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Provider Update: January 6, 2016

Reminder Regarding the Skilled Nursing Code Change

Per Centers for Medicare and Medicaid Services mandate, all G0154 Skilled Nursing Codes have been converted to the new code for the Skilled Nursing-Home Health – Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN-only) - G0300.

NOTE- The effective date for the new codes was January 1, 2016. MSU requests Case Managers use the Skilled Nursing-Home Health – Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN-only) - G0300, unless otherwise indicated by the Home Care Provider as directed below. However, the MSU will automatically process all plans received with the discontinued G0154 code for a period of six months, ending on June 30, 2016, during which time the MSU will convert to the G0300 as previously advised. 

For a Case Manager to request the Skilled Nursing-Home Health Registered Nurse (RN-only) G0299, rather than the Skilled Nursing-Home Health Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN-only) - G0300 code the Home Care Registered Nurse must specifically request that on the ADv6 (Nursing Evaluation Form), at the time of the IDT assessment/reassessment or 6 month supervisory visit. 

During this transition, if the Home Care Provider recommends the use of a Skilled Nursing- Home Health Registered Nurse (RN-only G0299) service code for all or some of the skilled nursing visits, the Home Care Nurse may submit a Provider Communication (02CB009E, formerly ADv9) form to the Case Manager, notifying the Case Manager of the need for a Skilled Nursing- Home Health Registered Nurse (RN-Only- G0299) code. The Provider Communication Form (02CB009E, formerly ADv9) form should only be used for Member's prior to their next 6-month supervisory or IDT assessment/reassessment visit, following the December 31, 2015 code conversion.  It will be appropriate to utilize the Provider Communication Form (02CB009E, formerly ADv9) until the end of FY16 (June 30, 2016).

Upon the receipt of the Provider Communication Form (02CB009E, formerly ADv9), the Case Manager may submit an addendum reflecting the appropriate code(s) and date(s) of service for the Nursing visit type requested. The Case Manager must include the Provider Communication Form (02CB009E, formerly ADv9) and/or the Nursing Assessment monitoring form (ADv6) as justification for the requested change.

NOTE- Any Service Plan or Service Plan Addendum received with the G0154 code after June 30, 2016 will not be authorized. The Case Manager will be notified via condition on an ADv6g and must submit the correction for the appropriate code for authorization.

REMINDER ON DUPLICATE SUBMISSIONS:

Unless directed to do so by MSU Provider Question or another MSU source, please DO NOT resend a request either by mail, fax or hand delivery. Time spent researching whether or not documents have already been processed is time not spent reviewing original service plan requests. If directed to submit a duplicate submission please indicate on the first page the number of submission attempts ( i.e.  2nd SUBMISSION).

If you have any questions or concerns regarding the information provided above, please feel free to contact us via Smarter Mail at:  aauproviderquestion@aau.okdhs.org

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