The September 2003 Health Insurance Portability and Accountability Act (HIPAA) implementation resulted in the following changes in the Medi-Cal provider manuals. All changes are effective for dates of service on or after September 22, 2003.

Important:

New HIPAA In Review

A handy HIPAA In Review guide has been included in this bulletin for you to insert in your provider manual at the end of the UB-92 Completion: Inpatient Services section. This guide summarizes important long term care-related changes that resulted from the September 2003 phase of HIPAA implementation.

Conversion of Accommodation to Revenue Codes

Revenue Code Field (Box 42)

Local Medi-Cal accommodation codes are replaced with national revenue codes. Revenue codes are placed on the claim in the same location as accommodation codes.

Manual Changes

• Manual references to accommodation codes are changed to "revenue codes."
• A Code Correlation Guide showing the relationship between accommodation codes and revenue codes is added at the end of the UB-92 Completion: Inpatient Services section to help you understand how the Medi-Cal accommodation codes have been converted to national revenue codes.
• Section titles that included the word "Accommodation" are updated as follows. (The underlined word was previously "Accommodation.")
  
  - Obstetrics: Revenue Codes and Billing Policy
  - Obstetrics: Revenue Codes Billing Instructions
  - Revenue Codes for Inpatient Services

Note:

• Footnotes in the Revenue Codes for Inpatient Services section have been extensively revised. With local Medi-Cal accommodation codes changing to national revenue codes, billing requirements for per diem, per discharge and non-contract hospitals require fewer special instructions, such as the ones that were previously included in the footnotes.
• The Accommodation Rate Change Chart (form DHS 6004, rev. 8/97) at the end of the Revenue Codes for Inpatient Services is being updated and will be released at a later date. Providers may continue to submit this form until otherwise instructed.

Conversion of Place of Service to Facility Type Codes

Type of Bill Field (Box 4) and Payer Field (Box 50)

To help identify the provider type, the words "I/P Medi-Cal" must still be entered in the Payer field (Box 50).

Manual Changes

• Facility type and claim frequency codes are explained in the National Uniform Billing Committee (NUBC) UB-92 Billing Manual. This information is included in the claim completion section.
• Medi-Cal manual references to Place of Service are changed to "facility type."
• A Code Correlation Guide showing the relationship between Place of Service and facility type codes is added at the end of the UB-92 Completion: Inpatient Services section to help you understand how the Medi-Cal Place of Service codes have been converted to national facility type codes.

Conversion of Billing Limit Exception to Delay Reason Codes

Delay Reason Field (Box 31)

Local Medi-Cal billing limit exception codes are being replaced with national delay reason codes. Delay reason codes are entered in Box 31, to the right of the Condition Codes boxes on the claim. Do not enter delay reason codes in the Condition Codes field (Boxes 24 - 30) where you previously entered billing limit exception codes.

• A Code Correlation Guide showing the relationship between billing limit exception and delay reason codes is added at the end of the UB-92 Completion: Inpatient Services section to help you understand how Medi-Cal billing limit exception codes have been converted to national delay reason codes.

"From-Through" Billing

Statement Covers Period Field (Box 6)

"From-through" services with a "from" date of service on or after September 22, 2003 are billed with national codes. "From-through" services with a "from" date prior to September 22, 2003 are billed with local Medi-Cal codes.

Manual Changes

• The UB-92 Special Billing Instructions for Inpatient Services section is updated to include the preceding "from-through" information.

Conversion of Condition Codes

Condition Codes Field (Boxes 24 - 30)

Medi-Cal condition code A3 is being changed to national condition code "AI," which is used to bill for services related to Family Planning (FP).

CPT-4/HCPCS Codes to ICD-9-CM Volume 3 Procedure Codes

Principal Procedure and Other Procedure Fields (Boxes 80 and 81)

CPT-4 and formerly used HCPCS local codes are no longer to be entered on the UB-92 for inpatient surgical and delivery services. ICD-9-CM Volume 3 procedure codes will be required on the claim in the same location (Boxes 80 and 81) where CPT-4 or HCPCS codes were entered.

Manual Changes

• Appropriate policy wording is added to reflect the use of ICD-9-CM Volume 3 procedure codes on inpatient claims, most particularly in the areas of obstetrical and transplant services.
• A Code Correlation Guide showing the relationship between CPT-4 or HCPCS codes and ICD-9-CM Volume 3 procedure codes is added at the end of the UB-92 Completion: Inpatient Services section to help you understand how CPT-4 and local HCPCS codes have been converted to ICD-9-CM Volume 3 procedure codes.
• A list showing the relationship between transplant-related CPT-4 codes and ICD-9-CM Volume 3 procedure codes is added in the Transplants section to help you understand how CPT-4 and local HCPCS codes have been converted to ICD-9-CM Volume 3 procedure codes.

Vaginal Delivery Outside Hospital

For a vaginal delivery that occurs outside the hospital, include all the following on the claim:

• Admit type code "4" (newborn) in the Type of Admission field (Box 19)
• Admission source code "4" (extramural birth) in the Source Admission field (Box 20)
• Revenue code 119, 129, 139 or 159 in the Revenue Code field (Box 42)
• ICD-9-CM Volume 3 procedure code 73.99 (other operations assisting delivery, other) in the Principal Procedure field (Box 80)

Manual Changes

The Contracted and Non-Contracted Inpatient Services; Obstetrics: Revenue Codes and Billing Policy; and Obstetrics: Revenue Codes Billing Instructions sections are updated to include instructions for billing delivery-outside-hospital services.