child health and disability prevention (chdp) health ...€¦ · –anticipatory guidance/health...

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

https://www.aap.org/en-us/Documents/periodicity_schedule.pdf





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


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


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)


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


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



Alcohol and Substance Abuse Screening

• Includes assessment of alcohol and substance use

• Screening Tools: CRAFFT


• 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)


• 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


Tuberculosis (TB) Risk Assessment


• 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

http://files.medi-cal.ca.gov/pubsdoco/chdp_faq.asp



http://www.dhcs.ca.gov/services/chdp/Pages/HAG.aspx

http://www.dhcs.ca.gov/services/chdp/Pages/HAG.aspx

https://www.aap.org/en-us/documents/periodicity_schedule.pdf



https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/aap-recommends-fluoride-to-prevent-dental-caries.aspx























https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/TB-Risk-Assessment.aspx






https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html




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?