MO HealthNet Internet Provider Training Program

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• MO HealthNet Internet Provider Training Program
• Presented by the Provider Education Unit
• MO HealthNet Division

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Proper Completion of a Paper Second Surgical
Opinion Form

• Presented by the Provider Education Unit
• MO HealthNet Division

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Surgery Codes That Require a Second Surgical
Opinion Form

• 66840 Removal of lens material aspiration
  technique, one or more stages.
• 66850 removal of lens material
  phacofragmentation technique.
• 66852 removal of lens material pars plana
  approach, with or without virectomy.
• 66920 removal of lens material intracapsular.
• 66983 Intracapsular cataract extraction with
  insertion of intraocular lens prosthesis-one
  stage procedure.
• 66984 extracapsular cataract removal with
  insert, intraocular lens prosthesis-one stage
  procedure, manual or mechanical technique.

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Name of Participant
MO HealthNet ID Number
Surgical Procedure Recommended
ICD-9 DX Code
CPT Procedure Codes
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History and Physical Findings
Physicians Name
MO HealthNet Provider Identifier
Provider Taxonomy Code
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Physicians Address
Provider Specialty
Appointment Date
Physicians Signature
Date (Month/Day/Year)
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Need for Surgery
State Remarks
Surgical Procedure Recommended
CPT Procedure Codes
ICD-9 DX Code
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Physician Name
MO HealthNet Provider Identifier
Provider Taxonomy Code
Physicians Office Address
Provider Specialty
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Appointment Date
Physician Signature
Date (Month/Day/Year)
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Need For Surgery
State Remarks
Surgical Procedure Recommended
CPT Procedure Codes
ICD-9 DX Code
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Provider Taxonomy Code
Physicians Name
Physician MO HealthNet Identifier
Physicians Office Address
Provider Specialty
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Appointment Date
Physician Signature
Date (Month/Day/Year)
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Surgical Procedure Recommended
CPT Procedure Codes
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ICD-9 DX Code
Name and Address of Surgery Site
Date of Surgery (Month/Day/Year
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Surgeons Name
MO HealthNet Provider Identifier
Provider Taxonomy Code
Surgeons Office Address
Provider Specialty
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Surgeons Signature
Date (Month/Day/Year)
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• The physician who performs the surgery must
  retain the patients medical records and the
  completed Second Surgical Opinion Form. The
  surgeon is responsible for furnishing a copy of
  the Second Surgical Opinion Form to the
  hospital/ambulatory surgical center where the
  surgery was performed.
• Staff interns, residents, and nurse practitioners
  are not permitted to provide the first, second,
  or third opinion.

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Exceptions to Second Opinion Requirement

• Medicare/MO HealthNet Crossover claims are
  exempt.
• The Second Surgical Opinion form is not required
  if the surgeon does not participate in the MO
  HealthNet Program. This must be stated in field
  19 of the CMS-1500 Claim form and the physicians
  full name listed.
• Those surgical operations specified (in previous
  screen) are exempt from the Second Surgical
  Opinion if any one of them is performed
  incidental to a more major surgical procedure
  that does not require a Second Surgical Opinion.

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Exceptions to Second Opinion Requirement
(Continued)

• If the service was performed as an emergency and
  a Second Surgical Opinion could not be obtained
  prior to rendering the service, complete the
  claim form and enter emergency in field 19 of
  the CMS-1500. Attach a Certificate of Medical
  Necessity form (or other adequate documentation
  such as operative notes, admit or discharge
  summaries, etc.) to the claim. The provider must
  state on the Certificate of Medical Necessity
  form, in detail, the reason for the emergency
  provision of service.

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Exception to Second Opinion Requirement
(Continued)

• If the participant was not eligible for MO
  HealthNet at the time of service, but was made
  retroactive to that time. If the provider is
  unable to obtain an eligibility approval letter
  from the participant, the claim may be submitted
  with a completed Certificate of Medical Necessity
  (CMN) form indicating the participant was not
  eligible at the time of service but became
  eligible retroactively to that date. The CMN can
  be submitted electronically through the MO
  HealthNet Internet billing Web site, emomed.com,
  as an attachment to the medical claim by clicking
  on the Medical Necessity link at the right side
  of each line of the claim on the claim form.

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Obtaining a Copy of the Paper Form

• To Obtain a paper copy of the form, go to the MHD
  
• public Web site, www.dss.mo.gov/mhd//providers/ind
  ex.htm.
• In the left hand column, click on MO HealthNet
  forms.
• Then scroll down the list and click on Second
  Surgical
• Opinion Form. You can print the form once it
  opens
• on your computer screen.

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• The completed Second Surgical Opinion
• Form can be mailed to Infocrossing
• Healthcare Services, P.O. Box 5900,
• Jefferson City, MO 65102 or you may enter
• the information from this form via the Internet
• at www.emomed.com. You should retain a
• copy of this form in the patient file.

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• Thank you again for participating in this
• training program. If you have questions
• regarding the information in this
• presentation, please contact the Provider
• Education Unit at 573-751-6683.