RA Messages for October 17, 2000

PHARMACY PROVIDERS, PLEASE NOTE!!!

IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790                                   

PLEASE MAKE THE FOLLOWING CHANGES TO THE 5/15/00 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

REFERENCING PAGE 24-15 OF THE PHYSICIAN SERVICES MANUAL, SPIROMETRY (CPT CODE 94010) IS A COMPREHENSIVE CODE THAT INCLUDES RESPIRATORY FLOW VOLUME LOOP (CPT CODE 94375). WHEN SPIROMETRY IS BILLED, RESPIRATORY FLOW VOLUME LOOP MAY NOT BE BILLED ON THE SAME DATE OF SERVICE BY THE SAME PROVIDER OR GROUP FOR THE SAME RECIPIENT.  BRONCHOSPASM EVALUATION (CPT CODE 94060) IS A COMPREHENSIVE CODE THAT INCLUDES SPIROMETRY AND RESPIRATORY FLOW VOLUME LOOP (CPT CODES 94010 AND 94375). THEREFORE, WHEN BRONCHOSPASM EVALUATION IS BILLED, NEITHER SPIROMETRY NOR RESPIRATORY FLOW VOLUME LOOP MAY BE BILLED ON THE SAME DATE OF SERVICE BY THE SAME PROVIDER OR GROUP FOR THE SAME RECIPIENT.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

CPT CODE 33140 (TRANSMYOCARDIAL REVASCULARIZATION - TMR) WILL PEND FOR MEDICAL REVIEW AND WILL BE PAID ONLY IF THE CRITERIA PRINTED IN THE 11-99 ISSUE OF THE MEDICARE PROVIDER NEWS ARE MET.

NOTICE TO PROFESSIONAL SERVICE PROVIDERS

CPT CODE 69990 (USE OF OPERATING MICROSCOPE), WHEN USED IN ADDITION TO CPT CODE 69436, WILL BE DENIED UNLESS THERE IS AN UNUSUAL SITUATION WHICH JUSTIFIES THE USE OF A MICROSCOPE. IF THE PROCEDURE APPEARS ROUTINE AND THE MICROSCOPE VISION IS JUST MENTIONED IN THE OPERATIVE REPORT, THE CLAIM WILL BE DENIED WITH AN ERROR CODE 774 (INCLUDED IN THE RELATED PROCEDURE).

NOTICE TO AUDIOLOGISTS AND PHYSICIANS

THE LOUISIANA MEDICAID PROGRAM RECEIVED CLARIFICATION FROM THE LOUISIANA BOARD OF EXAMINERS FOR SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY THAT CPT CODE 92568 AND CPT CODE 92567 ARE NO LONGER ONE SERVICE BUT TWO SEPARATE SERVICES WHICH ARE NOT INCLUSIVE OF ONE ANOTHER.  WE ARE THEREFORE REVISING OUR POLICY EFFECTIVE OCTOBER 1, 2000 TO REFLECT THIS.

NOTICE TO PHYSICIAN'S BILLING CLERKS

WE WOULD LIKE TO CLARIFY INFORMATION GIVEN BY THIS OFFICE ON SEPTEMBER 25, 2000 ABOUT THE REMITTANCE ADVICE DATED SEPTEMBER 20, 2000 WHICH LISTS THE CLAIMS ON WHICH RECOUPMENTS ARE BEING MADE.

SOME INACCURATE INFORMATION WAS GIVEN DURING THOSE PHONE CONVERSATIONS.  YOU WERE TOLD THAT 7% LESS THAN OFFSET AMOUNT OF $1.48 WOULD BE RECOUPED ON EACH CLAIM.  THE TRUE AMOUNT BEING RECOUPED IS 7% LESS.0534.  THIS FORMULA APPLIES TO RECOUPMENTS ON STRAIGHT MEDICAID CLAIMS, ONLY.

RECOUPMENTS ON PROFESSIONAL CROSS-OVER CLAIMS MAY TOTAL MORE OR LESS THAN 7%.  NO OFFSET AMOUNT SUCH AS .0534 IS BEING APPLIED TO THESE CLAIMS.

PLEASE NOTATE YOUR RECORDS ACCORDINGLY.  WE APOLOGIZE FOR ANY CONFUSION OUR INCORRECT INFORMATION MAY HAVE CAUSED.