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Provider Update Newsletter

June 2003, Volume 128
 

All Providers

HIPAA Happenings

Home Health Providers

T1000 Private Duty/Independent Nursing Service(s) 

Assisted Living Providers Providers

Diagnosis Codes

 Vision Providers

Reminder on Optometric Services

HIPAA Happenings

Transaction and Code Sets

The Final Rule adopting changes to the HIPAA Electronic Transactions and Code Set 
Standards was published in the Federal Register on February 20, 2003. This final rule 
modifies a number of the electronic transactions and code sets adopted as national 
standards under HIPAA and eliminates the NDC code set as the standard for all providers 
except retail pharmacies. It does not adopt a standard reporting drugs and biologics on 
non-retail pharmacy transactions. 

The modifications are published as Addenda to the ASC X12N Implementation Guides 
and are available through the Washington Publishing Company website 

On April 17, 2003, the Department of Health and Human Services, Office of the Secretary, 
published an interim final rule request for comments on the Final Rule for Civil Money Penalties: 
Procedures for Investigations, Impositions of Penalties and Hearings. This interim final rule 
establishes the rules of procedures for the imposition of civil money penalties by the Secretary 
of  HHS on entities that violate standards adopted by the Administrative Simplification provisions 
of the Health Insurance Portability and Accountability Act, 1996.

This document is available electronically at the following web sites of the Department of Health 
and Human Services website as well as the Centers for Medicare and Medicaid Services website.
It is also available at the web site of the Government Printing Office website.

Please check the DHS HIPAA web site regularly for HIPAA updates.

T1000 Private Duty/Independent Nursing Service(s)

T1000 PRIVATE DUTY/ INDEPENDENT NURSING SERVICE(S)- 
LICENSED UP TO 15 MINUTES

The following modifiers should be used when billing the above code:

  Modifier           Description                         Modifier           Description

DL                    Day Shift LPN                      DS                 Day Shift
EL                     Evening Shift LPN                ES                  Evening Shift
HL                    Holiday Shift LPN                 HS                 Holiday Shift
NL                    Night Shift LPN                    NS                 Night Shift
WL                   Week-End Shift LPN            WS                Week End Shift

Diagnosis Codes

Please note that until October 2003, you may use the following diagnosis V604 : No Family 
to care. 

After October 2003, a valid ICD 9 diagnosis code must be documented for each of 
your clients serviced, prior to that date.

Vision Providers

A Reminder from the Surveillance Utilization Review Team on Office Visit Documentation for 
Optometric Services

These are some policy issues that seem to need special attention. Please use this reminder to 
prevent recoupments or denials for claims you submit. 

The Medical Assistance Program allows recipients age 21 and older to have coverage for: 
one (1) refractive examination once per 24- month period.
one (1) pair of eyeglasses (lenses, frames and dispensing fee) once per 24- month period.
one (1) pair of contact lenses once per 24- month period.

Medically necessary office visits for diagnosis and treatment of illness or injury to the eyes are 
not limited to a 24-month limitation.

For recipients under the age of 21 this 24-month time frame limitation does not exist, however,
Full documentation to support medical necessity must be in the office record.
If glasses are lost, stolen, broken and are being replaced that information must be documented.