New HIPAA Procedure Codes take effect on 11/1/2004

Transcription

1 Issue Social Services Information System November 2, 2004 SSIS on CountyLink: New HIPAA Procedure Codes take effect on 11/1/2004 DHS Bulletin # titled Conversion to National HIPAA Procedure Codes for Home Care, Waiver and AC (dated September 21, 2004), addresses changes to MMIS billing codes for clients on waivered services and the AC program. Use of the new national HIPAA procedure codes is planned for a two-phase implementation. Phase 1 changes will become effective on 11/1/2004; Phase 2 changes are targeted for a future implementation. The new national HIPAA procedure codes was updated in SSIS tables on Monday, November 1. Applicable modifiers will be automatically included on the Time_Record_Mod table for staff activity time entry. Counties using Service Agreements will need to add the modifier(s) manually on the SSIS Service Agreement Entry Screen if they want them to be carried on the Service Agreements. CDCS was applicable in 37 counties for AC and all waiver programs, effective 10/1/2004 DHS Bulletin # titled MMIS Changes to Support Consumer-directed Community Supports (CDCS) for Elderly Waiver (EW) and Alternative Care (AC) Programs (dated September 16, 2004), addresses the expansion of the CDCS program in two phases. The first phase involves the expansion of CDCS across all waiver programs and AC in the thirty-seven counties that are currently authorized to provide CDCS under the MR/RC waiver, effective 10/1/2004. The second phase of implementation will involve the remaining fifty counties. It is the Department s goal to implement the second phase on April 1, To accommodate CDCS, SSIS will add six new TR_Activity codes, one for each of the six new Consumer Directed Community Support (CDCS) services. The six activities will be associated with the Approved Pilot Project BRASS codes in the Children s Services 158x (CW and EID), DD Services 558x, and Adult Services 658x (AS, AC, EW, CAC, CADI, and TBI) workgroups. MMIS billing codes and modifiers for CDCS will be assigned as follows: Activity Description HCPC Code Modifier 100 CDCS - Personal assistance (available for AC, EW, CAC, CADI, MR/RC, and TBI) 101 CDCS - Treatment and training (available for AC, EW, CAC, CADI, MR/RC, and TBI) 102 CDCS - Environmental modifications and provisions (available for AC, EW, CAC, CADI, MR/RC, and TBI) 103 CDCS - Self direction support activities (available for AC, EW, CAC, CADI, MR/RC, and TBI) 104 CDCS - Background check (available for AC, EW, CAC, CADI, MR/RC, and TBI) T2040 U2 U3 U4 105 CDCS - Mandatory case management (available only for AC and EW) T2041 Codes continued on page 2

2 SSIS Project Update Issue 177 November 2, 2004 Page 2 Codes from page 1 Applicable modifiers will be included on the Time_Record_Mod table for CDCS staff activity time entry, but counties using Service Agreements will need to add the modifiers manually on the SSIS Service Agreement Entry Screen if they want them are to be carried on the Service Agreements. MR/RC clients whose MMIS Service Agreements were established with the old HCPC CDCS codes will need to use them on the claims submitted to MMIS. SSIS will carry the new HIPAA codes on time records for all CDCS services. Time sheets for CDCS can be/will be imported from SSIS into CSIS when the CDCS procedure codes have been entered in the CSIS Procedure Code Control File. CSIS will not create claims for CDCS in the next CSIS software release (04.3). The CSIS Waiver Billable Time Proof List and CSIS Waiver Claims Edit Report will display messages to indicate that the procedure should be claimed manually (Direct Entry or MN-ITS). CSIS claims processing of CDCS may be added in a later CSIS release. The current Cross Reference - Procedure Codes for Potentially Billable Staff Provided Activities is attached to this issue. This document includes a cross-walk of the old HCPC codes to the new HIPAA billing codes, along with notation indicating whether or not a diagnosis code will be required on the claim form. The new CDCS activity codes are also included. CSIS counties should refer to CSIS User Memo #04-03 recently sent to CSIS counties. Version Updates available SSIS Version Update (for October 1-22) is available on CountyLink. The new report, updated every other Friday, documents the problem reports that have passed testing in the previous two weeks. It will provide information on fixes and enhancements well before a new release is distributed statewide. Find SSIS Version Update under Related Links on the right margin, or click on Support>Release Notes. _access/documents/pub/dhs_id_ hcsp Upload Update The October upload is due today, October 29. This upload is for the AFCARS reporting period that starts April 1 and ends September 30. Project Update is an information sheet of SSIS progress. The SSIS Project A County/State Partnership Minnesota Department of Human Services 444 Lafayette Road N., St. Paul, MN (651) (651) (fax) (651) (Help Line) ssishelp@state.mn.us

3 Cross Reference Procedure Codes for Potentially Billable Staff Provided Activities Note: The following procedure codes are included with the time record when a worker reports one of the listed service/activity combinations. The time record identifies which procedure code should be used for claiming, assuming that billing requirements are met. The county is responsible for verifying that all billing requirements are met prior to claiming. Before claiming, the county should: Verify MA eligibility Verify that other eligibility determinations have been made and documented according to the program rules Follow program rules for retroactive billing Verify client ages for Targeted Case Management (see general billing requirements and comments in table below) Verify that the worker entered a contact as completed. Contacts entered as attempted carry a procedure code but should not be billed Verify that the worker who reported the activity is qualified to bill according to the program rules Procedure codes contact method required on time record CW-TCM: The following services qualify for CW-TCM claiming when associated with qualifying staff-provided activities and client eligibility. Service 104-CP Assessment/Investigation 107-Child Welfare Assessment Program Comments Available in CP assessment workgroups only; worker should use for Traditional assessment track only Available in all Children s Services programs except licensing 108-Alternative Response Assessment Available in CP assessment workgroups only; worker should use for Alternative Response assessment track only 109-Concurrent Planning Assessment Available in CP workgroups only. See DHS Provider Update # Alternative Response Case Management 193-General Case Management 492-Child General Case Management 592-Child Rule 185 Case Management-Non Waiver Available in CP case management workgroups only; worker should use for Alternative Response case management track only Available in all Children s Services programs Available in CMH only Available in DD only C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 1 of 16

4 Activities for all CW-TCM services are mapped to procedure codes as follows. The procedure code is only added to the SSIS time record for the contact method listed. Activity Contact method Procedure Codes Modifier 1-face to face U3 1-face to face U3 15-CW-TCM out of county contact 2-telephone U3 and U4* *If the contact method for CW-TCM out of county contact is face to face, the modifier will be U3 without the U4. CW-TCM General Billing requirements CW-TCM county verification requirements County verification for all claims: Client must have CW-TCM eligibility determination Client must be < age 21 Contact status must be completed Additional county verification for U4 only: Child must be in placement out of county Only two consecutive telephone contacts are billable under U4 C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 2 of 16

5 MH-TCM: Procedure codes are mapped to the following services and programs and are only added to the SSIS time record for the contact method listed. See DHS Bulletin (MH case management payment update) for details on MH-TCM. Service Activity Contact method 491-Adult Rule 79 Case 1-face to face management Service is available in AMH and CMH. If workgroup is CMH, this service should only be used if client is age 18 to telephone Procedure code Modifier HE HE and U4* MH-TCM billing requirements /Comments County verification: Client must be eligible for MH-TCM (SPMI) Client must be age 18 or older * A telephone contact with the adult or the adult s legal representative is billable if the worker recorded a face-to-face contact within the preceding two months. 490-Child Rule 79 Case management Service is only available in CMH. 1-face to face HE and HA County verification: Client must be eligible for MH-TCM (SED) Client must be age 17 or less VA/DD-TCM: Procedure codes are mapped to the following services and programs and are only added to the SSIS time record for the contact method listed. See DHS Bulletin # for details on VA/DD-TCM. Service Activity Contact method Procedure code Modifier VA/DD-TCM billing requirements /Comments 593-Rule 185 Adult case management/non-waiver - age 21 & over 1-face to face 2-telephone and U4 See bulletin # for billing rules. 1-face to face 2-telephone and U4 604-Adult protection assessment/investigation 1-face to face 2-telephone and U4 See bulletin # for billing rules. Procedure code is only added to the SSIS time record when the program is AP. 1-face to face 2-telephone and U4 C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 3 of 16

6 Service Activity Contact method Procedure code Modifier VA/DD-TCM billing requirements /Comments 607-General assessment 1-face to face See bulletin # for 2-telephone and U4 billing rules. Procedure code is only added to the SSIS time record when the program is AP. 1-face to face 2-telephone and U4 693-Adult protection general case management 1-face to face 2-telephone and U4 See bulletin # for billing rules. Procedure code is only added to the SSIS time record when the program is AP. 1-face to face 2-telephone and U4 C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 4 of 16

7 Procedure codes contact method not required on the time record New code as of 11/1/2004 (Old code, ending 10/31/2004) Children s Services Service Activity Procedure code Modifier General Billing Requirements/Comments 105-Long Term Care Consultation Procedure code is only added to the SSIS time record when the program is CW, EID, or MP. 124-Home-based support services Service is available for all Child Service programs except licensing. Procedure codes are only added to the SSIS time record when the program is CW, EID, or A/G. 125-Homemaking services Service is available for all Child Service programs except licensing. 28-Screening See Bulletin # for billing rules. 30-Service delivery-extended home health aide 38-Service delivery-extended personal care G0156 (X5650) T1019 (X5581) UC CAC, CADI or. Diagnosis CAC, CADI, TBI, or MR/RC waiver client. Diagnosis 29-Service delivery S5130 (X5655) CAC, CADI or Procedure code is only added to the SSIS time record when the program is CW, EID, or A/G. 145-Social & recreational services Procedure code is added to the SSIS time record in all Children s Services programs except licensing. 155-Individual counseling Service is available for all Child Service programs except licensing. 20-Personal support 11-Counseling 43-Individual therapy 45-Maintenance S min (X hour) X5590 X5592 X5591 MR/RC waiver client. Diagnosis required CADI or Procedure codes are only added to the SSIS time record when the program is CW, EID, or A/G. C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 5 of 16

8 Service Activity Procedure code Modifier General Billing Requirements/Comments 156-Group counseling 39-Family counseling/ training (CADI, TBI) S5110 (X5460) CADI or 41-Family counseling (CAC) S5110 (X5676) Service is available for all Child 40-Family training (CAC) X5677 Service programs except licensing. 44-Group therapy X5593 Procedure codes are only added to the SSIS time record when the program is CW, EID, or A/G. 158-Approved pilot projects Service is available only for CW and EID workgroups. Procedure codes are only added to the SSIS time record when the program is CW or EID. 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check T2040 U2 U3 U4 CAC, CADI or. Diagnosis CAC, CADI or. Diagnosis CAC, CADI or. Diagnosis CAC, CADI or. Diagnosis CAC, CADI or 191-CAC/CADI/TBI Case management Service is available only for CW, EID, and A/G workgroups. Procedure codes are only added to the SSIS time record when the program is CW, EID, or A/G. 194 Relocation Service Coordination Service is available only for CW workgroups. 19-Paraprofessional case management 34-Transportation 35-Travel in county 36-Travel out of county 07-Client Contact 08-Collateral Contact 34-Transportation 35-Travel in county 36-Travel out of county X5491 CAC, CADI or (activities 07-19). Actual billing may be subject to cap (activities 07-19). C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 6 of 16

9 Developmental Disabilities 505-MR/RC Screening 28-Screening X Homemaking services 29-Service delivery S5130 (X5655) MR/RC waiver client 531-In-home family support services 29-Service delivery S min (X min) MR/RC waiver client. Diagnosis 33-Training-family/individual S5116 (X5263) 558-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check T2040 U2 U3 U4 MR/RC waiver client. Diagnosis MR/RC waiver client. Diagnosis MR/RC waiver client. Diagnosis MR/RC waiver client. Diagnosis MR/RC waiver client. 591-Rule 185 Case managementwaiver 31-Service Planning 34-Transportation 35-Travel in county 36-Travel out of county Actual billing may be subject to cap (activities 07-36). C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 7 of 16

10 Adult Services Note: The following services are available for Adult Services (AS) and Adult Protective Services (AP). The procedure code will be included on time records for AS unless noted. 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. Procedure code is included for both AS and AP programs. 616-Transportation 29-Service delivery X5265 AC waiver client 622-Companion services 29-Service delivery S min (X min) 623-Chore services 29-Service delivery S min (X min) 624-Home-based support services 29-Service delivery G0156 (X5660) 30-Service delivery-extended home health aide G0156 (X5650) AC, EW, or AC, EW, TBI or MR/RC waiver client AC waiver client. Diagnosis EW, CAC, CADI, or. Diagnosis 33-Training-family/individual 38-Service delivery-extended personal care S5116 (X5263) T1019 (X5581) UC AC or EW waiver client EW, CAC, CADI, TBI, or MR/RC waiver client. Diagnosis 42-Service delivery-personal care assistance 48-Service delivery - visit T1019 (X5653) T1021 (X5285) AC waiver client. Diagnosis AC waiver client. Diagnosis 625-Homemaking services 29-Service delivery S5130 (X5655) AC, EW, CAC, CADI, or TBI waiver client 645-Social and recreational services 20-Personal support S min MR/RC waiver client. Diagnosis (X hour) 655-Individual counseling 11-Counseling 43-Individual therapy 45-Maintenance X5590 X5592 X5591 CADI or 656-Group counseling 39-Family counseling/ training (CADI, TBI) 41-Family counseling (CAC) 40-Family training (CAC) 44-Group therapy S5110 (X5460) S5110 (X5676) X5677 X5593 CADI or C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 8 of 16

11 658-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check 105-CDCS Mandatory case management T2040 T2041 U2 U3 U4 AC, EW, CAC, CADI or TBI waiver client. Diagnosis AC, EW, CAC, CADI or TBI waiver client. Diagnosis AC, EW, CAC, CADI or TBI waiver client. Diagnosis AC, EW, CAC, CADI or TBI waiver client. Diagnosis AC, EW, CAC, CADI or TBI waiver client AC or EW waiver client 691-AC/EW/CAC/CADI/TBI Case management 05-Case conversion-ac 19-Paraprofessional case management (X5477) X5491 AC client AC, EW, CAC, CADI or TBI waiver client (activities 07-19). Actual billing may be subject to cap (activities 07-19). 34-Transportation 35-Travel in county 36-Travel out of county 694-Relocation Service Coordination Service is available for AS only. 07-Client Contact 08-Collateral Contact 34-Transportation 35-Travel in county 36-Travel out of county C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 9 of 16

12 Adult Waivered Services Programs AC Alternative Care Waiver 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. 616-Transportation 29-Service delivery X5265 AC waiver client 622-Companion services 29-Service delivery S min (X min) 623-Chore services 29-Service delivery S min (X min) 624-Home-based support services 29-Service delivery G0156 (X5660) 33-Training-family/individual S5116 (X5263) 42-Service delivery-personal care assistance T1019 (X5653) 48-Service delivery visit T1021 (X5285) AC waiver client AC waiver client 625-Homemaking services 29-Service delivery S5130 (X5655) AC waiver client AC waiver client. Diagnosis AC waiver client. AC waiver client. Diagnosis AC waiver client. Diagnosis 658-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check 105-CDCS Mandatory case management T2040 T2041 U2 U3 U4 AC waiver client. Diagnosis AC waiver client. Diagnosis AC waiver client. Diagnosis AC waiver client. Diagnosis AC waiver client. AC waiver client. C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 10 of 16

13 05-Case conversion-ac (X5477) AC waiver client 691-AC/EW/CAC/CADI/TBI Case management 19-Paraprofessional case management X5491 AC waiver client AC waiver client AC waiver client AC waiver client AC waiver client AC waiver client Actual billing may subject to cap (activities 07-19) EW Elderly Waiver 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. 622-Companion services 29-Service delivery S min (X min) 623-Chore services 29-Service delivery S min (X min) 624-Home-based support services 33-Training-family/individual S5116 (X5263) 30-Service delivery-extended home health aide G0156 (X5650) 38-Service delivery-extended personal care T1019 (X5581) UC EW waiver client EW waiver client EW waiver client EW waiver client. Diagnosis EW waiver client. Diagnosis 625-Homemaking services 29-Service delivery S5130 (X5655) EW waiver client C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 11 of 16

14 658-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check 105-CDCS Mandatory case management T2040 T2041 U2 U3 U4 EW waiver client. Diagnosis EW waiver client. Diagnosis EW waiver client. Diagnosis EW waiver client. Diagnosis EW waiver client. EW waiver client. 691-AC/EW/CAC/CADI/TBI Case management 19-Paraprofessional case management X5491 EW waiver client EW waiver client EW waiver client EW waiver client EW waiver client EW waiver client Actual billing may be subject to cap (activities 07-19) CAC Community Alternative Care Waiver 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. 624-Home-based support services 30-Service delivery-extended home health aide 38-Service delivery-extended personal care G0156 (X5650) T1019 (X5581) UC. Diagnosis. Diagnosis 625-Homemaking services 29-Service delivery S5130 (X5655) 656-Group counseling 41-Family counseling (CAC) 40-Family training (CAC) S5110 (X5676) X5677 C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 12 of 16

15 658-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check T2040 U2 U3 U4. Diagnosis. Diagnosis. Diagnosis. Diagnosis. 691-AC/EW/CAC/CADI/TBI Case management 19-Paraprofessional case management X5491 Actual billing may be subject to cap (activities 07-19) CAD Community Alternatives for Disabled Individuals Waiver 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. 624-Home-based support services 30-Service delivery-extended home health aide 38-Service delivery-extended personal care G0156 (X5650) T1019 (X5581) UC CADI waiver client. Diagnosis CADI waiver client. Diagnosis C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 13 of 16

16 625-Homemaking services 29-Service delivery S5130 (X5655) CADI waiver client 655-Individual counseling 11-Counseling X5590 CADI waiver client 656-Group counseling 39-Family counseling/ training (CADI, TBI) S5110 (X5460) CADI waiver client 658-Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check T2040 U2 U3 U4 CADI waiver client. Diagnosis CADI waiver client. Diagnosis CADI waiver client. Diagnosis CADI waiver client. Diagnosis CADI waiver client. 691-AC/EW/CAC/CADI/TBI Case management 19-Paraprofessional case management X5491 CADI waiver client CADI waiver client CADI waiver client CADI waiver client CADI waiver client CADI waiver client Actual billing may be subject to cap (activities 07-19) TBI - Traumatic Brain Injury Waiver 605-Long Term Care Consultation 28-Screening See Bulletin # for billing rules. C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 14 of 16

17 622-Companion services 29-Service delivery S min (X min) 623-Chore services 29-Service delivery S min (X min) 624-Home-based support services 30-Service delivery-extended home health aide 38-Service delivery-extended personal care G0156 (X5650) T1019 (X5581) UC. Diagnosis. Diagnosis 625-Homemaking services 29-Service delivery S5130 (X5655) 655-Individual counseling 11-Counseling 43-Individual therapy 45-Maintenance X5590 X5592 X Group counseling 39-Family counseling/ training (CADI, TBI) 44-Group therapy S5110 (X5460) X Approved pilot projects 100-CDCS Personal assistance 101-CDCS Treatment and training 102-CDCS Environmental modifications and provisions 103-CDCS Self direction support activities 104-CDCS Background check T2040 U2 U3 U4. Diagnosis. Diagnosis. Diagnosis. Diagnosis. C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 15 of 16

18 19-Paraprofessional case management X AC/EW/CAC/CADI/TBI Case management Actual billing may be subject to cap (activities 07-19) 34-Transportation 35-Travel in county 36-Travel out of county C:\Documents and Settings\pwpal46\Local Settings\Temporary Internet Files\OLK15\Billing code cross reference doc Page 16 of 16