FOLIC ACID CODING TRAINING MODULE Revised July 1, 2006

1. FOLIC ACID CODING TRAINING MODULERevised July 1, 2006

2. FOLIC ACID CODING • Folic acid should be offered to ALL female patients of childbearing age, who have not had a hysterectomy • Refer to the Public Health Practice Reference (PHPR) updated guidelines for best practice requirements Cabinet for Health and Family Services

3. CPT Codes for Folic Acid Counseling • E/M visit by MD, Mid-level, RN or LPN during which the patient received education about the benefits of folic acid (99201-99215) • Counseling visit by nutritionists, health educators, or social workers acting as health educators (99401-99404) • Medical Nutrition Therapy by RD/CN (97802-97803) Cabinet for Health and Family Services

4. CPT Codes for Provision of Folic Acid Supplementation • Provision of multivitamin containing 400 mcg of folic acid three month supply (W0506)-Nurse-Nutritionist-Health Educator • Provision of folic acid supplements for women with pregnancy history of Neural Tube Defect (NTD)-Prescriptive Authority Only (W0507) • Provision of prenatal vitamin (W0509)-Nurse-Nutritionist-HealthEducator Cabinet for Health and Family Services

5. ICD Codes for Folic Acid Counseling • ICD code 2662- Vitamin Deficiency Folic Acid for patients who do not have a history of problems • ICD code V1369 Personal History of Congenital Malformation for patients who have had a previous pregnancy where these problems have occurred • ICD code V653- Medical Nutrition Therapy (primary position) plus a secondary code of either 2662- or V1369 Cabinet for Health and Family Services

6. Documentation Guidelines • Provision of a multivitamin containing 400 mcg of folic acid (three month supply) will be recorded on the Patient Encounter Form (PEF) in the Patient Services Reporting System (PSRS) with W0506 service code-ICD codes will be automatically assigned from those used for the visit • ICD code is not entered along side the above code • W0507 service code used with ICD code of V1369 in secondary or lower position first visit and in the primary position for subsequent visits Cabinet for Health and Family Services

7. Documentation as Part of a WIC Only Service • Record on the PEF an 80000 code with the 2662- or V1369 in the primary position and the W0506 for the multivitamin with 400 mcg folic acid or W0509 for the prenatal vitamin Cabinet for Health and Family Services

8. Women who have a history of NTD pregnancies and express the desire to become pregnant • The 4 mg supplement of folic acid-one month supply at a time-may be given ONLY on physician or mid-level provider order (according to the DPH protocol for issuance of prescription drugs) • These women must be seen and counseled monthly and the supplement given only one month at a time Cabinet for Health and Family Services

9. Women who have a history of NTD pregnancy and do not desire to become pregnant • Provide the multivitamin containing 400 mcg of folic acid (three month supply). • Discuss need for genetic counseling, medical nutrition therapy, and consultation for possible prescription levels of folic acid if a pregnancy is planned in the future. Cabinet for Health and Family Services

10. Women with a history of NTD and are pregnant • As soon as the woman becomes pregnant and begins taking prenatal vitamins, the supplement given to her will be 3 mg (three 1 mg tablets per day) to be provided as part of a monthly counseling. The other 1 mg will be provided as part of her daily prenatal vitamin intake Cabinet for Health and Family Services

11. Contact Information • If you provide the 4 mg supplement to a patient, please contact Joyce Robl at 502-564-3756, ext. 3768 with the following information: 1. Name of mother (at the time of the affected child’s birth); 2. Stillbirth or live birth; 3. Name and date of birth; and 4. Birthing hospital of affected child Cabinet for Health and Family Services

12. WIC SERVICES Guidelines for Folic Acid Supplementation • Provide a (three month) supply of prenatal vitamins if a WIC participant is pregnant and is not receiving a prenatal vitamin from her primary prenatal medical care provider • Follow guidelines for pregnant participants who have a history of NTD • Provide a three month supply of the folic acid supplementation if a WIC client is postpartum or breastfeeding and not taking a multivitamin Cabinet for Health and Family Services

13. Financial Information • Billing code 7 will be assigned to the W0506, W0507, and W0509 codes • Neither the patient nor a third party shall be charged for folic acid supplementation • Health departments reimbursed through the Medicaid Primary Care Center Program shallnot add the cost of the supplements to the amount to be paid by the Medicaid Program Cabinet for Health and Family Services

14. Service Reimbursement • $5.25/patient/year-Counseling and supplementation (W0506) • $1.25/patient/additional bottle (limit 3 annually-W0506) • $4.00/patient/year-Counseling only if a patient refused the supplement (Appropriate ICD code for provider type) • $3.00/patient/year-prenatal vitamin (W0509) Cabinet for Health and Family Services

15. Service Reimbursement (Cont.) • $12.00/patient/month-Counseling and prescription level supplementation (W0507) • Only a physician or mid-level provider with prescriptive authority may give the 4 mg folic acid supplement one month at a time with counseling Cabinet for Health and Family Services

16. Community Services Information • Enter folic acid community services provided in the Community Services Reporting System in the 818 Cost Center • The folic acid supplementation and counseling program (802 Cost Center) funding may not be used for community service activities Cabinet for Health and Family Services

17. Contact Information • DPH Folic Acid Program Coordinator-Sandy Cleveland-502-564-2154, ext. 3784 • DPH Dietitian Consultant-Emma Walters-502-564-3827, ext. 3854 • DPH Local Health Administrative Systems-Libby Sammons-502-564-7213, ext. 3649 Cabinet for Health and Family Services