CHILD HEALTH AND DISABILITY PREVENTION (CHDP) Health ...€¦ · –Anticipatory guidance/Health...
Transcript of CHILD HEALTH AND DISABILITY PREVENTION (CHDP) Health ...€¦ · –Anticipatory guidance/Health...
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Presented by: Ashli Pickerill | Coding Resource Specialist
Quality Improvement
CHILD HEALTH AND DISABILITY PREVENTION (CHDP)
Health Assessment Guidelines
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AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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TAKE AWAY //
HOW DOES THIS EFFECT YOU?
Understand CHDP Health Assessment Guidelines
Understand what CPT codes to use for reimbursement
Impact on CBI and capitation visit requirements
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AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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// WHAT IS CHDP?
1973
CHDP program implemented
• Program aims to ensure that all low-income children and youth in California have access to preventive health care services
• Annually, approximately 1.1 million children and youth receive preventive services, and over 2 million receive immunizations
• Diagnostic and Treatment services are not CHDP benefits
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AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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// COMPLETE HEALTH ASSESSMENT
CHDP visits should be in accordance to the CHDP Health Assessments Requirements and follow the Bright Futures Periodicity Schedule.
• Bright Futures Periodicity Schedule: https://www.aap.org/en-us/Documents/periodicity_schedule.pdf
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// COMPLETE HEALTH ASSESSMENT
Age and gender appropriate: – History and physical – Nutritional assessment – Sensory screenings – Developmental/Behavioral
screenings – Depression screening – Alcohol and Substance use screening – Immunizations – TB test – Screening labs – Oral health – Anticipatory guidance/Health
education
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// COMPLETE HEALTH ASSESSMENT
History, physical exam and anticipatory guidance recommended for ages:
• Months: 1, 2, 4, 6, 9, 12, 15, 18, 24, 30
• Annually: for years 3-20
Including:
• Vitals*
• Nutritional assessment
• Physical activity assessment
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Sensory Screenings
// COMPLETE HEALTH ASSESSMENT - SCREENINGS
Vision acuity screening
• Separately reimbursable,
when performed
• Years: 3, 4, 5, 6, 8, 10, 12, 15
• Bill with CPT code 99173
Audiometric hearing screening
• Separately reimbursable,
when performed
• Years: 4, 5, 6, 8, 10, 12, 16, 20
• Bill with CPT code 92551
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// COMPLETE HEALTH ASSESSMENT - SCREENINGS
Developmental Screenings
Autism Spectrum Disorder Screening
• Months: 18, 24
• CPT 96110 with use of
standardized instrument
Developmental Screening
• Months: 9, 18, 30
• Bill with CPT 96110 with use of
standardized instrument
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// COMPLETE HEALTH ASSESSMENT – DEVELOPMENTAL SCREENING TOOLS
Developmental Screening Tools:
Ages and Stages Questionnaire (ASQ)
Ages and Stages Questionnaire: Social-Emotional (ASQ-SE)
Battelle Developmental Inventory Screening Tool, 2ND ed (BDI-ST)
Child Development Inventory (CDI)
Denver Developmental Screening Test (DDST)
Save Environment for Every Kid (SEEK) parent questionnaire Autism Screening Tool:
Modified Checklist for Autism in Toddlers (MCHAT)
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// COMPLETE HEALTH ASSESSMENT - SCREENINGS
Psychosocial/Behavioral Assessment
• Includes assessment of child social-emotional health, caregiver depression, and social determinants of health
• Included in preventive visits, unless assessment with scoring and documentation performed
• Months: 1, 2, 4, 6, 9, 12, 15, 18, 24, 30
• Annually for years: 3-19
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// COMPLETE HEALTH ASSESSMENT - SCREENINGS
Depression Screening
• Includes assessment of clinical depression using a standardized tool
• Included in office encounters
• Screening Tools: PHQ-2, PHQ-9, PHQ-9M, BDI-FS, CESD-R
• Annually for years: 12-21
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// COMPLETE HEALTH ASSESSMENT - SCREENINGS
Alcohol and Substance Abuse Screening
• Includes assessment of alcohol and substance use
• Screening Tools: CRAFFT
• Annually for years: 12-21
• HCPCS Code: G0442
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// COMPLETE HEALTH ASSESSMENT –IMMUNIZATIONS CHILDREN (BIRTH TO 15 MONTHS)
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// COMPLETE HEALTH ASSESSMENT –IMMUNIZATIONS CHILDREN (18 MONTHS – 18 YEARS)
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*The 2019 Childhood and Adolescent Immunization schedule can be found at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
// COMPLETE HEALTH ASSESSMENT –IMMUNIZATIONS CHILDREN (18 MONTHS – 18 YEARS)
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// COMPLETE HEALTH ASSESSMENT - SCREENINGS
• Included in preventive visits
• Years: 1 month, 6 months, 12 months and then annually
• Start with TB Risk Assessment – if a new risk is identified,
latent tuberculosis infection (LTBI) testing is recommended
Tuberculosis (TB) Risk Assessment
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California TB Risk Assessment: Pediatrics
// COMPLETE HEALTH ASSESSMENT - SCREENINGS
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Tuberculosis (TB) Risk Assessment
// COMPLETE HEALTH ASSESSMENT - SCREENINGS
• Avoid testing persons at low risk
• “A Decision to test is a decision to treat”
• Negative test for LTBI does not rule out active Tuberculosis
• Symptoms of tuberculosis should trigger evaluation for active TB
• TB is a community issue – check with your TB control programs for local recommendations
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// COMPLETE HEALTH ASSESSMENT – Tests
Screening Tests
Anemia
Months: 12
Lead
Months: 12 & 24
Dyslipidemia
Years: between 8-11 & 17-19
STD/HIV
As appropriate for years 11+
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// COMPLETE HEALTH ASSESSMENT – ORAL HEALTH
Oral Health
Assess whether child has a dental home
• Referral to dental home at first tooth or first birthday, whichever is comes first
• Additionally, refer members every 6 months for routine dental care
Fluoride Varnish
• Recommended in the primary care setting every 3–6 months starting at tooth emergence.
• Bill with 99188
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AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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• CHDP Providers must enroll in the Vaccines for Children (VFC) program
• Provider purchased vaccines are not reimbursable if they are available free from other sources, including the VFC program
• Members 18 and younger need to get their vaccines from their PCP or be referred to a pharmacy or another PCP
• Vaccine administration reimbursement
// VACCINES
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// CLAIM EXAMPLE – cms1500 (5 y/o Well Child Exam)
Health assessment billed with 99393
Hearing assessment billed with 92551
MMRV vaccine billed with 90710
DTaP/IPV vaccine billed with 90696 Modifier SL used with each CPT code indicates vaccines were part of VFC stock
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// CLAIM EXAMPLE – UB04 (11 y/o Well Child Exam)
Health assessment billed with 99393
Meningococcal vaccine billed with 90621
HPV vaccine billed with 90651
Note: Both vaccines have the modifier “SL”, to indicate that they are part of VFC stock.
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// EFFECTS ON CBI
Care Based Incentives (CBI) measures affected
Initial Health Assessment
Bill with correct cross-walked codes: 99381-99385; 99391-99395
Well Adolescent
Bill with correct cross-walked codes: 99384, 99385, 99394, 99395
Well Child
Bill with correct cross-walked codes: 99382, 99383, 99392, 99393
Immunizations: Children Bill with correct vaccine codes and keep registry updated
Immunizations: Adolescent Bill with correct vaccine codes and keep registry updated
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// EFFECTS ON CAPITATION REQUIREMENTS
Reimbursement for CHDP-enrolled providers for complete health assessments are fee-for-service (FFS)
Claim submissions for CHDP services are excluded from the capitation monitoring data extract
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// NEED CLAIMS HELP? Excellent customer service: what you deserve and we
provide! You can reach the Customer Service
line
Monday - Friday from 9 am – 4 pm
831-430-5503 or 800-700-3874
x5503
Our Customer Service Representatives can:
answer your questions
help solve problems and get you on your way
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AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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// RESOURCES – Contact Information
Karen S Jones, MSN, PHN III CHDP Deputy Director County of Santa Cruz
1430 Freedom Blvd. Suite A Watsonville, CA 95076 Phone: (831) 763-8099
Fax: (831) 763-8410
County of Monterey Health Department 1270 Natividad Rd Salinas, CA 93906
Phone: (831) 755-4500 Email: [email protected]
County of Merced Health Department
206 E. 15th St. Merced, CA 95431
Phone: (209) 381-1215 Fax: (209) 381-1215
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CHDP FAQs - http://files.medi-cal.ca.gov/pubsdoco/chdp_faq.asp
CHDP Health Assessment Guidelines - http://www.dhcs.ca.gov/services/chdp/Pages/HAG.aspx
Bright Futures/AAP Preventive Pediatric Schedule - https://www.aap.org/en-us/documents/periodicity_schedule.pdf
Fluoride Varnish - https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/aap-recommends-fluoride-to-prevent-dental-caries.aspx
TB Risk Assessment Guidelines: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/TB-Risk-Assessment.aspx
Child & Adolescent Immunization Schedule: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
// RESOURCES
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General CHDP questions | Please contact your
Provider Relations Representative
Phone: 800-700-3874 ext. 5504
Any coding related questions | Contact Ashli Pickerill
Phone: 831-430-4111
Email: [email protected]
QUESTIONS?