CULTURALLY COMPETENT PATIENT CARE

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					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


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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
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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.

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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?

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 •    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.




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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

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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.
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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/




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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)

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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.




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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
                                                      hummingbird0to3@gmail.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
                                                      ronda.horton@nau.edu
                                                      P.O. Box 5630
                                                      Flagstaff, AZ 86011
                                                      Ph: (928)-523-7054

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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                                 lrunyan@blake.easterseals.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
                                                     jguerra@blakefoundation.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
                                                     angelica.phillips@thementornetwork.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,            azeip_referrals_rise@acumen2.net
85215, 85234, 85256
                                                     1c: South Central Maricopa County –
Maricopa County, 1c: South Central, will include     Katrina Owens
the following zip codes:                             azeip_referrals_rise@acumen2.net
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                           mborboa@swhd.org

North Central, 1g: will include the following zip    1g: North Central Maricopa County–

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APPENDIX III
Statewide Referral List to Arizona Early Intervention Program

GEOGRAPHIC AREA                                     CONTRACTOR
codes:                                              Susan Raymond
85021, 85023, 85024, 85027, 85029, 85051,           mborboa@swhd.org
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
                                                    tlc4kids@infowest.com
                                                    1192 W. Sunset Blvd, Suite 2
                                                    St. George, UT 84770
                                                    Ph: (435) 673-5353

Navajo (Southern) County                            Northland Therapy Services
                                                    Judi Bassett
                                                    jb.northlandtherapy@frontiernet.net
                                                    P.O. Box 328
                                                    Show Low, AZ 85902
                                                    Ph (928)- 532-1532
                                                    Fax: (928)-532-1538
                                                    TF: 1-866-532-1532

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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
                                                   pseanez@navajo.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                                        lrunyan@blake.easterseals.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
                                                   janice.northam@nau.edu
                                                   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
                                                   eprovazek@cfraz.org
                                                   1020 S. 4th Ave. suite A
                                                   Yuma, AZ 85364
                                                   Ph: (928)- 783-4003
                                                   Fax: (928)- 329-8599
                                                   TF: 1-800-929-8194




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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




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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

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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




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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.




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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




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