May 2004 Medicare Bulletin - North Carolina Insert

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Table of Contents

• Injectable Anti-Emetics for Chemotherapy Related Nausea and Vomiting
• North Carolina Health Professional Shortage Areas (HPSAs)
• Policy Updates

Injectable Anti-Emetics for Chemotherapy Related Nausea and Vomiting

Chemotherapy related nausea and vomiting can be present beyond the day on which the chemotherapy is administered. In these situations, intravenous anti-emetics may be covered subject to the rules of medical necessity. When billing for injectable anti-emetics administered on a date succeeding the chemotherapy, providers must append modifier -KX to the applicable Level II HCPCS code. This attests to documentation in the medical record that the injectable anti-emetic was given for nausea and vomiting related to chemotherapy. Please use ICD-9 codes 787.01, 787.02, or 787.03, as applicable.

(04-0779)

Policy Updates

Upper Gastrointestinal Endoscopy
(LMRP 97-018-11)

The following codes were added to those that support medical necessity. These codes were originally added to the policy on October 1, 2000, but were omitted due to typographical error.

787.01 Nausea with vomiting

787.02 Nausea alone

787.03 Vomiting alone

B12 Injection (LMRP 95-02)

The following codes were added to those that support medical necessity. These codes were originally added to the policy July 23, 2003, but were omitted due to typographical error.

780.91 Fussy infant (baby)

780.92 Excessive Crying of Infant

780.99 Other General Symptoms

The following code was deleted from the policy. This code was added July 23, 2003, in error.

780.93 Memory Loss

Oxaliplatin for injection (Eloxatin) (LMRP 2003-003)

The following ICD-9 codes were added to those that support medical necessity:

154.2 Malignant Neoplasm of Anal Canal

154.3 Malignant Neoplasm of Anus Unspecified Site

Metabolic Laboratory Panels (LMRP 98-014)

The following ICD-9 code was added to those that support medical necessity:

272.4 Other and unspecified hyperlipidemia

Low Osmolar Contrast Material (LOCM) (LMRP 92-02)

The following HCPCS code was deleted from the policy:

A9525 Supply of low or iso-osmolar contrast material, 10MG of iodine

The following HCPCS codes were added to the policy:

A4644 Supply of low osmolar contrast material (100-199 MGS of iodine)

A4645 Supply of low osmolar contrast material (200-299 MGS of iodine)

A4646 Supply of low osmolar contrast material (300- 399 MGS of iodine)

Transthoracic Echocardiography (TTE) (LMRP 97-001-06)

The following ICD-9 code was added to those that may support medical necessity:

786.50 Unspecified Chest Pain

(04-0780)

North Carolina Health Professional Shortage Areas (HPSAs)

Designated Geographic Areas

COUNTY AREA NAME/PARTS RURAL/URBAN Alexander All Urban Anson All Rural Beaufort Bayboro - Aurora Richland Twp. Belhaven - Swan Quarter Bath Twp., Pantego Twp Rural Bertie All Rural Bladen5 All Rural Brunswick1 All Rural Caldwell Western Caldwell - Globe Twp., Johns River Twp., Mulberry Twp., Patterson Twp., Wilson Creek Twp., Rural Carteret5 Eastern Cateret - Atlantic Twp., Cedar Island Twp., Davis Twp., Harkers Islands Twp., Marshallberg Twp., Merrimon Twp., Portsmouth Twp., Sea Level Twp., Smyrna Twp., Stacy Twp., Strait Twp. Rural Caswell All Rural Cherokee3 Andrews Area, Valley Town Twp. Rural Clay All Rural Columbus All Rural Currituck All Urban Dare Hatteras - Ocracoke Hatteras Twp., Kinnakeet Twp., Rural Edgecombe All Urban Franklin All Urban Gates All Rural Graham All Rural Greene6 All Rural Guilford Inner City Greensboro - Census Tracts 101, 107.02, 108.01, 110, 111.01, 112, 113, 114, 115 Urban Harnett4 Western Harnett - Anderson Creek Twp., Barbecue Twp., Johnsonville Twp., Lillington Twp., Stewarts Creek Twp., Upper Little River Twp. Rural Hoke All Rural Hyde Belhaven-Swan Quarter Currituck Twp., Fairfield Twp., Lake Landing Twp., Lake Mattamuskeet Unorg., Swan Quarter Twp. Hatteras-Ocracoke Ocracoke Twp. Rural Lenoir East Kinston - Census Tracts 101-105, 107 Urban Macon5 Franklin - Burningtown Twp., Cartoogechaye Twp., Cowee Twp., Ellijay Twp., Flats Twp., Franklin Twp., Millshoal Twp., Nantahala Twp., Smiths Bridge Twp. Rural Mecklenburg Central Charlotte - Census Tracts 1, 4, 5, 6, 7, 8, 36, 37, 38.98, 39.01, 39.02, 41, 42, 45, 46, 47, 48, 49, 50, 51, 51.01, 52 Urban Montgomery5 All Rural Northampton All Rural Onslow1 All Urban Pamlico Bayboro - Aurora Rural Pender All Rural Person All Rural Randolph All Urban Robeson All Rural Stokes Danbury - Census Tracts 701, 702, and 703 Urban Tyrrell All Rural Warren2 All Rural Washington All Rural

¹ No longer classified as a HPSA, effective December 1, 1999.
² Classifed as a HPSA, effective March 1, 2001.
³ Classifed as a HPSA, effective July 1, 2001.
⁴ No longer classified as a HPSA, effective September 1, 2001.
⁵ No longer classified as a HPSA, effective August 1, 2002.
⁶ No longer classified as a HPSA, effective June 1, 2004.

(04-0875)