RA Messages for April 17, 2001

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 12/9/00 VERSION OF APPENDIX A

 PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:

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

NOTICE TO HOSPITALS

PLEASE NOTE: THE PROBLEM WITH REVENUE CODE 490 (AMBULATORY SURGICAL CARE) CLAIMS DENYING IN ERROR WITH ERROR EDIT 266 (REVENUE CODE INVALID FOR AMBULATORY SURGICAL PROCEDURE) OE EDIT 267 (REVENUE CODE 490 REQUIRES VALID ICD 9 SURGICAL PROCEDURE) HAS BEEN CORRECTED.
CLAIMS THAT DENIED IN ERROR HAVE BEEN RECYCLED ON YOUR REMITTANCE ADVICE DATED APRIL 1, 2001.  IF YOU HAVE BEEN HOLDING NEW CLAIMS FOR REVENUE CODE 490 BECAUSE OF THIS PROBLEM, YOU MAY SUBMIT THEM NOW.  WE APOLOGIZE FOR THE INCONVENIENCE THIS HAS CAUSED.  IF QUESTIONS ARISE, YOU MAY CALL PROVIDER RELATIONS AT (800)473-2783 OR (225)924-5040.

PROVIDERS OF PROFESSIONAL SERVICES

CPT CODE 81000 (URINALYSIS), 82010 (ACETONE OR OTHER KEYTONE BODIES, SERUM; QUANTITATIVE), 86683 (HEMOGLOBIN, FECAL), 87076 (ANAEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH ISOLATE), 87339 (HELIOBACTOR PYLORI), AND 87899 (INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; NOT OTHERWISE SPECIFIED) ARE BEING ADDED TO THE LIST OF PROCEDURES THAT REQUIRE A QW MODIFIER.  CLAIMS ON WHICH THE QW MODIFIER IS NOT ATTACHED WILL BEGIN TO DENY ON MAY 1, 2001.  IF QUESTIONS ARISE, PLEASE CONTACT TRACY ZIMMERMAN, PROGRAM SPECIALIST, AT (225)342-9319.  YOUR COOPERATION IS APPRECIATED.

PROVIDERS OF CRITICAL CARE SERVICES

PAGE 25-2 OF THE PHYSICIAN SERVICE MANUAL INDICATES THAT CPT CODES  93000, 93010, 93040, AND 93042 ARE INCLUDED IN CODES 99291 AND 99292.  THEREFORE, AT THIS TIME, THEY CANNOT BE BILLED SEPARATELY. THIS POLICY  WAS MADE BEFORE THE DESCRIPTORS IN CPT LISTED THE CODES IN 99291 AND  99292 AND 99295-99298, HOWEVER, SO EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2001, PROVIDERS WILL BE ALLOWED TO BILL CPT CODES 93000, 93010,  93040, AND 93042 IN ADDITION TO 99291 AND 99292 AND/OR 99295-99298 ON  THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. 
AS SOON AS PROGRAMMING CAN BE COMPLETED, THE PAYMENT OF CPT CODES 99291-99292 AND/OR99295 THROUGH 99298 FOR A RECIPIENT ON A PARTICULAR DAY WILL RESULT IN THE DENIAL OF REIMBURSEMENT FOR COMPONENT CODES BILLED ON THE SAME DAY BY THE SAME OR DIFFERENT PROVIDERS FOR THE SAME RECIPIENT. CONVERSELY, THE OPPOSITE IS TRUE: IF A PROVIDER IS PAID FOR A COMPONENT  CODE(S) ON A GIVEN DAY FOR RECIPIENT A, REIMBURSEMENT FOR CODES 99291-  99292 AND/OR 99295-99298 ON THAT SAME DAY BY THE SAME OR ANY OTHER PROVIDER FOR RECIPIENT A WILL BE DENIED. THE COMPONENT CODES FOR EACH OF THESE CPT CODES CAN BE FOUND ON PAGES 331, 332, AND 389 OF THE 2001 CURRENT PROCEDURAL TERMINOLOGY.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2001,LOCALLY ASSIGNED CODE Z9921 (LUNELL MONTHLY CONTRACEPTIVE INJECTION) WAS MADE PAYABLE AT A FEE OF $21.10.