DOCSLIB.ORG

Billing and Coding: MRI and CT Scans of the Head and Neck (A57204)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

FUTURE Local Coverage Article: Billing and Coding: MRI and CT Scans of the Head and Neck (A57204) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/17/2020. Page 1 of 237 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Article ID Original Effective Date A57204 10/01/2019 Article Title Revision Effective Date Billing and Coding: MRI and CT Scans of the Head and 10/01/2020 Neck Revision Ending Date Article Type N/A Billing and Coding Retirement Date AMA CPT / ADA CDT / AHA NUBC Copyright N/A Statement CPT codes, descriptions and other data only are copyright 2019 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Current Dental Terminology © 2019 American Dental Association. All rights reserved. Copyright © 2020, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial Created on 09/17/2020. Page 2 of 237 use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 or Laryssa Marshall at (312) 893-6814. You may also contact us at [email protected]. CMS National Coverage Policy Title XVIII of the Social Security Act, Section 1862(a)(7) excludes routine physical examinations. This provision excludes screening examinations. Title XVIII of the Social Security Act, Section 1862(a)(1)(A) allows coverage and payment for only those services that are considered reasonable and necessary. Title XVIII of the Social Security Act, Section 1833(e) prohibits Medicare payment for any claim, which lacks the necessary information to process the claim. Title XVIII of the Social Security Act, Section 1862(a)(1)(D) prohibits Medicare payment for services and items that are experimental or investigational. CMS publication 100-3, Medicare National Coverage Determinations, Sections 220.1 “Computerized Tomography”, and 220.2-220.2.B.2d and Section 220.2.C-220.2.D “Magnetic Resonance Imaging”. Denies coverage of MRI for: 1. Imaging of cortical bone and calcification; 2. Procedures involving spatial resolution of bone or calcification; 3. MRI is not covered for patients with metallic clips on vascular aneurysms CMS publication 100-04 Medicare Claims Processing Manual Chapter 13 Section 40. Denies coverage of MRI for: 1. Measurement of blood flow and spectroscopy Article Guidance Article Text: The following coding and billing guidance is to be used with its associated Local Coverage Determination. Documentation Guidelines Diagnostic evaluation of the head and neck (head/neck scans) performed by computerized tomography (CT) scanners is covered when the documentation supports that the scan is reasonable and necessary. Accurate coding information must be provided with claims to differentiate CT and/or MRI scans from other radiology services and to Created on 09/17/2020. Page 3 of 237 make coverage determinations. Sufficient documentation such as, history and physical notes, laboratory results, signs and symptoms of the disease to warrant the diagnostic test and to support the claim of reasonable and necessary must be included in the medical records. This information must be available to Medicare upon request. Coding Guidelines The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits in addition to guidance in this LCD. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Whichever guidance is more restrictive should be adhered to. Coding Information CPT/HCPCS Codes Group 1 Paragraph: CT Scans Group 1 Codes: CODE DESCRIPTION 70450 Ct head/brain w/o dye 70460 Ct head/brain w/dye 70470 Ct head/brain w/o & w/dye 70480 Ct orbit/ear/fossa w/o dye 70481 Ct orbit/ear/fossa w/dye 70482 Ct orbit/ear/fossa w/o&w/dye 70486 Ct maxillofacial w/o dye 70487 Ct maxillofacial w/dye 70488 Ct maxillofacial w/o & w/dye 70490 Ct soft tissue neck w/o dye 70491 Ct soft tissue neck w/dye 70492 Ct sft tsue nck w/o & w/dye 72125 Ct neck spine w/o dye 72126 Ct neck spine w/dye 72127 Ct neck spine w/o & w/dye Created on 09/17/2020. Page 4 of 237 Group 2 Paragraph: MRI Scans Group 2 Codes: CODE DESCRIPTION 70336 Magnetic image jaw joint 70540 Mri orbit/face/neck w/o dye 70542 Mri orbit/face/neck w/dye 70543 Mri orbt/fac/nck w/o &w/dye 70551 Mri brain stem w/o dye 70552 Mri brain stem w/dye 70553 Mri brain stem w/o & w/dye 70557 Mri brain w/o dye 70558 Mri brain w/dye 70559 Mri brain w/o & w/dye 72141 Mri neck spine w/o dye 72142 Mri neck spine w/dye 72156 Mri neck spine w/o & w/dye CPT/HCPCS Modifiers N/A ICD-10 Codes that Support Medical Necessity Group 1 Paragraph: The following list of ICD-10-CM codes represents diagnoses that, alone or together, support the medical necessity of either MRIs or CTs. These diagnoses must be supported by appropriate documentation of medical necessity in the medical record. These are the only covered diagnoses: Group 1 Codes: ICD-10 CODE DESCRIPTION A02.21 Salmonella meningitis A06.6 Amebic brain abscess A17.0 Tuberculous meningitis A17.1 Meningeal tuberculoma Created on 09/17/2020. Page 5 of 237 ICD-10 CODE DESCRIPTION A17.81* Tuberculoma of brain and spinal cord A17.82* Tuberculous meningoencephalitis A17.83* Tuberculous neuritis A17.89* Other tuberculosis of nervous system A18.01 Tuberculosis of spine A18.03* Tuberculosis of other bones A18.51 Tuberculous episcleritis A18.52 Tuberculous keratitis A18.53 Tuberculous chorioretinitis A18.54 Tuberculous iridocyclitis A18.59 Other tuberculosis of eye A18.6 Tuberculosis of (inner) (middle) ear A27.81 Aseptic meningitis in leptospirosis A32.11 Listerial meningitis A32.12 Listerial meningoencephalitis A32.7 Listerial sepsis A32.81 Oculoglandular listeriosis A32.89* Other forms of listeriosis A39.0 Meningococcal meningitis A39.1 Waterhouse-Friderichsen syndrome A39.2 Acute meningococcemia A39.3 Chronic meningococcemia A39.81 Meningococcal encephalitis A39.82 Meningococcal retrobulbar neuritis A39.83* Meningococcal arthritis A39.84* Postmeningococcal arthritis A39.89 Other meningococcal infections A41.9 Sepsis, unspecified organism A50.32 Late congenital syphilitic chorioretinitis A50.39 Other late congenital syphilitic oculopathy A50.40 Late congenital neurosyphilis, unspecified A50.41 Late congenital syphilitic meningitis Created on 09/17/2020. Page 6 of 237 ICD-10 CODE DESCRIPTION A50.42 Late congenital syphilitic encephalitis A50.43 Late congenital syphilitic polyneuropathy A50.44 Late congenital syphilitic optic nerve atrophy A50.45 Juvenile general paresis A50.49 Other late congenital neurosyphilis A50.59 Other late congenital syphilis, symptomatic A51.41 Secondary syphilitic meningitis A52.11 Tabes dorsalis A52.12 Other cerebrospinal syphilis A52.13 Late syphilitic meningitis A52.14 Late syphilitic encephalitis A52.15 Late syphilitic neuropathy A52.19 Other symptomatic neurosyphilis A54.81 Gonococcal meningitis A80.0 Acute paralytic poliomyelitis, vaccine-associated A80.1 Acute paralytic poliomyelitis, wild virus, imported A80.2 Acute paralytic poliomyelitis, wild virus, indigenous A80.39 Other acute paralytic poliomyelitis A80.4 Acute nonparalytic poliomyelitis A81.00 Creutzfeldt-Jakob disease, unspecified A81.01 Variant Creutzfeldt-Jakob disease A81.09 Other Creutzfeldt-Jakob disease A81.1 Subacute sclerosing panencephalitis A81.2 Progressive multifocal leukoencephalopathy A81.81 Kuru A81.82 Gerstmann-Straussler-Scheinker syndrome A81.83 Fatal familial insomnia A81.89 Other atypical virus infections of central nervous system A81.9 Atypical virus infection of central nervous system, unspecified A82.0 Sylvatic rabies A82.1 Urban rabies A83.0 Japanese encephalitis Created on 09/17/2020. Page 7 of 237 ICD-10 CODE
Recommended publications
  • 19-0603 ) Issued: January 28, 2020 DEPARTMENT of the TREASURY, ) INTERNAL REVENUE SERVICE, ) Holtsville, NY, Employer ) ______)

    19-0603 ) Issued: January 28, 2020 DEPARTMENT of the TREASURY, ) INTERNAL REVENUE SERVICE, ) Holtsville, NY, Employer ) ______)

    United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) S.L., Appellant ) ) and ) Docket No. 19-0603 ) Issued: January 28, 2020 DEPARTMENT OF THE TREASURY, ) INTERNAL REVENUE SERVICE, ) Holtsville, NY, Employer ) __________________________________________ ) Appearances: Case Submitted on the Record Thomas S. Harkins, Esq., for the appellant1 Office of Solicitor, for the Director DECISION AND ORDER Before: CHRISTOPHER J. GODFREY, Chief Judge ALEC J. KOROMILAS, Alternate Judge VALERIE D. EVANS-HARRELL, Alternate Judge JURISDICTION On January 18, 2019 appellant, through counsel, filed a timely appeal from a July 26, 2018 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act2 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.3 1 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 2 5 U.S.C.
  • Neck and Headache Pain

    Neck and Headache Pain

    Neck and Headache Pain ICD-9-CM code: 723.2 cervicocranial syndrome ICF codes: Activities and Participation Domain code: d4158 Maintaining a body position, other specified - specified as: maintaining the head in a flexed position, such as when reading a book; or, maintaining the head in an extended position, such as when looking up at a computer screen or video monitor Body Structure codes: s7103 Joints of head and neck region Body Functions code: b28010 Pain in head and neck Common Historical Findings: Unilateral neck pain with referral to occipital, temporal, parietal, frontal or orbital areas Headache precipitated or aggravated by neck movements or sustained positions Noncontinuous headaches (usually < 1 episode/day; < 2 episodes/week) Common Impairment Findings - Related to the Reported Activity Limitation or Participation Restrictions: Observable postural asymmetry of the head on neck (sidebent or extended) Headache reproduced with provocation of the involved segmental myofascia and/or joints O/C1, C1/C2, or C2/C3 restricted accessory motions with associated myofascial trigger points Physical Examination Procedures: Palpation/Provocation of Suboccipital Myofascia Joe Godges DPT, MA, OCS 1 KP So Cal Ortho PT Residency O/C1, C1/C2, or C2/C3 accessory motion testing using posterior-to-anterior pressures 0/C1 accessory motion testing using C1 lateral translatoty pressures C1 – C2 Rotation ROM testing with the C2 – C7 segments in flexion Joe Godges DPT, MA, OCS 2 KP So Cal Ortho PT Residency Neck and Headache Pain: Description, Etiology, Stages, and Intervention Strategies The below description is consistent with descriptions of clinical patterns associated with the term “Cervicogenic Headache.” Description: Cervicogenic headache is a headache where the source of the ache is from a structure in the cervical spine, such as a cervical facet, muscle, ligament, or dura.
  • A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy

    A Thesis Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy

    MYOFASCIAL TRIGGER POINTS AND INNERVATION ZONE LOCATIONS IN UPPER TRAPEZIUS MUSCLES MARCO BARBERO A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy QUEEN MARGARET UNIVERSITY 2016 1 ABSTRACT Myofascial pain syndrome is characterized by sensory, motor and autonomic symptoms, and a myofascial trigger point (MTrP) is considered the principal clinical feature. Clinicians recognise myofascial pain syndrome as an important clinical entity but many basic and clinical issues need further research. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Authors also suggest that MTrPs are located in the innervation zone (IZ) of muscles. The aim of this thesis was to describe both the location of MTrP and the IZ’ locations in the upper trapezius muscle. The hypothesis was that distance between the IZ and the MTrP in upper trapezius muscle is equal to zero. This thesis includes two preliminary studies. The first one address the reliability of surface electromyography (EMG) in locating the IZ in upper trapezius muscle, and the second one address the reliability of a manual palpation protocol in locating the MTrP in upper trapezius muscle. The intra- rater reliability of surface EMG in locating the IZ was almost perfect; with Kappa = 0.90 for operator A and Kappa = 0.92 for operator B. Also the inter- rater reliability showed an almost perfect agreement, with Kappa = 0.82. Both the operators conducted 900 estimations of IZ’ location through visual analysis of the EMG signals.
  • 1996 Masters Outdoor Championship

    1996 Masters Outdoor Championship

    MastersTrack.com: 1996 USATF National Masters Outdoor Championships, Spokane, W... Page 1 of 52 USATF 1996 National Masters Outdoor Track & Field Championship Hosted by Spokane Sports Unlimited Spokane Falls Community College - Spokane, WA Thursday Aug 15, 1996 to Sunday Aug 18, 1996 National Masters Results - Men M30+ 100 Meter Dash AGE GRA. Finals Results - Sunday 08/18/96 PLACE ATHLETE NAME AGE HOMETOWN TIME AGE-GRADED MARK ===== ================================= ============== 1 Stan Whitley M50 Alta Loma, CA 10.38 1.3 9.27 106.36% 2 Milton Silverstein M76 Tuscon, AZ 10.73 1.3 7.83 125.91% 3 James Stookey M66 Dickerson, MD 10.92 1.3 8.78 112.36% 4 Kevin Morning M40 Orangevale, CA 10.93 1.3 10.43 94.51% 5 Marion McCoy M46 Atlanta, GA 11.40 1.3 10.53 93.68% M30+ 100 Meter Dash FINALS Finals Results - Saturday 08/17/96 PLACE ATHLETE NAME AGE HOMETOWN TIME HT AGE-GRADED MARK ===== ================================= ================= ------------ Men 30 ------------- - *Paul Scarlett M33 Portland, OR 11.01 1.5 11 11.01 89.55% 1 David Barmer M32 Glendale, CO 11.03 1.5 11 11.03 89.39% 2 Brett Lawler M32 Sarasota, FL 11.35 1.5 11 11.35 86.87% 3 Joe Ngassa M32 Provo, UT 11.52 1.5 11 11.52 85.59% 4 Richard Washington M33 Scotch Plains, NJ 11.89 1.5 11 11.89 82.93% 5 Gregory Font M34 Mount Lake Terrace, WA 12.20 1.5 11 12.20 80.82% ------------ Men 35 ------------- 1 Martin Krulee M39 Campbell, CA 11.03 -1.1 10 10.88 90.66% 2 Derek Holloway M35 Sicklerville, NJ 11.22 -1.1 10 11.07 89.13% 3 Eugene Vickers M35 Bel Air, MD 11.26 -1.1 10 11.11 88.81%
  • U. S. Department of the Interior U.S. Geological Survey Ages of Rocks in Southwestern Washington and Northwestern Oregon As Indi

    U. S. Department of the Interior U.S. Geological Survey Ages of Rocks in Southwestern Washington and Northwestern Oregon As Indi

    U. S. DEPARTMENT OF THE INTERIOR U.S. GEOLOGICAL SURVEY AGES OF ROCKS IN SOUTHWESTERN WASHINGTON AND NORTHWESTERN OREGON AS INDICATED BY PALEONTOLOGICAL AND ISOTOPIC DATES by Wendy A. Niem^ and Alan R. Ni Open-File Report 92-344 This report is preliminary and has not been reviewed for conformity with U.S. Geological Survey editorial standards (or with the North American Stratigraphic Code). Any use of trade, product or firm names is for descriptive purposes only and does not imply endorsement by the U.S. Government ICorvallis, Oregon 1992 TABLE OF CONTENTS ESrraODUOTON---------------------------- Map and Sample Numbers 2 Location 2 Geologic Unit 2 Dates---------------------------------------------------------"^ Table 1 Paleontological Dates in Southwestern Washington and Northwestern Oregon 5 Table 2 Isotopic Dates in Southwestern Washington and Northwestern Oregon 86 REFERENCES CITED 107 Plate I Ages of rocks in southwestern Washington and northwestern Oregon as indicated by paleontological and isotopic dates - Paleontological Data Plate n Ages of rocks in southwestern Washington and northwestern Oregon as indicated by paleontological and isotopic dates - Isotopic Data AGES OF ROCKS IN SOUTHWESTERN WASHINGTON AND NORTHWESTERN OREGON AS INDICATED BY PALEONTOLOGICAL AND ISOTOPIC DATES by Wendy A. Niem and Alan R. Niem INTRODUCTION This report presents a compilation of 1,019 paleontologic dates and 301 isotopic dates of rocks in southwestern Washington and northwestern Oregon. The study area extends from Portland, Oregon (latitude 45°30' N.) to Bellevue, Washington (latitude 47°35f N.) and from the east flank of the Cascade Range (longitude 121°20f W.) to the coastline (longitude approximately 124°00f W.). The data are presented in two tables and come from previous summaries of isotopic ages, open-file reports, published papers and maps, and theses.
  • Right of Passage

    Right of Passage

    Right of Passage: Reducing Barriers to the Use of Public Transportation in the MTA Region Joshua L. Schank Transportation Planner April 2001 Permanent Citizens Advisory Committee to the MTA 347 Madison Avenue, New York, NY 10017 (212) 878-7087 · www.pcac.org ã PCAC 2001 Acknowledgements The author wishes to thank the following people: Beverly Dolinsky and Mike Doyle of the PCAC staff, who provided extensive direction, input, and much needed help in researching this paper. They also helped to read and re-read several drafts, helped me to flush out arguments, and contributed in countless other ways to the final product. Stephen Dobrow of the New York City Transit Riders Council for his ideas and editorial assistance. Kate Schmidt, formerly of the PCAC staff, for some preliminary research for this paper. Barbara Spencer of New York City Transit, Christopher Boylan of the MTA, Brian Coons of Metro-North, and Yannis Takos of the Long Island Rail Road for their aid in providing data and information. The Permanent Citizens Advisory Committee and its component Councils–the Metro-North Railroad Commuter Council, the Long Island Rail Road Commuters Council, and the New York City Transit Riders Council–are the legislatively mandated representatives of the ridership of MTA bus, subway, and commuter-rail services. Our 38 volunteer members are regular users of the MTA system and are appointed by the Governor upon the recommendation of County officials and, within New York City, of the Mayor, Public Advocate, and Borough Presidents. For more information on the PCAC and Councils, please visit our website: www.pcac.org.
  • Miklos A. Vasarhelyi Rutgers Business School 1 Washington Park, Room 946 Newark, NJ 07102 Miklosv@Business.Rutgers.Edu Mobile (201) 454-4377 Fax (973) 353-1283

    Miklos A. Vasarhelyi Rutgers Business School 1 Washington Park, Room 946 Newark, NJ 07102 [email protected] Mobile (201) 454-4377 Fax (973) 353-1283

    Miklos A. Vasarhelyi Rutgers Business School 1 Washington Park, Room 946 Newark, NJ 07102 [email protected] Mobile (201) 454-4377 Fax (973) 353-1283 CURRENT POSITION Rutgers University: KPMG Distinguished Professor of Accounting Information Systems Rutgers Business School - Newark & New Brunswick Director, Rutgers Accounting Research Center & Continuous Auditing & Reporting Lab EDUCATION University of California, Los Angeles, Graduate School of Management, Ph.D. Major: Accounting Information Systems - Minor: Finance & Computer Methods. Dissertation Title: Man Machine Planning Systems: A Behavioral Examination of Interactive Decision Making, 1973. Massachusetts Institute of Technology, Alfred P. Sloan School of Management M.S. in Management, Emphasis: Finance, 1969. Catholic University of Rio de Janiero, Brazil, B.S. Electrical Engineering, 1966. State University of Guanabara, Brazil, B.S., Economics, 1966. PROFESSIONAL EXPERIENCE ACADEMIC Rutgers University, Graduate School of Management, Professor of Accounting Information Systems (1999-2001), Area Chair (1989, 1992), Director of the RARC (Rutgers Accounting Research Center) (1990-Present), Director of CAR Lab (2003-Present) University of Southern Europe - Monaco, Visiting Professor (2001-2002) University of Hawaii, Visiting Professor, Summer Sessions (1994, 1995) Theseus Institute, Sophia Antipolis, France, Visiting Professor (Fall 1993); Professor Vacataire (1993-Present) Columbia University, Graduate School of Business, Associate Professor of Accounting (1978-1987); Director of the Accounting Research Center (1983-1987) University of Southern California, Department of Accounting, School of Business Administration, Assistant Professor of Accounting (1974-1978) Catholic University of Rio de Janeiro, Associate Professor (1972-1974). Creator and Coordinator of the MBA Program (1972-1974), Director of Rio Datacenter - 150 employees, at the time the largest data processing center in South America (1972-1974).
  • Effect of Grootvlei Mine Water on the Blesbokspruit

    Effect of Grootvlei Mine Water on the Blesbokspruit

    THE EFFECT OF GROOTVLEI MINE WATER ON THE BLESBOKSPRUIT by TANJA THORIUS Mini-dissertation submitted in partial fulfilment of the requirement for the degree MASTER OF SCIENCE in ENVIRONMENTAL MANAGEMENT in the Faculty of Science at the Rand Afrikaans University Supervisor: Professor JT Harmse July 2004 The Impact of Grootvlei Mine on the Water Quality of the Blesbokspruit i ABSTRACT Gold mining activities are widespread in the Witwatersrand area of South Africa. These have significant influences, both positive and negative, on the socio-economic and bio -physical environments. In the case of South Africa’s river systems and riparian zones, mining and its associated activities have negatively impacted upon these systems. The Blesbokspruit Catchment Area and Grootvlei Mines Limited (hereafter called “Grootvlei”) are located in Gauteng Province of South Africa. The chosen study area is east of the town of Springs in the Ekurhuleni Metropolitan Municipality on the East Rand of Gauteng Province. Grootvlei, which has been operating underground mining activities since 1934, is one of the last operational mines in this area. Grootvlei pumps extraneous water from its underground mine workings into the Blesbokspruit, which includes the Blesbokspruit Ramsar site. This pumping ensures that the mine workings are not flooded, which would result in the gold reserves becoming inaccessible and would shortly lead to the closure of Grootvlei. This closure would further affect at least three other marginal gold mines in the area, namely, Springs-Dagga, Droogebult-Wits and Nigel Gold Mine, all which rely on Grootvlei’s pumping to keep their workings dry. Being shallower than Grootvlei, they are currently able to operate without themselves having to pump any extraneous water from their underground workings.
  • Gauteng Gauteng

    Gauteng Gauteng

    Gauteng Gauteng Thousands of visitors to South Africa make Gauteng their first stop, but most don’t stay long enough to appreciate all it has in store. They’re missing out. With two vibrant cities, Johannesburg and Tshwane (Pretoria), and a hinterland stuffed with cultural treasures, there’s a great deal more to this province than Jo’burg Striking gold International Airport, says John Malathronas. “The golf course was created in 1974,” said in Pimville, Soweto, and the fact that ‘anyone’ the manager. “Eighteen holes, par 72.” could become a member of the previously black- It was a Monday afternoon and the tees only Soweto Country Club, was spoken with due were relatively quiet: fewer than a dozen people satisfaction. I looked around. Some fairways were in the heart of were swinging their clubs among the greens. overgrown and others so dried up it was difficult to “We now have 190 full-time members,” my host tell the bunkers from the greens. Still, the advent went on. “It costs 350 rand per year to join for of a fully-functioning golf course, an oasis of the first year and 250 rand per year afterwards. tranquillity in the noisy, bustling township, was, But day membership costs 60 rand only. Of indeed, an achievement of which to be proud. course, now anyone can become a member.” Thirty years after the Soweto schoolboys South Africa This last sentence hit home. I was, after all, rebelled against the apartheid regime and carved ll 40 Travel Africa Travel Africa 41 ERIC NATHAN / ALAMY NATHAN ERIC Gauteng Gauteng LERATO MADUNA / REUTERS LERATO its name into the annals of modern history, the The seeping transformation township’s predicament can be summed up by Tswaing the word I kept hearing during my time there: of Jo’burg is taking visitors by R511 Crater ‘upgraded’.
  • APCD Landscape -National Association of Health Data Organizations (NAHDO) 28Th Annual Conference

    APCD Landscape -National Association of Health Data Organizations (NAHDO) 28Th Annual Conference

    All-Payer Claims Database Policy & Procedures Enhancements Subcommittee Meeting May 8, 2014 1 Agenda • Call to Order and Introductions • Public Comment • Approval of Minutes for the February 21, 2014 Meeting • Overview of Claims Adjustment Reason Codes and Remittance Advice Codes • Review of Denied Claims Data Use Cases • Discussion of Dental Data Collection and Stakeholder Engagement • Next Steps • Future Meetings 2 Overview of Claims Adjustment Reason Codes and Remittance Advice Codes 3 Denial and Adjustment Code Sets Claim Adjustment Remittance Advice Claim Adjustment Group Reason Codes Remark Codes Codes (CAGC) (CARC) (RARC) NCPDP Reject Code Offers a reason for the Delivers supplemental positive/negative Provides information Assigns financial responsibility information (in addition financial adjustment regarding a retail for the Claims Adjustment to a CARC) about why a Purpose: specific to particular pharmacy claim Reason Code (CARC). claim or service line is claim or rejection not paid in full service referenced Code Set Codes National Council for Centers for Medicare & ASC X12 Standards Committee Maintenance Committee Prescription Drug Steward: Medicaid Services (CMS) (BCBSA) Programs (NCPDP) Count: 5 ~268 ~930 NA Example: CO - Contractual Obligation CR - Corrections and Reversal N19 - Procedure code 26 - Expenses incurred OA - Other Adjustment incidental to primary NA prior to coverage. PI - Payer Initiated Reductions procedure. PR - Patient Responsibility http://www.wpc- http://www.wpc- Reference: http://www.wpc- edi.com/reference/codelists/h edi.com/reference/codelists/h edi.com/reference/codelists/healthcare/cl https://www.ncpdp.org/ aim-adjustment-reason-codes/ ealthcare/claim-adjustment- ealthcare/remittance-advice- reason-codes/ remark-codes/ 4 Denial and Adjustment Code Set Values Examples1 ASC X12 CARC CARC Description2 RARC RARC Description3 CAGC 163 Attachment/other documentation referenced on the N678 Missing post-operative images/visual field results.
  • Prioritization of Health Services

    Prioritization of Health Services

    PRIORITIZATION OF HEALTH SERVICES A Report to the Governor and the 74th Oregon Legislative Assembly Oregon Health Services Commission Office for Oregon Health Policy and Research Department of Administrative Services 2007 TABLE OF CONTENTS List of Figures . iii Health Services Commission and Staff . .v Acknowledgments . .vii Executive Summary . ix CHAPTER ONE: A HISTORY OF HEALTH SERVICES PRIORITIZATION UNDER THE OREGON HEALTH PLAN Enabling Legislatiion . 3 Early Prioritization Efforts . 3 Gaining Waiver Approval . 5 Impact . 6 CHAPTER TWO: PRIORITIZATION OF HEALTH SERVICES FOR 2008-09 Charge to the Health Services Commission . .. 25 Biennial Review of the Prioritized List . 26 A New Prioritization Methodology . 26 Public Input . 36 Next Steps . 36 Interim Modifications to the Prioritized List . 37 Technical Changes . 38 Advancements in Medical Technology . .42 CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES Practice Guidelines . 47 Age-Related Macular Degeneration (AMD) . 47 Chronic Anal Fissure . 48 Comfort Care . 48 Complicated Hernias . 49 Diagnostic Services Not Appearing on the Prioritized List . 49 Non-Prenatal Genetic Testing . 49 Tuberculosis Blood Test . 51 Early Childhood Mental Health . 52 Adjustment Reactions In Early Childhood . 52 Attention Deficit and Hyperactivity Disorders in Early Childhood . 53 Disruptive Behavior Disorders In Early Childhood . 54 Mental Health Problems In Early Childhood Related To Neglect Or Abuse . 54 Mood Disorders in Early Childhood . 55 Erythropoietin . 55 Mastocytosis . 56 Obesity . 56 Bariatric Surgery . 56 Non-Surgical Management of Obesity . 58 PET Scans . 58 Prenatal Screening for Down Syndrome . 59 Prophylactic Breast Removal . 59 Psoriasis . 59 Reabilitative Therapies . 60 i TABLE OF CONTENTS (Cont’d) CHAPTER THREE: CLARIFICATIONS TO THE PRIORITIZED LIST OF HEALTH SERVICES (CONT’D) Practice Guidelines (Cont’d) Sinus Surgery .
  • Dipaleseng Macro Strategic Development Concept

    Dipaleseng Macro Strategic Development Concept

    PLAN 37: DIPALESENG MACRO STRATEGIC DEVELOPMENT CONCEPT Project Projects No SPATIAL OBJECTIVE: EXPLOIT ECONOMIC OPPORTUNITIES T 7 PHASE 3 & 4 MAPS: DIPALESENG PROJECTS: STRATEGIES: o 1 N /N 1 Compilation of an implementation plan to create mining enabling environment 17 18 C n i o g v LOCAL MUNICIPALITY 2 Beneficiation of coal 24 28 D e e Govan Mbeki Local 29 35 F l D o F Municipality (MP307) 3 (n/a) Development of a Tourism Strategy 38 43 G T 4 (n/a) Access suitable land for irrigation farming and beneficiation of agricultural products 44 46 H 47 50 I 5 (n/a) Access agricultural support programmes for the development of arable land 52 J 1! 7 (n/a) Beneficiation of agricultural products K 23! 8 (n/a) Implement land reform Programme L L 8 15 (n/a) SMME/BEE Development Programmes 4 5 SPATIAL OBJECTIVE: CREATE SUSTAINABLE HUMAN SETTLEMENTS R 17 Thusong service centres. F 18 Draft detailed Urban Design Framework for nodes E P e t r u s v d M e r w e ! 19 Upgrade of the R23 road between Greylingstad and Balfour P e t r u s v d M e r w e 1 1 5 HHaarrooffff DDaamm 20 Upgrade of the R51 road between Balfour and Grootvlei R 21! 21 Maintain R23 transport corridor to the east of Greylingstad and to the north of Balfour N 22 (n/a) Upgrade gravel access roads to schools to enable public transport provision 23 Maintain R51-R548 main road south of Grootvlei (to Vaal River) and north of Balfour (to Devon, Secunda) F 55! ´ S i y a t h e m b a 24 Develop services master plans (roads, water, sewer, electricity) for Balfour, Greylingstad and Grootvlei T S i y a t h e m b a o 28 Identification of new cemetery and land fill sites in all main towns H / ! B 1 ! e /!!! 53 L B aa ll ff o u r L 29 Upgrade Main Substations (Bulk Electricity supply) id ! u r e 53 30 (n/a) Rural Water Supply (15 boreholes) lb e 32 (n/a) Provision of VIP's rg 1:320 000 35 Develop Storm Water Master Plan N N 19! 38 Sewer Reticulation & Maintenance L B B R 39 Sewer Reticulation 700 H/H Ext.