF provides a version better suited for printing.
The current and immediate past bulletins are available on this site.

Susan Ryan, DMA, 919-857-4019
 
 



Attention: Optical Providers
Confirmation/Prior Approval Reminder

Eye Refraction Confirmation Number

Any eye exam/refraction confirmation number obtained through the Automated Voice Response System (AVR) must NOT be entered on the HCFA-1500 claim form. Instead, keep the confirmation number with the recipient's permanent office record. In the event another provider bills for the same service, retaining the confirmation number will ensure payment to the provider that obtained proper authorization.

NOTE: Entering the confirmation number on the HCFA-1500 claim form will result in delayed payment.

Visual Aids Requests

All requests for visual aids (i.e. eyeglasses and contact lenses) must be submitted in writing to EDS using a Request for Prior Approval for Visual Aids Form. Phone requests for information regarding visual aids eligibility are not accepted due to the following:

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



Attention: Physicians and Health Departments
Physical and Occupational Therapy Evaluations

Effective with date of service July 1, 2000 Medicaid will reimburse for the following CPT codes:

97001 Physical therapy evaluation
97002 Physical therapy re-evaluation
97003 Occupational therapy evaluation
97004 Occupational therapy re-evaluation

The services must relate to an active written treatment regimen established by the attending physician. For a re-evaluation to be considered reasonable and necessary there must be an expectation that the patient's condition will improve significantly in a reasonable period of time.

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



Attention: Carolina ACCESS (CA) Primary Care Physicians (PCPs)
Billing Procedures When a Carolina ACCESS Medicaid Recipient Has Been in an Accident

Medicaid has established procedures for filing claims and notifying the Medicaid agency when Medicaid recipients are involved in accidents. For these purposes, an "accident" is defined as any occurrence for which a third party may be liable. The liable third party is usually a liability insurance carrier such as an auto insurer, homeowner insurer, etc. For additional information on this topic, please refer to the July 1997 Medicaid Bulletin.

PCPs are paid a monthly management fee from Medicaid to manage and arrange the health care needs of their enrollees. The PCP accepts the enrollee as a Medicaid patient when the patient is assigned to the PCP and a management fee is paid. CA enrollees are locked into their PCPs on a monthly basis and are dependent on them for care/referrals. CA PCPs must not deny services or demand payment of services prior to treatment if a recipient is assigned to them. PCPs must treat their assigned enrollees regardless of the possible or probable existence of third party insurance. The guidelines provided in the July 1997 Medicaid Bulletin article titled "Notice and billing procedures when Medicaid recipients have been in an accident" must be followed for filing claims. The PCP must not bill the Medicaid recipient.

Deborah Bowen, DMA Managed Care Section 919-857-4226
 



Attention: All Providers
Renovation of The MMIS System - ITME Project

The Division of Medical Assistance plans to upgrade and enhance the Medicaid Management Information System (MMIS).

Implementation Schedule
The system changes will be implemented in November 2000.
 

Provider Impact

Eligibility Verification System (EVS)

The format of information returned as a result of your EVS inquiry will change with ITME implementation. To allow time to modify your systems and lessen the impact to your business, please notify your Value Added Networks (VAN) contact now for information relating to the new format.

EDS 1-800-688-6696 or 919-851-8888
 



Attention: Hospital Providers and Physicians
Resident Supervision Requirements in Teaching Hospitals and Residency Programs

When providing care and billing the Medicaid program for services to patients, teaching physicians assume full responsibility for the health and safety of the patient. The teaching physician must continue to use the "immediately available" standard of supervision for services provided by the supervised resident physician and billed to the Medicaid program. The service rendered must be furnished under the supervisory physician's overall direction and control but the supervisory physician's presence is not required. The supervisory physician must have immediate availability via phone or page.

Direct supervision is defined as the physician being present in the site and immediately available to furnish assistance and direction throughout the performance of a procedure. It does not require that the physician be present in the room when the service is performed. The degree of direct supervision remains the responsibility of the teaching physician and is based on the skill level, experience and level of training of the resident, and the complexity and severity of the patient's condition. Regardless of the type of supervision, written documentation in the medical record must clearly designate the supervising physician and must be signed by that physician.

Board certified or eligible physicians, with a valid North Carolina medical license and a current Medicaid provider number, may directly bill the Medicaid program for services provided while concurrently pursuing fellowship training or training in an additional specialty. Associated salary and other pertinent costs for that physician's time must not also be included in the hospital cost reports submitted to federal or state programs.

EDS, 1-800-688-6696 or 919-851-8888
 



Attention: All Mental Health/Substance Abuse Providers
A New Health Benefit

This bulletin article is a follow-up to the article that was printed in the May 2000 Medicaid Bulletin. Effective July 1, 2000 a new preventive/early intervention mental health benefit will be available to approximately 400,000 state employees and teachers and 60,000 children enrolled in Health Choice. Medicaid will adopt this policy for recipients under the age of 21, which allows for 26 unmanaged visits in a calendar year.

Billing guidelines:

Prior approval: Prior approval is not required for Area Mental Health Centers. Please note that this process will replace the current policy of requesting prior approval after the 2nd visit for recipients under the age of 21. Prior approval forms can be obtained by calling Provider Services at EDS, 1-800-688-6696 or 919-851-8888.

Carolyn Wiser, DMA, 919-857-4025
 



Attention: All Providers
Preventive Medicine Services

The Preventive Medicine Services are Evaluation and Management visits which provide annual health assessments for eligible recipients age 21 and above. Effective July 1, 2000, these codes will replace the Adult Health Screening (Code W8001), with the expectation that it will prevent illness through early detection and treatment. The extent and focus of the services depend on the age of the individual.

Policies are unchanged for the Health Check Program (preventive services for recipients under the age of 21).

The Initial Preventive Medicine Evaluation and Management visits includes a comprehensive history, a comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, new patient.

The Periodic Preventive Medicine re-evaluation and management of an individual includes a comprehensive history, comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures, established patient.

Ancillary studies involving laboratory, radiology, and injectable medications are separately reimbursed.

This table contains the age restriction, and specific Medicaid guidelines for the Preventive codes.
 
CODE
DESCRIPTION
AGE
GUIDELINES
99385
Initial preventive medicine 
21 through 39 years 
Health Screening
99386
Initial preventive medicine
40 through 64 years
Health Screening
99387
Initial preventive medicine
65 years and over
Health Screening
99395
Periodic preventive medicine, established patient
21 through 39 years
Health Screening
99396
Periodic preventive medicine, established patient
40 through 64 years
Health Screening
99397
Periodic preventive medicine, established patient
65 years and over 
Health Screening

The Preventive Medicine visits provide for annual health assessments for recipients age 21 and over.

EDS 1-800-688-6696 or 919-851-8888
 



Attention: All Physicians
Update to Injectable Drug List

Effective with date of service June 1, 2000, the following changes have been made to the list of injectable drugs. Please make these changes to the list published in the October 1999 Medicaid Bulletin.

New Codes:
 
Old Code Description New Code Description Fee
W5166 Camptosar 5cc J9206 Irinotecan 20mg  $111.92
W5167 Doxil 10ml  J9001 Doxorubicin HCl liposone
(Doxil) 10mg
$296.13
W5193 Valstar (Valrubicin) 800mg J9357 Valstar (Valrubicin) 200mg  $402.06
W5194 Piperacillin Sodium (Pipracil) 4gm J2543 Piperacillin Sodium
(Pipracil) 1.125gm
$6.30
W5196 Infliximab (Remicade) 5mg J1745 Infliximab (Remicade) 10 mg $57.72

New Descriptions:
 
Code Old Description New Description Fee
J1260 Dolasetron Mesylate 1mg Dolasetron Mesylate 10mg $14.07
J1650 Emoxaparin Sodium (Lovenox) 30mg Enoxaparin Sodium (Lovenox) 10mg $1.68

EDS, 1-800-688-6696 or 919-851-8888
 



Attention: Health Check Providers
Health Check Billing Guide Error

The CPT code for Pneumococcal vaccine printed on page six of the Health Check Billing Guide 2000 is incorrect. The correct CPT code is 90732 for this (UCVDP) Pneumococcal vaccine.

EDS, 1-800-688-6696 or 919-851-8888
 



Attention:  Anesthesia Providers
Monitored Anesthesia Care and Diagnosis Editing

The following procedures are subject to diagnosis editing when billed with modifier QS for Monitored Anesthesia Care (MAC). Documentation in medical records must support the diagnosis used.
 
10040 10060  10061  10080  10081  10120
10121 10140 10160 10180 11000 11001 
11040 11041 11042 11043 11044 11100
11101 11200  11201 11462 11463 11470
11471 11600 11601 11602 11603 11604
11606 11740 11750 11752 11755 11760
11762 11770 11771 11772 11900 11901
11920 11950 11951 11952 11954 11960
11970 11971 11975 11976 12020  12021 
13100  13101  13160  13300  14000  14001 
14350  15050  15200  15201  15570  15600 
15734  15738  15782  15792  15793 15819 
15820  15821  15822  15823  15825  15832 
15834  15835  15836  15837  15850  15851 
15852 15879 15931  15934  15935  15936 
15937  15940  15944  17010  17110  17250
17260  17261  17262  17263  17264  17266 
19020  19100  19101  19110  19112  19120 
19125  19126  19140  19160  19290  19291 
20000  20005  20100  20101  20103  20200 
20205 20501  20520  20525  20662  20663 
20680  20690  20920  20922  20926  20950 
21084  21085  21088  21493  21494  21495 
21497  21501  21550  21555  21556  21700 
21720  21725  21920  23930  24065  24075 
24200 24615 25065  25075  55500  25505 
25600  25605  25611  26011  26596  26990
26991  27040  27041  27047 27370  29000 
29010  29015  29020  29025  29035  29040 
29044  29046  29049  29055  29058  29065 
29075  29085  29105  29125  29126  29130 
29131  29260  29345  29355  29358  29365 
29405  29425  29435  29445  29450  29505 
29515  29700  29705  29715  29720  29730 
29740  30000  30020  30100  30110  30115 
30117  30118  30120  30124  30125  30130 
30140  30300  30310  30320  30400  30410 
30420  30430  30435  30450  30460  30462 
30520  30540  30545  30560  30580  30600 
30620  30630  30801  30901  30903  30905 
30906  30915  30920  31000  31002  31020 
31646 32940 33206  33207  33208  33210 
33211 33214 33216 33217  33218  33222
33223 35450  35454  35460  35470  35471 
35472 35473  35474  35475  35476  36000 
36005 36010  36100  36215  36245  36800 
37620 37788  37790  38200  38500  38505 
38530 38760 40800 40801  40804  40805 
40808  40810  40812  40814  40816  40818 
40820  40830  40831  40840  40842  40843 
40844  40845  41000  41005  41006  41007 
41008  41009  41010  41015  41016  41017 
41018  41100  41105  41108  41110  41112 
41113  41114  41115  41116  41120  41130 
41135  41140  41145  41150  41153  41155 
41250  41251  41252  41500  41510  41520 
41800  41805  41806  41820  41821  41822 
41823  41825  41826  41827  41828  41830 
41850  41870  41872  41874  42000  42100 
42104  42106  42107  42120  42140  42145 
42160  42180  42182  42200  42205  42210 
42215  42220  42225  42226  42227  42235 
42260  42415 42440  42450  42500  42505
42665  42700  42720  42800  42802 42804
42806  42808  42809  42810  42815 42820
42821  42825  42826  42830  42831  42835
42836  42842  42844  42845  42860  42870
42880  42890  42892  42894  42900  42950
42953  42955  42960  42961  42962  42970
42971  42972  43200  43202  43204  43205 
43215  43216  43217  43219  43220  43226
43227  43228  43235  43239  43241  43243
43244  43245  43246  43247  43248 43249
43250  43251  43255  43258  43259  43260
43261  43262  43263  43264  43265  43267
43268  43269  43271  43272  43760  44360
44361  44363  44364  44365  44366  44369
44372  44373  44376  44377  44378  44380
44382  44385  44386  44388  44389  44391
44392  44393  45355  47000  47001  47550
47552  47553  47554  47555  47556  55450
56350  59000  60000  60001  60200 60281 
62284  62290  62291  63685  63688  64590
64595 64746  64786  64858 65091  65101 
65110  65112  65114  65205 65210  65220 
65222  65235  65260  65265  65270  65272 
65273  65275  65280  65285  65286  65290 
65400  65410  65420  65426  65430  65435 
65436  65450  65600  65710  65730  65750 
65755  65760  65765  65767  65770  65772 
65775  65800  65805  65810  65850  65855 
65860  65865  65870  65875  65880  65900 
65920  65930  66020  66030  66130  66150 
66155  66160  66165  66170  66172  66180 
66185  66220  66225  66250  66500  66505 
66600  66605  66625  66630  66635  66680 
66682  66700  66710  66720  66740  66761 
66762  66770  66820  66821  66825  66830 
66840  66850  66852  66920  66930  66940 
66983  66984  66985  66986  67005 67010 
67015  67025  67028  67030  67031  67036 
67038 67039  67040  67101  67105  67107 
67108  67110  67112  67115  67120  67121 
67141  67145  67208  67210  67218  67227 
67228  67250  67255  67311  67312  67314 
67316  67318  67320  67331  67332  67334 
67335  67340  67343  67345  67350  67400 
67405  67412  67413  67414  67415  67420 
67430  67440  67445  67450  67500  67505 
67515  67570  67700  67710  67715  67800 
67801  67805  67808  67810  67820  67825
67830  67835  67840  67850  67880  67882 
67901  67902  67903  67904  67906  67908 
67909  67911  67914  67915 67916  67917 
67921  67922  67923  67924  67930  67935 
67938  67950  67961  67966  67971  67973 
67974  67975  68020  68040  68100  68110 
68115  68130  68135  68200  68320  68325 
68326  68328  68330  68335  68340  68360 
68362  68400  68420  68440  68500  68505 
68510  68520  68525  68530  68540  68550 
68700  68705  68720  68745  68750  68760 
68761  68770  68800  68820  68825  68830 
68840  68850  69205 69210  70010  70015 
70030  70100  70110  70120  70130  70134 
70140  70150  70160  70170  70190  70200 
70210  70220  70240  70250  70260  70300 
70310  70320  70328  70330  70332  70336 
70350  70355  70360  70370  70373  70380 
70390  70450  70460  70470  70480  70481 
70482  70486  70487  70488  70490  70491 
70492  70540  70541  70551 70552  70553 
71010  71015  71020 71021  71022  71023 
71030  71034  71035  71036  71038  71040 
71060  71090  71100  71101  71110  71111 
71120  71130  71250  71260  71270  71550 
72010  72020  72040  72050  72052  72069 
72070  72072  72074  72080  72090  72100 
72110  72114  72120  72125  72126  72127 
72128  72129  72130  72131  72132  72133 
72141  72142  72146  72147  72148  72149 
72156  72157  72158  72170  72190  72192 
72193  72194  72196  72200  72202 72220 
72240  72255  72265  72270  72285  72295 
73000  73010  73020  73030  73040  73050 
73060  73070  73080  73085  73090  73092 
73100  73110  73115  73120  73130  73140 
73200  73201  73202  73220  73221  73500 
73510  73520  73525  73530  73540  73550 
73560  73562  73564  73565  73580 73590 
73592  73600  73610  73615  73620  73630 
73650  73660  73700  73701  73702  73720 
73721  73725  74000  74010  74020  74022 
74150  74160  74170  74181  74190  74210 
74220  74230  74235  74240  74241  74245 
74246  74247  74249  74250  74251  74260 
74270  74280  74283  74290  74291  74300 
74301  74305  74320  74327  74328  74329 
74330  74340  74350  74355  74360  74400 
74405  74410  74415  74420  74425  74430 
74440  74445  74450  74455  74470  74475 
74480  74485  74710  74740  74775  75552 
75553  75554 75555  75556  75600  75605 
75625  75630  75650  75658  75660  75662 
75665  75671  75676  75680  75685  75705 
75710  75716  75722  75724  75726  75731 
75733  75736  75741  75743  75746  75756 
75774  75790  75801  75803  75805  75807 
75809  75810  75820  75822  75825  75827 
75831  75833  75840  75842  75860  75870 
75872  75880  75885  75887  75889  75891 
75893  75894 75896  75898  75900  75940 
75960  75961  75962  75964  75966  75968 
75970  75978  75980  75982  75984  75989 
75992  75993  75994  75995  75996  76000 
76001  76003  76010  76020 76040  76061 
76062  76065  76066  76070  76075  76080 
76086  76088  76090  76091 76092  76093 
76094  76095  76096  76098  76100  76101 
76102  76120  76125  76140  76150  76350 
76355  76360  76365  76370  76375  76380 
76400  76506  76511  76512  76513  76516 
76519  76529  76536  76604  76645  76700 
76705  76770  76775  76778  76800  76805 
76810  76815  76816  76818  76825  76826 
76827  76828  76830  76856  76857  76870 
76872  76880  76930  76932  76934  76936 
76938  76941  76942  76945  76946  76950 
76960  76965  76970  76975  76986 77261 
77262  77263  77280  77285  77290  77295 
77300  77305  77310  77315  77321  77326 
77327  77328  77331  77332  77333  77334 
77336  77370  77401  77402  77403  77404 
77406  77407  77408  77409  77411  77412 
77413  77414  77416  77417  77419  77420 
77425  77430  77431  77432  77470  77600 
77605  77610  77615  77620  77750  77761 
77762  77763  77776  77777  77778  77781 
77782  77783  77784  77789  77790  78000 
78001  78003  78006  78007  78010  78011 
78015  78016  78017  78018  78070  78075 
78102  78103  78104  78110  78111  78120 
78121  78122  78130  78135  78140  78160 
78162  78170  78172  78185  78190  78191 
78195  78201  78202  78205  78215  78216 
78220  78223  78230  78231  78232  78258 
78261  78262  78264  78270  78271  78272 
78278  78282  78290  78291  78300  78305 
78306 78315  78320  78350  78351  78414 
78428  78445  78455  78457  78458  78460 
78461 78464  78465  78466  78468  78469 
78472  78473  78478  78480  78481  78483 
78580  78584  78585  78586  78587  78591 
78593  78594  78596  78600  78601  78605 
78606  78607  78610  78615  78630  78635 
78645  78647  78650  78660  78700  78701 
78704  78707  78710 78715  78725  78727 
78730  78740  78760  78761  78800  78801 
78802  78803  78805  78806 78807  78890 
78891  78990  79000  79001  79020  79030 
79035  79100  79200  79300  79400  79420 
79440  79900  92018  92019  92235  92265 
92270  92275  92283  92284  92499  92516 
92531  92532  92541  92542  92543  92544 
92545  92953  92960  92975  92977  92980 
92981  92982  92984  92995  92996  93307 
93308  93312  93313  93314  93320  93321 
93325  93350  93501  93505 93510  93511 
93514  93524  93526  93527  93528  93529 
93536  93539  93540  93541  93542  93543 
93544  93545  93555  93556  93561  93660 
93720  93721  93722  93724  93731  93732 
93734  93735  93737  93738  93880  93882 
93888  93922  93923  93924  93925  93926 
93930  93931  93965  93970  93971  93975 
93976  93978  93979  93990  95004  95010 
95015  95024  95027  95028  95044  95052 
95056  95065  95070  95071  95078  95115 
95117  95120  95125  95130  95131  95132 
95133  95134  95144  95145  95146  95147 
95148  95149  95165  95170  95180  95933 
96400  96405  96406       

DIAGNOSIS CODES REQUIRED FOR GLOBAL MONITORED ANESTHESIA:
 
V440 V540 038.0-038.9
185 216.0-216.8 242.00-242.01
242.10-242.11 242.20-242.21 242.30-242.31
242.40-242.41 242.80-242.81 242.90-242.91
243 244-244.9  250.00-250.03
250.10-250.13 250.20-250.23 250.30-250.33
250.40-250.43 250.50-250.53 250.60-250.63
250.70-250.73 250.80-250.83 250.90-250.93
251.0-251.9 252.0-252.9 253.0-253.9
254.0-255.9 263.0 276.0-276.9
278.01 290.0-294.9 295.00-295.04
295.10-295.14 295.20-295.24 295.30-295.34
295.40-295.44 295.50-295.54 295.60-295.64
295.70-295.74 295.80-295.84 295.90-295.94
296.00-296.05 296.10-296.15 296.20-296.25
296.30-296.35 296.40-296.45 296.50-296.55
296.60-296.65 296.7 296.80-296.89
296.90-296.99 297.0-297.9 298.0-298.9
299.00-299.01 299.10-299.11 299.80-299.81
299.90-299.91 300.00-300.10 300.20-300.21
300.29 304.0-304.9 305.00-305.02
305.20-305.22 305.30-305.32 305.40-305.42
305.50-305.52 305.60-305.62 305.70-305.72
305.80-305.82 324.0 331.0
345.00-345.01 345.10-345.11 345.2
345.3 345.40-345.41 345.50-345.51
345.60-345.61 345.70-345.71 345.80-345.81
345.90-345.91 361.89 362.56
391.0-391.2 394.0-397.9 401.0
402.00-402.01 402.10-402.11 402.90-402.91
404.00-404.03 404.11-404.13 404.91-404.93
405.01-405.91 410.00-410.02 410.10-410.12
410.20-410.22 410.30-410.32 410.40-410.42
410.50-410.52 410.60-410.62 410.70-410.72
410.80-410.82 410.90-410.92 411.0-411.1
411.81 411.89 412
413.0-413.9 414.00-414.03 414.10-414.19
414.8 414.9 415.0
415.11 415.19 416.0
416.9 420.0 420.90-420.99
421.0-421.9 422.0-422.99 423.0-423.9
424.0-424.99 425.0-425.9 426.0-427.69
427.81-427.89 428.0-428.9 430-431
432.0-432.9 433.00-433.01 433.10-433.11
433.20-433.21 433.30-433.31 433.80-433.81
433.90-433.91 434.00-434.01 434.10-434.11
434.90-434.91 435.0-435.9 436
437.0-437.9 490-496 500-505
506.0-506.9 508.0-508.9 510.0-510.9
512  518.0-518.82 550.00-550.90
551.0-551.9 552.00-552.03 552.1
552.20-552.29 570-571.8  572.0-572.8 
578.9 584.5-586 611.72
685.1 722.10 780.1
780.3 785.50-785.59 786.1
793.8 934-939.3 995.0-995.4
995.60-995.69  996.53 998.5-998.59

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



Attention: Home Infusion Therapy (HIT) Providers
Home Infusion Therapy Visits

EDS is offering individual provider visits for home infusion therapy 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: Chiropractor Providers
Chiropractor Visits

EDS is offering individual provider visits for chiropractor providers. Please complete and return the Chiropractors Provider Visit Request Form to:

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


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: Personal Care Services (PCS) Providers
Personal Care Services Seminars

Personal Care Services seminars are scheduled in August 2000. The July 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 Issue Form to:

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


EDS, 1-800-688-6696 or 919-851-8888
 



Attention: Hospital Providers
Hospital Seminar Schedule

Seminars for hospital providers will be held in July and August 2000. Agenda topics include the following: UB-92 billing instructions, sterilization, hysterectomy and abortion consent guidelines, reimbursement methodology, claim resubmission information, and Medicaid Managed Care.

All hospital personnel involved in verifying Medicaid information including the admitting, discharge, ER, and billing staff are encouraged to attend.

Note: Since the November 1997 North Carolina Medicaid Hospital Manual, with 1998 and 1999 updates, will be the main source of reference throughout the seminar, providers are required to bring their manual to the seminar. Manuals will be available for purchase at a cost of $9.00 per copy during registration. 
 

Due to limited seating, pre-registration is required. Providers not registered are welcome to attend when reserved space is adequate to accommodate. 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 9:30 a.m. to complete registration.

Directions are below.
Thursday, July 6, 2000
Catawba Valley Technical College
Highways 64-70
Hickory, NC
Auditorium
Tuesday, July 11, 2000
Four Points Sheraton
5032 Market Street
Wilmington, NC
Thursday, July 13, 2000
Holiday Inn Conference Center
530 Jake Alexander Blvd., S.
Salisbury, NC
Tuesday, August 1, 2000
Wake Medical Center 
MEI Conference Center
3000 New Bern Avenue
Raleigh, NC
Park at East Square Medical Plaza

Print and return the Hospital Provider Seminar Registration Form to:

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




Directions to the Hospital Seminars

HICKORY, NORTH CAROLINA
CATAWBA VALLEY TECHNICAL COLLEGE

Take I-40 to exit 125 and go approximately .5 mile to Highway 70. Travel East on Highway 70 and the college is approximately 1.5 miles on the right. Ample parking is available. Entrance to Auditorium is between the Student Services and the Maintenance Center. Follow sidewalk (toward Satellite Dish) and turn right to Auditorium Entrance.

WILMINGTON, NORTH CAROLINA
FOUR POINTS SHERATON

I-40 East into Wilmington to Highway 17 - just off I-40. Turn left onto Market Street and the Four Points Sheraton is located approximately .5 mile on the left.

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 .5 mile and 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
June 13, 2000
July 11, 2000
August 8, 2000
June 20, 2000
July 18, 2000
August 15, 2000
June 29, 2000
July 27, 2000
August 24, 2000


Electronic Cut-Off Schedule
June 9, 2000
July 7, 2000
August 4, 2000
June 16, 2000
July 14, 2000
August 11, 2000
June 23, 2000
July 21, 2000
August 18, 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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