child health and disability prevention (chdp) health
TRANSCRIPT
Presented by: Ashli Pickerill | Coding Resource Specialist
Quality Improvement
CHILD HEALTH AND DISABILITY PREVENTION (CHDP)
Health Assessment Guidelines
AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
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
AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
// 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
AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
// 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
// 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
// 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
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
// 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
// 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)
// 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
// 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
// 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
// COMPLETE HEALTH ASSESSMENT –IMMUNIZATIONS CHILDREN (BIRTH TO 15 MONTHS)
// COMPLETE HEALTH ASSESSMENT –IMMUNIZATIONS CHILDREN (18 MONTHS – 18 YEARS)
*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)
// 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
California TB Risk Assessment: Pediatrics
// COMPLETE HEALTH ASSESSMENT - SCREENINGS
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
// 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+
// 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
AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
• 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
// 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
// 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.
// 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
// 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
// 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
AGENDA
WHAT IS CHDP?
WELL CHILD VISIT
GUIDELINES
CODING AND CLAIMS
RECOMMENDATIONS
RESOURCES
// 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
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
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?