Message from the Medical Director CPT Codes 95165 and 95144
Increase in Fee for 21453 Code 68761 Payable for Optometrists
Code J9395 in Non-Pay Status Diagnosis Code V06.4
Professional Component of Code 79030 Anesthesia Funding for Code 32854
Increase in Fee for Code 95120 Notice to All Chiropractors
LADUR Education Article Status of Application for 1115 Waiver
Unisys Telephone Number Changes Claims for Non-Physician Laboratories
Documentation Reminder Oxygen Concentrator Policy Change

Message from the Medical Director

As many of you know, Dr. Gregg Pane has been promoted to the Unisys headquarters where he will work on new projects and oversee our work in Louisiana.  I would like to introduce myself to you as the new Unisys Medical Director.  I am looking forward to working with all of you to continue providing excellent health care for Louisiana residents.  I will always attempt to keep the provider community informed about any issues that may affect it.

I would like to address some of the progress and problems we have all experienced with the Pre-Certification Program.  The program has now been implemented for 183 facilities.  We have had some difficulties with phone lines and the holidays but we have purchased new equipment and are using new technology to handle the volume of admission and extension requests.  I appreciate your patience with some of the temporary measures we have had to take while working out the start-up kinks.

We realize that delays in pre-certification are frustrating to providers, so we would like to enlist your help in speeding up the process.  Please make an attempt to concisely organize information and documentation so that you fax Unisys only the pertinent information required by Medicaid.  The Pre-Certification Program does not require the same information that Utilization Review might require.

Unisys is now requesting that a patient stay abstract be submitted to concisely organize information and documentation.  As a guideline for acute care hospital extension, Unisys is issuing a one-page form for summarizing medical information.  This new form is the "Request for Acute Care Extension, Physician Reconsideration Review, or Hospitalization for Outpatient Procedures."  This form can be used in three ways:  1) as an extension request, 2) as a physician request for physician review of a pre-certification denial, and 3) for hospital documentation of outpatient procedures performed as inpatient for cases in which the outpatient procedure code is the primary or only code.  In the future this form may replace the prior authorization form that physicians currently submit for these outpatient procedures to streamline all documentation.

Unisys requests psychiatric/substance abuse, rehabilitation, and long term hospitals to submit the physician's history, physical exam, evaluation (e.g., comprehensive psych assessment), and treatment plan pertinent to hospitalization with the admission.  If these notes are not available, then please submit them at the first extension request.  In the absence of these notes, the physician's admit note and admitting orders may be submitted.  Subsequent extension requests should summarize pertinent clinical information, response to treatment, and reason for continuing need for hospitalization.

I understand and empathize with the process adjustment you are going through.  Please help us by reading and undertaking these suggestions so that we will not have large volumes of unnecessary information.  Thank you for your understanding and your assistance in speeding up the pre-cert process.

Charles Lucy, MD, MPH

Policy Notes

CPT Codes 95165 and 95144

CPT codes 95150 and 95155 were deleted in CPT '94 with instructions to use code 95165 - professional services for the supervision and provision of antigens for allergen immunotherapy ; single or multiple antigens, multiple dose vial(s), (specify number of doses).  Codes 95150 and 95155 were restricted to one per recipient per 90-day period.  This same restriction also applies to code 95165.

CPT code 95144 - professional services for the supervision and provision of antigens for allergen immunotherapy, single or multiple antigens, single dose vials (specify number of vials) - is a new code in CPT '94 and replaces codes 95135 and 95140.  Code 95144 has a UVS of 10.  Reimbursement is for 10 vials/month rather than 10 vials/day.

Increase in Fee for 21453

BHSF is pleased to inform you of an increase in fee for CPT code 21543 - closed treatment of mandibular fracture with interdental fixation - to $402.89 effective date of service March 30, 1994.

If you have performed this service since March 30, 1994 and wish to receive the additional fee, you must submit an adjustment form to Unisys.  The instructions for this can be found in the Physicians Services Manual, page 35-1.

Code 68761 Payable for Optometrists

Effective with date of service February 1, 1995, CPT code 68761 - closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery plug, each - is being added to the list of codes payable to optometrists.  The fee for this code is $70.04.

Code J9395 in Non-Pay Status

Effective with date of service February 1, 1995, BHSF will place code J9395-Lupron Injectable 3.5 mg-into non-pay status.  The code to bill in its place is J9217 (which is the code Medicare uses from Lupron).  The fee for code J9217 is $451.25.  This code will be restricted to one injection monthly.

Diagnosis Code V06.4

Effective with date of service December 1, 1994, the age restriction on the diagnosis code V06.4-Vaccination for measles, mumps, and rubella-is being changed to zero to 21.  It previously had an age restriction of 1 to 21.

Professional Component of Code 79030

Effective with date of service January 1, 1995, BHSF will pay the professional component of CPT code 79030-radionuclide ablation of gland for thyroid carcinoma.

The professional fee for this code is $69.31.  To receive reimbursement for the professional component of 79030, attach the 26 modifier to the code.

Anesthesia Funding for Code 32854

Due to an oversight, the anesthesia for CPT code 32854-lung transplant, double (bilateral sequential or en bloc) with cardiopulmonary bypass-was never funded.  Anesthesia for CPT code 32854 is now being funded effective with date of service January 1, 1994, with 25 base units of anesthesia.  To receive reimbursement for anesthesia code 32854, bill the code with modifiers and minutes.

Increase in Fee for Code 95120

BHSF is pleased to inform you of an increase in fee for CPT code 95120-professional services for allergen immunotherapy in prescribing physician's office or institution, including the provision of allergenic extract; single injection-to $9.10 effective with date of service February 1, 1995.

Notice to All Chiropractors

DHH is interested in obtaining information regarding the billing practices of chiropractors linked with the Behrman Chiropractic Clinics.  All chiropractors associated with these clinics should contact the Surveillance and Utilization Review Unit at Unisys immediately at (504) 237-3293.

Louisiana Drug Utilization Review (LADUR) Education

Antiarrhythmic Drugs:  Drug-Drug Interactions


       Antiarrhythmic drugs are classified according to their site of action, electrophysiologic action, and their ability to increase ventricular threshold.

       These drugs have a high incidence of drug-drug interactions.

       Side effects and interactions vary by class and each class is discussed in this article.

Arrhythmias are generally defined as alterations or abnormalities in normal cardiac rhythm.  Most arrhythmias are caused by either alterations in impulse generation leading to enhanced or abnormal automaticity, or by an abnormality in impulse conduction resulting in the re-entry phenomenon.  Depending on the etiology of the specific arrhythmia, various lines of drug intervention are used.

Certain agents suppress automaticity primarily by decreasing diastolic depolarization and/or raising the threshold of discharge to a less negative voltage.  Other agents prevent re-entry either by improving conduction in the abnormal pathway or by slowing conduction and/or increasing the refractory period to convert a unidirectional block into a bidirectional block.

Antiarrhythmic drugs can be classified from three distinct points of view:  1) according to their site of action, 2) according to their electrophysiologic action, or 3) according to their ability to increase ventricular fibrillation threshold.  The most common classification scheme is based on their electrophysiologic action, focusing on their direct, predominant effects on the cardiac action potential.

Electrophysiologic Classification of Antiarrhythmic Drugs

Class   Action  Drugs


 Sodium Channel Blockade
A.  Moderate phase 0 depression and slow conduction (2+)

B.Minimal phase 0 depression and slow conduction (0-1+)

C.Minimal phase 0 depression and slow conduction (3-4+)


B. Lidocaine

C. Encainide


Beta-Adrenergic Blockade   Propanolol
Acebutolol, others


Prolong Repolarization Amiodarone


Calcium Channel Blockade  Verapamil

Antiarrhythmic agents as a group have a high incidence of drug-drug interactions.  Certain classes are known to create more than others.

Class IA.  Used therapeutically to treat a wide variety of arrhythmias including atrial, AV junctional, and ventricular tachyarrhythmias.  Side effects are common with this drug group including cinchonism with quinidine and a reversible lupus erythematosus-like syndrome that develops in 25-30% of patients taking procainamide.  Drug-drug interaction are also commonplace with quinidine having the most.  Phenytoin, rifampin, and barbiturates stimulate the metabolism of quinidine, disopyramide, and procainamide, while cimetidine inhibits their metabolism and increases the blood concentrations.  Quinidine can also increase the steady-state concentration of digoxin by displacing it from tissue bonding sites.  Occasionally, patients who are receiving warfarin or other anticoagulants will have an increase in prothrombin time after quinidine therapy is begun.  Amiodarone increases the plasma concentrations of quinidine and procainamide and, therefore, combination therapy with these agents is not recommended.  Co-administration with lidocaine may give rise to a 25% increase in the unbound form of this drug.

Class IB.  Used therapeutically to treat ventricular arrhythmias arising during myocardial ischemia, such as that experienced during a myocardial infarction.  In addition, lidocaine is effective in the treatment of digitalis-induced arrhythmia.  These drugs do not slow conduction and have little effect on atrial or AV junction arrhythmias.  Antiarrhythmic agents in Class IB have fewer adverse cardiac effects than those in either class IA or Class IC.  Main adverse side effects are in the CNS.  Adverse effects occur in more than 50% of patients receiving Tocainide, the most alarming being agranulocytosis, and deaths have been reported.  Few drug-drug interactions have been reported with lidocaine.  Cimetidine can increase the serum concentrations of all Class IB agents.  Lidocaine can potentiate the effects of succinylcholine.  Hepatic metabolism of mexiletine can be accelerated by concurrent administration of phenytoin or rifampin.  A large number of drug interactions have been reported for phenytoin, including chloramphenicol, dicumarol, disulfiram, isoniazid, cimetidine, or certain sulfonamides, which can increase the concentration of phenytoin in plasma by decreasing its rate of metabolism.  Carbamazepine, which may enhance the metabolism of phenytoin, causes a well-documented decrease in phenytoin concentration.  Conversely, phenytoin may reduce the concentration of carbamazepine.

Class IC.  Useful in treating refractory ventricular arrhythmias.  Particularly useful in suppressing premature ventricular contraction.  Propafenone may potentiate the effect of warfarin.  Digoxin levels are increased from 35% at 450 mg/l of propafenone daily to 855 at 900 mg daily.  The negative inotropic effect of beta blockers or calcium antagonist is additive.  The drug must be used under strict supervision in combination with these agents.  The drug has been combined with quinidine, procainamide, and amiodarone at reduced doses.

Class II.  These agents are useful in treating tachyarrhythmia caused by increased sympathetic activity.  They are also used for atrial flutter and fibrillation, and for AV nodal re-entrant tachycardia.  Numerous pharmacokinetic and pharacodynamic interactions have been noted between beta blockers and other drugs.  Cholestyramine and colestipol may decrease the absorption of beta blockers.  Drugs such as phenytoin, rifampin, and phenobarbital may induce hepatic biotransformation enzymes and may decrease plasma concentration of beta blockers that are metabolized extensively.  Cimetidine and hydralazine may increase the bioavailability of agents such as propranolol and metoprolol by affecting hepatic blood flow.  Beta blockers can impair the clearance of lidocaine.  Beta blocker and calcium channel blockers have additive effects on the cardiac conducting system.

Class III.  Bretylium is useful for life-threatening ventricular arrhythmias, especially recurrent ventricular fibrillation or tachycardia.  Amiodarone is effective in the treatment of severe refractory supraventricular and ventricular tachyrhythmia.  Amiodarone increases the plasma concentrations and effects of digoxin, warfarin, quinidine, procainamide, phenytoin, encainide, flecainide, and diltiazem.  Amiodarone increases the likelihood of bradycardia, sinus arrest, and AV block when beta blockers or calcium channel blockers are administered correctly.

Class IV.  Useful as the drug of choice for abolishing acute episodes of paroxysmal supraventricular tachycardia due to AV nodal re-entry or due to anomalous AV connections.  Also useful in reducing ventricular rate in atrial flutter and fibrillation.  Concurrent use of verapamil and beta blockers or digitalis can lead to significant bradycardia or AV block.  The main reason for this is the additive effects of these drugs on the sinus or AV nodes.  In addition, verapamil interacts with digoxin in a manner similar to the quinidine-digoxin interaction.  Concomitant use of verapamil or diltiazem with antihypertensive drugs that depress the sinus node (reserpine and methyldopa) can intensify bradycardia.

In summary, a wide variety of agents is useful in the treatment of numerous types of arrhythmias.  Side effects and drug-drug interactions are common with this group of pharmacological agents and should be administered with these considerations in mind.


Antonaccio, Michael J., ed. 1990 "Antiarrhythmic Drugs" in Cardiovascular Pharmacology, 3rd Edition. Raven Press, New York. pp. 369-485.

Goodman and Gilman, 1990. "Antiarrhythmic Drugs" in The Pharmacological Basis of Therapeutics, 8th Edition. Elmsford, New York, pp. 870-874.

Munson, Paul L., ed. 1995. "Antiarrhythmic Drugs" in Principles of Pharmacology, Basic Concepts and Clinical Applications, 1st Edition. Chapman and Hall, New York. pp. 495-528.

Tatro, David S., ed. 1994. Drug Interaction Facts (Fact and Comparisons). J.B. Lippincott Co., St. Louis.

Status of Application for 1115 Waiver

As most providers are aware, the Louisiana Department of Health and Hospitals is currently applying for a Section 1115 Medicaid Waiver from the Health Care Financing Administration.  This waiver would allow Louisiana to restructure its Medicaid system from the current fee-for-service to include more managed care.  Below is a chronological summary of DHH's activities in November and December 1994 concerning the proposed Managed Health Care Delivery System.

During the month of November 1994, nine regional public forums were held in various parts of the state.  These meetings drew a total of about 2,000-2,500 attendants.  The nine meetings were scheduled as follows:  11/7 in Lake Charles, 11/9 in Lafayette, 11/10 in Thibodaux, 11/14 in Alexandria, 11/16 in Baton Rouge, 11/18 in Hammond, 11/21 in New Orleans, 11/29 in Monroe, and 11/29 in Shreveport.  At these public forums, all verbal comments were recorded and all written comments were collected so that they could be compiled and reconsidered.  DHH reviewed and analyzed all public comments and recommendations concerning the 1115 waiver proposal.

As the public forums were continuing, technical staff workgroups met and developed the specific details of the waiver proposal.  These workgroups tried to discuss and outline all facets of a proposed Managed Care Plan (MCP).  Their working agendas included many of the following topics:

       Governance and organization of MCP

       Benefit package for MCP

       Specialized services (special handling of beneficiaries under Office of Mental Health, Substance Abuse, and Developmental Disabilities)

       Eligibility/enrollment processes

       Service delivery

       Systems and administration (management information systems)

       Legal aspects

       Public and governmental relations/marketing (planned regional public forums; specialized Medicaid Recipient Mailouts; publicized plan through meetings, production of introductory video, and various PSAs)

       Finance (met with actuarial consultants to strategize financial aspect of MCP)

       Consumer oversight

On November 29, 1994, the U.S. Department of Health and Human Services (Bureau of Health Services Financing) approved the media plan for public input of the 1115 Waiver Proposal.  On December 7, 1994, DHH Secretary and staff met with the HCFA Project Staff in Washington, D.C. to present the 1115 Waiver Proposal.  As these events transpired, DHH continued to work with managed care consultants-Covington and Burling, Mercer (actuaries), and Pelrine ( to develop the waiver document.

DHH met with the Committee on Louisiana Health Care Reform on December 8 in Baton Rouge to provide the current proposal development.  They then met with the governor and legislative leadership on December 12 to again discuss the waiver proposal.  On the same day, DHH held a focus meeting with consumers and beneficiaries to provide an update on the status of the 1115 waiver and to solicit input.

After all of this preparation, the 1115 Waiver document was put on public display for final review before submission at noon on December 15.  The document was disseminated through all regional managers of DHH (Office of Public Health, Office of Mental Health, Office for Citizens with Developmental Disabilities, Office and Alcohol and Drug Abuse, Medicaid, and DSS Office of Family Support and Community Service).  The next day was the final Public Hearing to receive input before submission to Washington.  The public could continue adding input until December 23, 1994.

Finally, the Waiver Proposal was submitted to HCFA in Washington, D.C. on December 31, 1994.

There was a day-long planning retreat on January 24, 1995, to prepare for the next phase of the managed care project.  The retreat was held at the Bluffs, St. Francisville, and focused on two main areas:  internal administration and personnel features of the project, and the implementation plan.  Although Louisiana will not receive a response to the waiver proposal for several months, DHH is presently working to create a development and implementation plan in order to be prepared if the waiver is approved.

Unisys Telephone Number Changes

To better serve all Medicaid providers, Unisys is in the process of updating and expanding its phone system.  Please note that the general operator telephone number has changed to (504) 237-3200.

Each Unisys employee can now be reached by direct dial rather than through an automated menu system.  Most employees can be reached by dialing (504) 237-3 plus the same last three digits of their old extensions.  For example, EMC is not (504) 237-3303 (it was 2303).

This change will not affect our provider information lines.  Please continue dialing into the following departments just as you always have.  Provider Relations is (504) 924-5040 or (800) 473-2783.  Prior Authorization is (504) 928-5263 or (800) 488-6334.  Pre-Certification is (800) 877-0666.  The REVS line is (800) 776-6323.

Claims for Non-Physician Laboratories

HCFA has advised that Non-Physician Laboratories holding a certificate type 4 or 5 are to have claims submitted to Medicaid edited for compliance with billing only the codes allowed by their certificate type.  Louisiana Medicaid began editing claims submitted in Non-Physician Laboratories in February 1995.  Non-Physician Laboratories should also contact Medicaid Provider Enrollment if the most current CLIA number and certificate type have not been previously reported.

Documentation Reminder

Please remember that a service not documented is a service not rendered.  Therefore, your documentation must always be complete!

Oxygen Concentrator Policy Change

Physicians should note the following changes to pp. 7-23 and 7-24 of the Medical Services Manual and p. 11-12 of the Medicaid Eligibility Manual (Durable Medical Equipment Manual).

1.     The arterial oxygen saturation level requirements of "at or below 85%" referenced under Group I should be changed to "at or below 88%."  The reference to arterial oxygen saturation level requirement of "at or above 86%" in the last paragraph under Group I should be changed to "at or above 89%."

2.     The reference under Group II to arterial blood oxygen saturation of 86%-89% should be changed to 89%.

3.     Group III should be changed to read as follows.
"Medicaid reimbursement will not be made for patients with arterial PO2 levels at or above 60 mm Hg., or arterial blood saturation at or above 90%."