"CULTURALLY COMPETENT PATIENT CARE"
MERCY C ARE PROVIDER MANUAL APPENDIX I CULTURALLY COMPETENT PATIENT CARE A Guide for Providers and Their Staff Institute for Health Professions Education Georgia G. Hall, Ph.D., MPH October 2001 INTRODUCTION This guide is intended to help providers and their staff meet the challenge of caring for an increasingly diverse patient population whose culture, including: language, lifestyle, values, beliefs and attitudes, may differ from those of the dominant society. Since these and other elements of culture can influence the experience of illness, access to care, and the process of getting well, providers and their staff are compelled to learn about them and incorporate that knowledge into the patient care plan. Cultural competence can be defined as a combination of knowledge, clinical skills, and behaviors that lead to positive outcomes of patient care with ethnically and culturally diverse populations. Central to cultural competency is the provision of services, education and information in appropriate languages and at appropriate comprehension and literacy levels. BENEFITS OF A CULTURALLY COMPETENT APPROACH TO CARE: • Devise more appropriate plans of care • Improve quality of patient care and outcomes • Reduce patient non-compliance • Improve patient satisfaction • Provide enhanced individual and family care • Gain sensitivity to patient needs • Work more effectively with diverse patient populations • Adhere to federal and state requirements A-1 MERCY C ARE PROVIDER MANUAL APPENDIX I SECTION TWO CULTURALLY COMPETENT HEALTHCARE An understanding of value systems and their influence on health is essential to providing culturally competent health care. Every culture has a value system that dictates behavior directly or indirectly by setting and encouraging specific norms. Health beliefs and practices, in particular, reflect that value system. Providing care for patients from diverse backgrounds requires understanding one’s own values as well as the values of other groups. There is a natural tendency for people to be culture bound; that is, to assume that their values, customs, attitudes and behaviors are always appropriate and right. The following list, comparing dominant Anglo–American values with those of more traditional cultures demonstrates their differing views. VALUES Anglo-American More traditional cultures Personal control over environment Fate Change Tradition Time dominates Human interaction dominates Human equality Hierarchy/rank/status Individualism/privacy Group welfare Self-help Birthright inheritance Competition Cooperation Future Orientation Past orientation Action/goal/work “Being” orientation Orientation/informality Formality Directness/openness/honesty Idealism Practicality/efficiency Spiritualism Materialism Source: Cross-Cultural Counseling: A guide for Nutrition and Health Counselors, U.S. Department of Agriculture/US Department of Health and Human Services, Nutrition Education Committee for Maternal and Child Nutrition Publications, 1986. GENERAL BELIEFS Beliefs about the cause, prevention, and treatment of illness vary among cultures. These beliefs dictate the practices used to maintain health. Health practices can be classified as folk, spiritual or psychic healing practices, and conventional medical practices. Patients may follow a specific A-2 MERCY C ARE PROVIDER MANUAL APPENDIX I process in seeking health care. Cultural healers may be used in addition to conventional medical care. UNDERSTANDING YOUR VALUES AND BELIEFS Cross-cultural healthcare requires providers and their staff to care for patients without making judgments about the superiority of one set of values over the other. Providers are not only influenced by the cultural values they were raised with, but also by the culture of medicine which has its own language and values. The complexity of the health care system today is time oriented, hierarchical and founded on disease management and the preservation of life at any cost. Realizing these values as part of the current medical culture will be useful when dealing with patients with different values. KNOWING YOUR PATIENT The difference between a provider who is culturally competent and one who is culturally aware is in the service that person provides. A culturally competent provider is aware of cultural differences and even more aware of the individual and his or her personal needs. APPRECIATE THE HETEROGENEITY THAT EXISTS WITHIN CULTURAL GROUPS As studies about cultural and ethnic groups demonstrate, there are distinctive characteristics that contribute to their uniqueness. Knowledge about these unique characteristics is important to the development of culturally relevant programs. Since significant variability may exist between and among individuals from the same cultural and ethnic group, over-generalization is a danger. Such variability can be due to: age, level of education, family, rural/urban residence, religiosity, level of adherence to traditional customs, and for immigrant patients, degree of assimilation and acculturation. THE ROLE OF ECONOMICS The culture of poverty is as important as a person’s ethnicity, social status and cultural background. Economic status may influence the patient’s ability to acquire medical supplies or other resources (such as running water, electricity, adequate space, healthful or specific diet, etc.) needed for continuity of care and wellness. Decisions that are made about lower income patients’ care must be sensitive to the differing degrees of access to resources. THE ROLE OF RELIGIOUS BELIEFS Religious beliefs often influence a patient’s decision about medical treatment. Because of their religious faiths, patients may request diagnosis but not treatment. If a particular treatment is absolutely necessary, providers may find it helpful to consult with the patient’s spiritual leader. A-3 MERCY C ARE PROVIDER MANUAL APPENDIX I Patients who seek mainstream medical care may also seek treatment from healers in their culture. Rather than discouraging this, especially if the alternative treatment is not harmful, providers and their staff may want to incorporate traditional healing into the general treatment plan. THE ROLE OF THE FAMILY Traditional cultures place a greater emphasis on the role of the family. Decision making about health issues may be a family affair. It can be helpful for providers and their staff to take this into account as medical decision making takes place. QUESTIONS TO CONSIDER • How many family Members can accompany the patient into the room? • Should friends be allowed in the room? • Who can or should be told about the patient’s condition? SECTION THREE CULTURAL ASSESSMENT Cultural assessment of the patient is an important step in identifying their views and beliefs about health and illness. Beliefs about the cause, prevention, and treatment of illness vary among cultures. Such beliefs dictate the practices used to maintain health. Studies have classified health practices into several categories: folk, spiritual, or psychic healing practices, and conventional medical practices. In addition to the general data collected from a patient, the following checklists may be helpful in gaining specific cultural information: • Where were you born? • If you were born outside the USA, how long have you lived in this country? • Who are the people you depend upon the most for help? (Family Members, friends, community services, church etc.) • Are there people who are dependent on you for care? Who are they? What kind of care do you provide? • What languages do you speak? • Can you read and write in those languages? • What is the first thing you do when you feel ill? • Do you ever see a native healer or other type of practitioner when you don’t feel well? • What does that person do for you? • Do you ever take any herbs or medicines that are commonly used in your native country or cultural group? A-4 MERCY C ARE PROVIDER MANUAL APPENDIX I • What are they, and what do you take them for? • What foods do you generally eat? How many times a day do you eat? • How do you spend your day? • How did you get here today? • Do you generally have to arrange for transportation when you have appointments? The questionnaire below will help determine a patient’s beliefs about his or her problem: Tools To Elicit Health Beliefs • What do you call your problem? What name does it have? • What do you think caused your problem? • Why do you think it started when it did? • What does your sickness do to you? How does it work? • How severe is it? Will it have a short or long course? • What do you fear most about your disorder? • What are the chief problems that your sickness has caused for you? • What kind of treatment do you think you should receive? What are the most important results you hope to receive from treatment? Further Questions to Consider • Do individuals in this culture feel comfortable answering questions? • When the provider asks questions, does the patient, or family, perceive this as a lack of knowledge? • Who should be told about the illness? • Does the family need a consensus or can one person make decisions. • Does the patient feel uncomfortable due to the gender of the provider? • Does more medicine mean more illness to the patient? • Does no medication mean healthy? • Does the patient prefer to feel the symptoms, or mask them? • Does the patient prefer ONE solution or choices of treatment? • Does the patient want to hear about risks? Source: Kleinman, Arthur A. Patients and Healers in the Context of Culture. The Regents of the University of California. 1981. A-5 MERCY C ARE PROVIDER MANUAL APPENDIX I SECTION FOUR COMMUNICATION Intercultural communication is a key clinical issue in medicine and can determine quality of care. The language barrier is a particularly serious problem for providers and patients alike. Since effective communication between patients and providers is necessary for positive outcomes, the use of translators is essential. Even with English speaking populations, it can be a challenge for the patient to try to understand the medical jargon that is commonplace among professionals in the healthcare setting. For example, words like “diet” have different meanings to professionals than they have in the general public. OTHER FACTORS INFLUENCING COMMUNICATION Conversational style: It may be blunt, loud and to the point – or quiet and indirect. Personal space: People react to others based on their cultural conceptions of personal space. For example, standing “too close” may be seen as rude in one culture and appropriate in another. Eye contact: In some cultures, such as Native American and Asian, avoiding direct eye contact may be a sign of respect and represents a way of honoring a person’s privacy. Touch: A warm handshake may be regarded positively in some cultures, and in others, such as some Native American groups, it is viewed as disrespectful. Greeting with an embrace or a kiss on the cheek is common among some cultures. Response to pain: People in pain do not always express the degree of their suffering. Cultural differences exist in patient’s response to pain. In an effort to “be a good patient” some individuals may suffer unnecessarily. Time orientation: Time is of the essence in today’s medical practice. Some cultural groups are less oriented to “being on time” than others. What’s in a name: Some patients do not mind being called by their first name; others resent it. Clarify the patient’s preference early on in the patient-provider relationship. Nonverbal communication: Messages are communicated by facial expressions and body movements that are specific to each culture. Be aware of variations in non-verbal communication to avoid misunderstandings. When English is a second language: According to the US Census Bureau, 14% of Americans speak a language other than English in their home and 6.7 million people have limited or no A-6 MERCY C ARE PROVIDER MANUAL APPENDIX I English skills. As these numbers continue to grow, the need for multilingual care becomes more significant. Patients with limited English proficiency may have more difficulty expressing thoughts and concerns in English and may require more time and patience. It is best to use simple vocabulary and speak slowly and clearly. Do not assume that because the patient can speak English that he can read and write in English as well. Remember, just because somebody speaks with a “perfect” American accent, doesn’t mean that they will have complete and full mastery of the English language. Translators: Often volunteers from the community or relatives are brought by the patient to help with translation. This should not be encouraged, as patients may be reluctant to confide personal problems with non-professionals and may leave out important facts. Realize that it may be difficult for patients to discuss personal issues in front of a third non-professional party. The use of employees as translators (secretaries, house keeping etc.) may not be a better solution. Translators should understand and speak a language well enough to manage medical terminology. The ideal translator is a professional. If a professional translator is not available, over the phone translation services can be used. ENHANCING CROSS-CULTURAL COMMUNICATION Communicate effectively: Allow more time for cross-cultural communication, use translators who are not family Members and ask questions about cultural beliefs. Understand differences: Realize that family integration is more important than individual rights in many cultures. Involve spiritual or religious advisors when appropriate. Be aware of your own cultural beliefs and biases. Be sensitive to your authority as a medical professional. Identify areas of potential conflict: Determine who is the appropriate person to make decisions and clarify and discuss important ethical disagreements with them. Compromise: Show respect for beliefs that are different from your own. Be willing to compromise about treatment goals or modalities whenever possible. Remember that taking care of patients from other cultures can be time-consuming and challenging. In almost all instances, however, the extra time and effort expended will result in more satisfied patients, families and professionals. SECTION FIVE CULTURAL RESOURCES AND INTERPRETATION SERVICES ALL AHCCCS contracted Health Plans and Program Contractors provide a variety of cultural competency resources, including interpretation/translation services and cultural awareness training. Under the AHCCCS program, these organizations are required to provide these services to providers and Members free of charge. A-7 MERCY C ARE PROVIDER MANUAL APPENDIX I If you need interpretation/translation services for patient care or wish to receive more information about available cultural competency resources, please contact Mercy Care Plan to make the necessary arrangements. AHCCCS and its participating Health Plans and Program Contractors encourage you to use professional interpretation/translation services. Use of non-professional interpretation/translation services such as by bilingual staff and/or a patient’s family Member may jeopardize patient outcomes. INTERNET RESOURCES There are many cultural competency resources available on the Internet. The following listing is intended for informational purposes only. General Reference sites: AMA Cultural Competence Initiative - http://www.ama-assn.org/ethic/diversity/ National Center for Cultural Competence: Bureau of Primary Health Care Component http://www.dml.georgetown.edu/depts/pediatrics/gucdc/nccc.html. Home page http://www.dml.georgetown.edu/ depts/pediatrics/gucdc/cultural.html Ethnomed: University of Washington: cultural profiles, cross cultural topics, patient education http://healthlinks.washington.edu/clinical/ethnomed/ http://www.baylor.edu/~Charles_Kemp//hispanic health.htm Great site for information on Hispanic and other cultures (i.e. Bosnian refugees). Society of Teachers of Family Medicine: Multicultural Health Care and Education http://stfm.org/corep.html. General curriculum information and listings of print, experiential exercises, games, simulations and video resources (not online). STFM homepage http://stfm.org/index.html AMSA (American Medical Student Association): http://www.amsa.org/programs/gpit/cultural.htm Cross Cultural Health Care Program (CCHCP) Site offers schedules/location/fees for cultural competency training, interpreter training, research projects, community collaboration, and other services. Online registration for training sessions, interpreter and translation services. http://www.xculture.org/ Opening Doors: in progress - cultural issues of health care - contains discussion forum on cultural issues in healthcare, articles, etc. http://www.opening-doors.org/ A-8 MERCY C ARE PROVIDER MANUAL APPENDIX I Bridge to Wellness: Cultural Competency http://www.serve.com/Wellness/culture.html. Homepage: www.serve.com/ Wellness -Developed for Adult Psychiatry- list of cultural competency principles for health care clinicians. U.S. Department of Health and Human Services: The Initiative to Eliminate Racial and Ethnic Disparities in Health http://raceandhealth.hhs.gov/ National Institute of Health Office of Research on Minority Health http://www1.od.nih.gov/ormh/main.html Health and Human Services: Health Resources and Services Admin.: news articles http://www.hrsa.dhhs.gov/ US Department of Health and Human Services: Office of Public Health and Sciences: Office of Minority Health Resource Center http://www.omhrc.gov/ Bureau of Primary Health Care Supported Community Health Programs http://www.bphc.hrsa.dhhs.gov/ databases/fqhc/fqhcquery.cfm The Center for Cross Cultural Health: (410 Church street, Suite W227, Minneapolis, MN 55455) http://www.umn.edu/ccch/ Cross Cultural Health Care Program (Pacific Medical Clinics / 1200 12th Avenue South, Seattle, WA 98144-2790 / Phone: (206) 326-4161) http://www.xculture.org/ Department of Health and Human Services / Health Resources and Services Administration / Bureau of Primary Health Care (4350 East-West Highway, Bethesda, MD 20814) Simulation Training System (218 Twelfth Street, Del Mar, CA 92014-0901) / Resources for Cross- cultural Health Care: http://www.diversityrx.org/ National Urban League (Phone: 212-310-9000) or http://www.nul.org/ African Community Health and Social League (Phone: (510) 839-7764) http://www.progway.org/ACHSS.html Association of Asian Pacific Community Health Organizations (Phone: (510) 272-9536) http://www.aapcho.org National Coalition of Hispanic Health and Human Services Organizations / Phone: (202) 387- 5000 http://www.cossmho.org Center for American Indian and Alaskan Native Health Phone: (410) 955-6931 / http://ih1.sph.jhu.edu/cnah/ www.culturalorientation.net or www.erc.msh.org “Providers Guide to Quality and Culture) A-9 MERCY C ARE PROVIDER MANUAL APPENDIX II Claims Coding for EPSDT/Well-Child Visits CPT Codes Preventive Medicine Services (UB82/92 or HCFA 1500) 99381 New patient under 1 year 99382 New patient (ages 1 – 4 years) 99383 New patient (ages 5 – 11 years) 99384 New patient (ages 12 – 17 years) 99385 New patient (ages 18 – 39 years) 99391 Established patient under 1 year 99392 Established patient (ages 1 – 4 years) 99393 Established patient (ages 5 – 11 years) 99394 Established patient (ages 12 – 17 years) 99395 Established patient (ages 18 – 39 years) 99431 Newborn care (history and examination) 99432 Normal newborn care OR CPT Codes Evaluation and Management (UB82/92 or HCFA 1500) 99201 - 99205 New patient 99211 - 99215 Established patient In conjunction with ICD-9 Diagnosis codes V20.2 Routine infant or child health check V70.0 Routine medical examination (routine) V70.3 – V70.9 General medical examination OR ICD-9 Diagnostic Codes (UB 82/92 or HCFA 1500) V20.2 Routine infant or child health check V70.0 Routine medical examination (routine) V70.3 – V70.9 General medical examination And Not in Conjunction with Category of Service 03 Respiratory Services 06 Physical Therapy 07 Speech/Hearing Therapy 11 Dental 12 Pathology & Laboratory 13 Radiology 15 Durable Medical Equipment & Supplies 30 Home Health Nurse Services 31 Non-emergency Transportation 40 Medical Supplies Please Note: Providers who bill for administration of vaccines under the Federal Vaccines for Children program must bill the appropriate CPT code for the immunization with the “SL” (State supplied vaccine) modifier. A-10 MERCY C ARE PROVIDER MANUAL APPENDIX III AzEIP Arizona Early Intervention Program (AzEIP) AzEIP is an early intervention program that offers a statewide system of support and services for children birth through three years of age and their families who have disabilities or developmental delays. Although anyone can refer a child, PCPs should refer to AzEIP when developmental delays are identified during EPSDT screenings. Referrals to AzEIP can be made the following ways: Arizona Early Intervention Program For Infants and Toddlers Referral to Arizona Early Intervention Program Online: www.azdes.gov/AzEIP/familyinfo.asp To refer a member, please go to the following link: https://www.azdes.gov/AzEIP/familyinfo.asp#referchild By Mail: Department of Economic Security, Arizona Early Intervention Program (DES/AzEIP) 3839 N. Third St., Suite 304 Phoenix, AZ 85012 Phone: (602) 532-9960, toll free in Arizona (888) 439-5609 Fax: Use attached referral form and fax to the appropriate program based on county/zip code (list attached). Other services family is receiving and/or referred to: Statewide Referral List to Arizona Early Intervention Program GEOGRAPHIC AREA CONTRACTOR Apache (Southern) County Hummingbird Early Intervention Services, LLC Laura L. Denali email@example.com PO Box 107 Nutrioso, AZ 85932 Ph/Fax: (928) 339-4465 Other: (928) 587-3993 Coconino County, including the entire Hopi Northern Arizona University, reservation and the Colorado Strip, but not Institute for Human Development including Colorado City or the Navajo Nation (NAU/IHD) – AzEIP First Ronda Horton firstname.lastname@example.org P.O. Box 5630 Flagstaff, AZ 86011 Ph: (928)-523-7054 A-11 MERCY C ARE PROVIDER MANUAL APPENDIX III Statewide Referral List to Arizona Early Intervention Program GEOGRAPHIC AREA CONTRACTOR Fax: (928)-523-7941 TF: 1-800-841-5201 Gila County, including the entire San Carlos Easter Seals Blake Foundation Reservation, but not including the White Referrals may be emailed to Mountain Reservation email@example.com 1115 E. Florence Blvd, Suite C Casa Grande, AZ 85222 Ph: (520) 723-4429 Fax: (520) 421-9400 TF: 1-800-851-6266 Graham, Greenlee, and Cochise Counties Easter Seals Blake Foundation Janette Guerra firstname.lastname@example.org 1939 A. South Frontage Rd. Sierra Vista, AZ 85635 Ph: (520) 452-7920 Fax: (520) 452-0814 TF: 1-800-464-7920 La Paz and Mohave Counties, not including the REM/The Mentor Network Colorado Strip Angelica Phillips email@example.com 2060 W. Acoma, Suite 201 Lake Havasu, AZ 86403 Ph: (928)- 680-1637 Fax: (928)- 680-6550 TF: 1-877-725-0417 Maricopa County, 1a: East, will include the Rise Services Inc. following zip codes: 1a: East Maricopa County - Katrina Owens 85201, 85203, 85204, 85205, 85206, 85213, firstname.lastname@example.org 85215, 85234, 85256 1c: South Central Maricopa County – Maricopa County, 1c: South Central, will include Katrina Owens the following zip codes: email@example.com 85025, 85040, 85042, 85044, 85045, 85048, 85202, 85210, 85224, 85225, 85226, 85233, 4554 E. Iverness Ave 85248, 85251, 85257, 85281, 85282, 85283, Mesa, AZ 85206 85284, 85286, 85295 Ph. 480-497-1889 #7 Fax 480-497-4756 Maricopa County, 1b: Southeast, will include the Southwest Human Development following zip codes: 1b: Southeast Maricopa County – 85207, 85208, 85209, 85212, 85236, 85242, Amy Robinson 85249, 85296, 85297, 85298 firstname.lastname@example.org North Central, 1g: will include the following zip 1g: North Central Maricopa County– A-12 MERCY C ARE PROVIDER MANUAL APPENDIX III Statewide Referral List to Arizona Early Intervention Program GEOGRAPHIC AREA CONTRACTOR codes: Susan Raymond 85021, 85023, 85024, 85027, 85029, 85051, email@example.com 85053, 85083, 85085, 85086, 85087, 85301, 85302, 85304, 85306, 85308, 85310 2850 N. 24th St. Phoenix, AZ 85008 Ph: (602) 468-3430 Fax: (602) 468-3407 Maricopa County, 1d: Southwest, will include the Child and Family Resources following zip codes: Lydia Medina 85007, 85009, 85017, 85019, 85031, 85033, AzEIP@cfraz.org 85035, 85037, 85039, 85041, 85043, 85322, 85323, 85326, 85329, 85337, 85338, 85339, 700 West Campbell, Suite 3 85340, 85343, 85353, 85354, 85392, 85395, Phoenix, AZ 85013 85396 Ph: (602)-234-3941option 36 Fax: (602) 234-3943 Maricopa County, 1e: Northwest, will include the United Cerebral Palsy (UCP) following zip codes: 1e: Northwest Maricopa County – 85303, 85305, 85307, 85309, 85311, 85312, Brie Hall/Kelly Donaldson 85318, 85320, 85335, 85342, 85345, 85351, AZEIPEReferrals@ucpofaz.org 85355, 85358, 85361, 85363, 85373, 85374, 1802 W. Parkside Ln. 85375, 85376, 85379, 85380, 85381, 85382, Phoenix, AZ 85027 85383, 85385, 85387, 85388, 85390 Ph: (602) 682-1837 Fax: (602) 944-1658 Maricopa County, 1f: Central & Northeast, will include the following zip codes: 1f: Northwest Maricopa County – 85003, 85004, 85006, 85008, 85012, 85013, Brie Hall/Kelly Donaldson 85014, 85015, 85016, 85018, 85020, 85022, AZEIPFReferrals@ucpofaz.org 85026, 85028, 85032, 85034, 85050, 85054, 1802 W. Parkside Ln. 85055, 85065, 85073, 85250, 85253, 85254, Phoenix, AZ 85027 85255, 85258, 85259, 85260, 85262, 85263, Ph: (602) 682-1838 85264, 85266, 85268, 85331, 85377 Fax: (602) 944-1658 Mohave County, only including Colorado City, The Learning Center for Families Cane Beds, and Centennial Park areas Debbie Justice firstname.lastname@example.org 1192 W. Sunset Blvd, Suite 2 St. George, UT 84770 Ph: (435) 673-5353 Navajo (Southern) County Northland Therapy Services Judi Bassett email@example.com P.O. Box 328 Show Low, AZ 85902 Ph (928)- 532-1532 Fax: (928)-532-1538 TF: 1-866-532-1532 A-13 MERCY C ARE PROVIDER MANUAL APPENDIX III Statewide Referral List to Arizona Early Intervention Program GEOGRAPHIC AREA CONTRACTOR Navajo Nation geographically located within AZ Interagency Agreement with Navajo Nation - Growing in Beauty (Window Rock) Paula Seanez firstname.lastname@example.org Office of Special Education and Rehabilitation Services P.O. Box 1420 Window Rock, AZ 86515 Ph: (928)- 871-6338 Fax: (928)- 871-7865 TF: 1-866-341-9918 Pima and Santa Cruz Counties Easter Seals Blake Foundation Jeanette Gomez AzEIP@blake.easterseals.com 717 S. Alvernon Way Tucson, AZ 85711 Ph: (520) 792-2636 x 5227 Fax: (520) 326-0564 TF: 1-877- 222-5432 Pinal County, including the entire Gila River Easter Seals Blake Foundation Reservation, but not including Tohono O’Odham Referrals may be emailed to Reservation email@example.com 1115 E. Florence Blvd, Suite C Casa Grande, AZ 85222 Ph: (520) 723-4429 Fax: (520) 421-9400 Yavapai County Northern Arizona University Janice Northam firstname.lastname@example.org P.O. Box 5630 Flagstaff, AZ 86011 Ph: (928)-759-5591 Fax: (928) 759-5593 TF: 1-800-841-5201 Yuma County Child and Family Resources Edie Provazek email@example.com 1020 S. 4th Ave. suite A Yuma, AZ 85364 Ph: (928)- 783-4003 Fax: (928)- 329-8599 TF: 1-800-929-8194 A-14 MERCY C ARE PROVIDER MANUAL APPENDIX IV COVERED FAMILY PLANNING BILLING CODES Procedure Code Accepted Family Planning Diagnoses V25.01 Prescription of oral contraceptives V25.02 Initiation of other contraceptive measures V25.03 Encounter for emergency contraceptive counseling and prescription V25.09 Other general counseling and advice V25.1 Insertion of intrauterine contraceptive device V25.2 Sterilization V25.40 Contraceptive surveillance, unspecified V25.41 (Surveillance) Contraceptive pill (surveillance) V25.42 (Surveillance) Intrauterine Contraceptive Device (surveillance) V25.43 (Surveillance) Implantable Subdermal Contraceptive (surveillance) V25.49 (Surveillance) Other Contraceptive Method V25.5 Insertion of Implantable Subdermal contraceptive V25.8 Other Specified Contraceptive Management V25.9 Unspecified Contraceptive Management V45.51 (Presence of) Intrauterine Contraceptive Device V45.52 (Presence of) Subdermal Contraceptive Implant V45.59 (Presence of) Other (Contraceptive Device) Accepted ICD-9 Codes for Family Planning 66.21 Bilateral Endoscopic Ligation and Crushing of Fallopian Tubes 66.22 Bilateral Endoscopic Ligation and Division of Fallopian Tubes 66.29 Other Bilateral Endoscopic Destruction or Occlusion of Fallopian Tubes 66.31 Other Bilateral Ligation and Crushing of Fallopian Tubes 66.32 Other Bilateral Ligation and Division of Fallopian Tubes 66.39 Other bilateral Destruction or Occlusion of Fallopian Tubes 66.4 Total Unilateral Salpingectomy 66.51 Removal of Both Fallopian Tubes at the Same Operative Session 66.52 Removal of Remaining Fallopian Tube 66.63 Bilateral Partial Salpingectomy, Not Otherwise Specified 66.69 Other Partial Salpingectomy 66.92 Insertion Destruction or Occlusion of Fallopian Tube 69.7 Insertion of Intrauterine Contraceptive Device 96.17 Insertion of Vaginal Diaphragm 97.71 Removal of Intrauterine Contraceptive Device 97.73 Removal of Vaginal Diaphragm 63.7 Vasectomy and Ligation of Vas Deferens 63.70 Male Sterilization Procedure, Not Otherwise Specified 63.71 Ligation of Vas Deferens 63.72 Ligation of Spermatic Cord 63.73 Vasectomy A-15 MERCY C ARE PROVIDER MANUAL APPENDIX IV FP Modifier is Not Needed with the Following 11976 Removal, Implantable Contraceptive Device 57170 Diaphragm or Cervical Cap Fitting with Instructions 58300 Insertion of Intrauterine Device (IUD) 58301 Removal of Intrauterine Device (IUD) 58600 Ligation or Transection of Fallopian Tube(s), Abdominal or Vaginal Approach, Unilateral or Bilateral During Same Hospitalization 58605 Ligation or Transection of Fallopian Tube(s), Abdominal or Vaginal Approach, Postpartum, Unilateral or Bilateral During Same Hospitalization 58611 Ligation or Transection of Fallopian Tube(s) When Done at the Time of Cesarean Delivery or Intra-abdominal Surgery 58615 Occlusion of Fallopian Tube(s) by Device (Band, Clip, Falope Ring), Vaginal or Suprapubic Approach 58670 Laparoscopy, Surgical, With Fulguration of Oviducts 58671 Laparoscopy, Surgical, With Occlusion of Oviducts by Device 00851 Anesthesia for Intraperitoneal Procedures in Lower Abdomen, including Laparoscopy; Tubal Ligation/Transection A4261 Cervical Cap A4266 Diaphragm J1055 Injection, Medroxyprogesterone Acetate for Contraceptive Use, 150 mg (Depo-Provera) J1056 Injection, Medroxyprogesterone Acetate/Estradiol Cypionate, 5 mg/25 mg (Lunelle) J7300 Intrauterine Copper Contraceptive J7302 Levonorgestrel – Releasing Intrauterine Contraceptive System, 52 mg J7303 Contraceptive Supply, Hormone Releasing Vaginal Ring, Each S4989 Contraceptive Intrauterine Device (e.g. Progestacert IUD) Including Implants and Supplies 55250 Vasectomy, Unilateral or Bilateral 55450 Ligation (Percutaneous) of Vas Deferens, Unilateral or Bilateral FP Modifier Is Needed With the Following 99201-99215 Office or Other Outpatient Visit 99241-99245 Office Consultation 99000 Handling and/or Conveyance of Specimen G0001 Routine Venipuncture for Collection of Specimen(s) 81000 Urinalysis, by Dip Stick or Tablet Reagent for Bilirubin, Glucose, Hemoglobin, Ketones, Leukocytes, Nitrite pH, Protein, Specific Gravity, Urobiligin, any Number of These Constituents; Non-Automated with Microscopy 81001 Automated with Microscopy 81002 Non-Automated, Without Microscopy 81025 Urine Pregnancy Test 82948 Glucose; Blood Reagent Strip 82951 Glucose; Tolerance Test A-16 MERCY C ARE PROVIDER MANUAL APPENDIX IV FP Modifier Is Needed With the Following 84702 Gonadotropin, chorionic (hcg); quantitative 84703 Gonadotropin, chorionic (hcg); qualitative 85014 Blood Count; Hematocrit 85018 Blood Count; Hemoglobin 86592 Syphilis Test; Quantitative (VDRL, RPR, ART) 86593 Syphilis Test; Quantitative 86689 HTLV or HIV Antibody, Confirmatory Test (e.g. Western Bolt) 86701 HIV-1 86702 HIV-2 86703 HIV-1 and HIV-2, Single Assay 86706 Hepatitis B Surface Antibody (HbsAB) 86781 Treponema Pallidium, Confirmatory Test (e.g. Western Bolt) 86803 Hepatitis C Antibody 86804 Hepatitis C Antibody, Confirmatory Test (e.g. Immunoblot) 87075 Culture, Bacterial; Any Source Except Blood 87106 Culture, Fungi, Definitive Identification, Each Organism, Yeast 87110 Culture, Chlamydia, Any Source 87207 Smear, Primary Source With Interpretation; Special Stain for Inclusion Bodies or Parasites (e.g. Malaria, Coccidian, Microsporidia, Trypanosomes, Herpes Viruses) 87210 Smear, Primary Source With Interpretation; Wet Mount for Infectious Agent (e.g. Saline, India Ink, KOH Preps) 87250 Virus Isolation; Inoculation of Embryonated Eggs, or Small Animal; Includes Observation and Dissection 87340 Infectious Agent Antigen Detection by Enzyme Immunoassay Technique, Qualitative or Semiqualitative, Multiple Step Method; Hepatitis B Surface Antigen (HbsAg) 87350 Hepatitis Be Antigen (HbeAg) 87390 HIV-1 87391 HIV-2 88141-88155 Cytopathology Slides/Smears, Cervical or Vaginal 88164-88167 Cytopathology Slides, Cervical or Vaginal 88174-88175 Cytopathology 88302 Level II-Surgical Pathology, Gross and Microscopic http://azahcccs.gov/Publications/Newsletters/ClaimsClues/ClaimsClues04/ClaimsClues_Oct-Nov04.pdf A-17 MERCY C ARE PROVIDER MANUAL APPENDIX V LabCorp September 2008 Please be aware that Mercy Care Plan (MCP) maintains an exclusive, capitated outpatient laboratory services agreement with LabCorp in Maricopa, Cochise, Pinal Yuma, LaPaz, Graham, Greenlee and Gila Counties. With the exception of a limited list of procedures, doctors in these counties must use LabCorp as the exclusive laboratory for all outpatient laboratory services. MCP will deny claims payment for services provided by anyone other than LabCorp. As a reminder, MCP members cannot be billed for these services. We encourage you to perform drawing procedures and ask that you bill MCP the drawing fee of $3.00, using CPT code 36415. In addition, physicians may perform the following tests in their offices under CLIA waiver/certification, and bill MCP according to the current fee schedule as indicated: CLIA-waived procedures CPT Code Urinalysis, by dip stick or tablet reagent 81000 Urinalysis, non-automated, w/o microscopy 81002 Test for blood, feces 82270 Urine pregnancy test by visual color comparison 81025 Sedimentation rate, non-automated 85651 Hemoglobin, copper sulfate method, non-automated 83026 Glucose blood monitor, FDA-cleared for home use 82962 Heterophile antibodies; screening 86308 Infectious agent detection – streptococcus 87880 Blood count; spun microhematocrit 85013 Blood count; other than spun hematocrit 85014 Blood count; hemoglobin 85018 Wet mount for infectious agents 87210 Tissue examination by KOH slide of samples from skin 87220 Streptococcus, group A 87880 CLIA-Certified Procedures CPT Code Thyroid stimulating hormone 84443 Hemogram and platelet count, automated/manual 85007/85027 Hemogram and platelet count, automated/automated 85025 Hemogram and platelet count, automated 85027 We will also allow for the provision of the following tuberculosis skin tests in physicians’ offices, with related CPT codes and fees: Intradermal 86580 Tine 86585 Please contact your Provider Services Representative if you require assistance in establishing specimen pick-up, or if you have any questions about laboratory services. Thank you for your efforts on behalf of Mercy Care Plan members. A-18 MERCY C ARE PROVIDER MANUAL APPENDIX VI REGIONAL BEHAVIORAL HEALTH AUTHORITIES County Regional Behavioral Health Contact Type Phone Number* Authorities (RBHA’s) Magellan Information & Referral (800) 564-5465 Maricopa Crisis Phone Line (602) 222-9444 Cochise Information & Referral (800) 771-9889 Community Partnership of Graham Crisis Phone Line (520) 622-6000 or Arizona (CPSA) Greenlee (800) 586-9161 Santa Cruz Gila Cenpatico Behavioral Health Information & Referral (866) 495-6738 Pinal Crisis Phone Line (866) 495-6735 Community Partnership of Information & Referral (800) 771-9889 Pima Southern Arizona (CPSA) Crisis Phone Line (520) 622-6000 Cenpatico Behavioral Health Information & Referral (866) 495-6738 Yuma Crisis Phone Line (866) 495-6735 A-19