HealthCare - www THOR org

HealthCare
#318
May 2010
THORConnect.org
Table of Contents
Provider Education
Attention, Coders................................................... 1
Audio Conference: Diagnostic Cardiology ......... 1
THOR
THOR Applications Training.................................. 1
Medical Policy
Medical Policies Available Online........................ 2
Coding Counts
Spinal Wiring and Spinal Instrumentation............. 2
HealthCare
Glad You Asked!
Trichiasis Treatment............................................... 2
Blue Distinction® Centers
Program Update.................................................... 3
HealthCare
Educational Opportunities
May 4-6
May 17
May 20
October 8
October 9
TRICARE Seminars
AAPC Educational Meeting
Audio conference: Diagnostic Cardiology
Coding Conference – Bismarck
Coding Conference – Fargo
Coding Counts
THOR Applications Training
May
Provider Data Exchange
Provider Education
Attention, Coders
The Red River Valley AAPC Chapter meets at 6 p.m. on the
third Monday of every month in the Blue Cross Blue Shield
of North Dakota corporate office in Fargo. On May 17,
Kathy Heide-Wrazidlo and Kenneth Heide, CPO, FAAOP, will
present “Breast Prosthesis and Accessories.”
HealthCare
Toll-free lines are available for coders outside the FargoMoorhead area to access the presentations and earn CEUs.
For information regarding the meetings, presenters and
access to toll-free lines, go to www.AAPC.com or contact
Education Officer Fran Allery at [email protected].
Audio Conference: Diagnostic Cardiology
Provider Education will host an audio conference
presented by Betty Johnson, BA, CPC, CPC-I, CCS-P,
CPC-H, PCS, RMC, CCP, CIC, CDERC, from 1-2:30 p.m. CDT
Thursday, May 20. Participants will learn about diagnostic
cardiology – cardiac catheterization, including anatomy
and diagnosis coding.
The audio conference is free and available to participating
providers.To register, e-mail [email protected] with
your name, facility name and phone number. Presentation
handouts and conferencing information will be e-mailed
on receipt of your registration. CEUs are available for
this presentation.
THOR
THOR Applications Training
Application Support Services offers WebEx training
sessions on the THOR applications. Each month, learn
about the functionality and benefits of an application.
In May, the focus will be Provider Data Exchange.
To register for a time convenient for your staff, call
800-544-8467 or e-mail [email protected] and include
your name, e-mail address, facility name, telephone
number and available dates and times for training.
HealthCare
Educational Opportunities
Medical Policy
Coding Counts
Medical Policies Available Online
Blue Cross Blue Shield of North Dakota regularly
develops and revises medical policies in response to
rapidly changing medical technology. Our commitment is
to update the provider community as medical policies are
adopted and/or revised. Benefit determinations are made
based on the medical policy in effect at the time of service.
The following medical policies were reviewed by the
Internal Medical Policy Committee on April 7, 2010.
Medical policies are available online at
www.THORConnect.org.
New Policies – Effective June 1, 2010
Mobile Telemetry
When wiring is performed on the spinous
process with other types of segmental or
nonsegmental instrumentation, do not report
CPT® code 22841(Internal spinal fixation by
wiring of spinous processes). Minimal wiring
is considered an inclusive component of the
segmental and nonsegmental instrumentation
CPT® codes.
Draft Policies Available for Comment
Injectable Clostridial Collagenase for
Fibroproliferative Disorders (Xiaflex)
Prosthetic Limbs
Oral Appliance for Sleep Apnea
Vertebral Fracture Assessment
Glad You Asked!
Revised Policies – Check online for effective
date of revision
Cochlear Implant
Esophageal ph Monitoring
Medical Treatment for Macular Degeneration
Gait Analysis
Question: If multiple eyelashes are treated for trichiasis
in a single session, can CPT® codes 67820 (Correction of
trichiasis; epilation, by forceps only) or 67825 (Correction
of trichiasis; epilation by other than forceps [eg, by
electrosurgery, cryotherapy, laser surgery]) be reported
for each eyelash?
HealthCare
Retired
Iplex
Annual Review
Blepharoplasty
Brachioplasty
Chronic Pain Program
Cleft Palate
Extracorporeal Shock Wave Therapy
Hearing Aids
Home Prothrombin Time Monitoring
Hyperbaric Oxygen Therapy
Medical Indications for Contraceptives
MRI Breast
Occupational Therapy Guidelines
Psych/Substance Abuse Out of State Admissions
Scanning Laser for Glaucoma
TMJ Dysfunction
Transcatheter Arterial Chemoembolization of Liver
Transcranial Magnetic Stimulation
Forteo
Gleevec
Noxafil
Tarceva
Tykerb
HealthCare
2
Spinal Wiring and Spinal Instrumentation
Trichiasis Treatment
Response: Trichiasis is a condition in which eyelashes are
ingrown or misdirected in their growth. CPT® Assistant
gives the following instruction, “Codes 67820 and 67825
are intended to be reported per procedure, not per eyelash
or per eyelid.”
#318 • May 2010 • THORConnect.org
Blue Distinction® Centers
Program Update
The Blue Cross and Blue Shield Association (BCBSA),
in conjunction with Blue Cross Blue Shield of North
Dakota (BCBSND), currently has Blue Distinction Center
(BDC) designations for the following conditions: Bariatric
Surgery; Cardiac Care; Complex and Rare Cancers;
Transplants; Knee and Hip Replacement; and Spine
Surgery. For detailed information about the
criteria for these conditions, go to
http://www.bcbs.com/innovations/bluedistinction/.
Cardiac Care: Trinity Health is newly designated as a
BDC for Cardiac Care. Trinity joins Altru Health System,
Innovis Health, Medcenter One Health Systems, MeritCare
Health System and St. Alexius Medical Center. The next
application cycle is planned for 2012.
Bariatric Surgery: Altru Health System, Medcenter One
Health Systems, MeritCare Health System and St. Alexius
Medical Center are designated as BDCs for Bariatric
Surgery. The next application cycle is planned for late
2011/early 2012.
HealthCare
Spine Surgery: St. Alexius Medical Center and MeritCare
Health System are newly designated as BDCs for Spine
Surgery. The next application cycle is scheduled for late
2011/early 2012.
Knee and Hip Replacement: Trinity Health, St. Alexius
Medical Center and MeritCare Health System are newly
designated as BDCs for Knee and Hip Replacement. The
next application cycle is scheduled for late 2011/early 2012.
BCBSND currently has no facilities designated for
Transplant or Rare and Complex Cancers, but the company
is diligently monitoring these programs for the potential
to nominate and designate North Dakota providers.
HealthCare
Upcoming programs: BCBSA is currently in the proof-ofconcept phase for Colon and Breast Cancer Programs. If
these programs are approved, BCBSND will review the
criteria and nominate facilities interested in applying
for these designations.
Providers currently designated in any of the
Blue Distinction Programs can obtain the approved
logos and advertising criteria from BCBSND.
Facilities not currently designated are encouraged to
visit the BCBSA web site to review program criteria.
To participate in the upcoming application cycles,
please contact the Director of Quality Management.
Contact your provider contractor to update your contact
information for these programs.
BDC contracts for currently designated facilities are effective
through the next cycle. When the application cycle opens,
the Director of Quality Management will contact each
facility to reapply for Blue Distinction Center status.
#318 • May 2010 • THORConnect.org
3
BlueCross BlueShield
PRSRT STD
U.S. POSTAGE
of North Dakota
PAID
An independent licensee of the Blue Cross & Blue Shield Association
Fargo, North Dakota
Permit No. 1397
4510 13th Ave S Fargo, ND 58121
HealthCare
RETURN SERVICE REQUESTED
Noridian Mutual Insurance Company
Routing Box
Date received:_________
Please route to:
m Office manager
m Physician
m Nurse
m Billing manager
m Billing agency
m Receptionist
m Other:_ _____________
HealthCare
HealthCare News is published as a service to health care providers.
Please send all written inquiries to:
Provider Service
Blue Cross Blue Shield
of North Dakota
4510 13th Avenue S.
Fargo, ND 58121
Provider Service
FEP
Case Management
800-368-2312
701-282-1090
800-548-4026
701-282-1468
8 a.m. – 4:30 p.m. CST
Monday through Friday
800-336-2488
701-277-2100
Fax: 701-277-2253
8 a.m. – 4:30 p.m. CST
Monday through Friday
HealthCare
8 a.m. – 4:30 p.m. CST
Monday, Tuesday,
Thursday, Friday
9:15 a.m. – 4:30 p.m. CST
Wednesday
The
Healthcare
Online
Resource
THOR is a user-friendly tool that can virtually eliminate the need for lengthy telephone
inquiries—not to mention lots of paper documents—by electronically connecting providers,
payers and other professionals.
THOR Applications: Bulletin Board, Claim Inquiry, Claim Adjustment, Claim Correction,
Contraceptive Medication Request, Electronic Payment Listing, FEP Outpatient Prior Approval
for Mental Health Substance Abuse, Membership, Injectables/Other Pharmacy Fee Schedule,
Non-Formulary Medication Request, Physician Payment Schedule, Preauthorization and Referral,
Provider Data Exchange, Reference Lab List and Provider Directory.
BlueCross BlueShield
of North Dakota
An independent licensee of the Blue Cross & Blue Shield Association
Register online at www.THORConnect.org
Call Application Support Services at 1-800-544-THOR (8467) for a demonstration
29313290
NoridianMutual Insurance Company
(4891)4-10