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Fall Coding Workshop

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Child & Teen Checkups (C&TC) is the name for Minnesota's Early and Periodic ... through the age of 20 who are enrolled in Medical Assistance or MinnesotaCare. ... – PowerPoint PPT presentation

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Title: Fall Coding Workshop


1
Fall Coding Workshop
  • Child and Teen Checkups
  • Facilitated by
  • JoAnne M. Wolf, RHIT, CPC

2
Objectives and Agenda
  • To network with colleagues
  • To obtain a clear understanding of the
    appropriate coding and billing of Child and Teen
    Check-ups
  • To obtain useful tools to improve the CTC rate
    in your practice

3
Sources
  • DHS website www.dhs.state.mn.us
  • MDH website www.health.state.mn.us
  • Dakota County website www.dakotacounty.us
  • Other PMAP Payers
  • www.primewest.org
  • www.UCare.org
  • www.medica.com
  • www.bluecrossmn.org
  • www.healthpartners.com
  • www.mhp4life.org

4
C TC
5
C TC
  • Child Teen Checkups (CTC) is the name for
    Minnesota's Early and Periodic Screening,
    Diagnosis and Treatment (EPSDT) Program.
  • CTC is a comprehensive child health program
    provided to children and teens from newborn
    through the age of 20 who are enrolled in Medical
    Assistance or MinnesotaCare.

6
C TC
  • The purpose of the CTC program is
  • To identify potential health problems or
    handicapping conditions
  • To provide diagnosis and treatment of those
    health problems or conditions and
  • To encourage the development of good health habits

7
Coding for CTC
  • Multiple Components
  • 99381-99395 Preventive Medicine Codes
  • These codes are used to report the preventive
    visit performed for either new or established pt
  • Documentation should include a comprehensive age
    appropriate evaluation and management service
  • The following components should not be billed
    separately are included in the above codes
  • Ht/wt/head circumference measurements, BP,
    history, physical, dental referrals, and
    subjective screens such as hearing, vision,
    developmental and mental health

8
Coding for CTC
  • Anticipatory Guidance Health Education
  • 99401-99404 Ind. Preventive Counseling
  • Age appropriate anticipatory guidance and health
    education must be documented at every visit
  • OK to use ck boxes to indicate the specific items
    discussed (eg, carseats, sunscreen, helmet use,
    etc.)
  • Above codes can be reported in addition to the
    prev visit if 15 min. of counseling is documented
  • Only for CTC
  • Only certain payers will reimburse separately for
    this (BCBS, MHP, Prime West, UCare, and MA)

9
Coding for CTC
  • Developmental Mental Health Screening
  • 96110 Developmental Screening
  • 96110-UC Mental Health Screening
  • These codes may be reported for objective
    developmental and mental health screening (using
    standardized tools) including autism screening
  • If subjective only screening is done, do not use
    these codes (included in preventive visit code)
  • MDH website includes list of recommended
    standardized tools http//www.health.state.mn.us/
    divs/fh/mch/devscrn/
  • Name of the screening instrument used and score
    should be documented if reporting these codes

10
Coding for CTC
  • Q How would you code the developmental and/or
    mental health screen for the following scenario?
  • 3 yr old est pt is seen for a CTC. Provider
    performs a complete HP and assesses the
    patients development and behavior during a
    discussion with the parent. All other components
    of the CTC are also documented.
  • A________________________________________
  • __________________________________________
  • __________________________________________

11
Coding for CTC
  • Q How would you code the developmental and/or
    mental health screen for the following scenario?
  • 2 yr old est pt is seen for a CTC. Provider
    performs a complete HP and assesses the
    patients development using the Denver
    Developmental test and the patients risk for
    autism using the M-CHAT.
  • A________________________________________
  • __________________________________________
  • __________________________________________

12
Coding for CTC
  • Immunizations / Review
  • 90465-90468 Imm Admin w/MD counseling
  • 90471-90474 Imm Admin w/out MD counseling
  • Report administration using codes above according
    to method or route (eg, injection vs. oral/nasal)
    and whether provider counseling was documented
  • Initial or first vaccine codes
  • 90465, 90467, 90471, or 90473
  • Use only one of these codes per day
  • Subsequent or additional vaccine codes
  • 90466, 90468, 90472, or 90474

13
Coding for CTC
  • Immunizations / Review
  • Q How would you code for the immunization
    administration for the following scenario
  • Provider provides counseling for the following
    vaccines being administered to a 4 month-old
    during a CTC (DTaP, rotovirus, IPV, PCV-7 and
    Hep B/Hib).
  • A________________________________________
  • __________________________________________
  • __________________________________________

14
Coding for CTC
  • Immunizations / Review cont.
  • Most vaccines required are part of the MnVFC
    program and are available free through the state
  • Append modifier SL to appropriate CPT code for
    vaccine (eg, 90715-SL) w/ .00 or .01 charge
  • Also report the administration codes
  • Documentation must show that the childs
    immunization status was reviewed
  • If immunizations were due, but not given,
    documentation must show the reason(s) why

15
Coding for CTC
  • Immunizations / Review cont.
  • New Vaccines See Attachment
  • Rotavirus (ROTARIX) GlaxoSmithKline (GSK)
  • CPT code 90681
  • Administered orally at 2 and 4 months of age
  • DTaP/IPV (KINRIX) GlaxoSmithKline (GSK)
  • CPT code 90696
  • Administered at 4 to 6 years of age
  • HPV (Cervarix) GlaxoSmithKline (GSK)
  • CPT code 90650

16
Coding for CTC
  • Screening Laboratory Tests
  • 83655 Blood Lead
  • 84030 Newborn metabolic (PKU)
  • 81000-81015 Urinalysis
  • 85013-85025 Hemoglobin/Hematocrit
  • Other tests as indicated (cholesterol, STD, TB,
    etc)
  • Documentation should include an order for the
    test and the result

17
Coding for CTC
  • Screening Laboratory Tests cont.
  • If test performed at an outside lab, clinic can
    still bill for test (recommended for lead)
  • When submitting claims for outside lab to MA and
    the PMAP plans be sure to include
  • the lab's provider number in box 24K on the
    CMS-1500 or Rendering Provider Number field in
    MN-ITS,
  • place of service 81 (independent lab), and
  • the claim line must include the lab procedure
    code with modifier -90

18
Coding for CTC
  • Vision Screening
  • 99173 Vision Screen
  • Use this code to report objective screen when
    visual acuity measurements are documented in
    chart (eg, Snellen chart)
  • Objective screening is required at age 3 yrs
  • Subjective screening for younger children (under
    age 3) is included in the preventive E/M codes

19
Coding for CTC
  • Hearing Screening
  • 92551 or V5008 Audiometry
  • Either of these codes can be used if simple
    puretone audiometry results are documented
  • Newborn screening recommended (AABR or OAE)
  • 92586 for AABR 92587 for OAE
  • Objective screening is required at age 3 yrs
  • Subjective screening is included in the
    preventive E/M codes

20
Coding for CTC
  • Dental Referral
  • Dental Referrals
  • Documentation of a dental referral is required
    for all CTC visits beginning at age 3 or earlier
    if indicated
  • Fluoride Varnish Application (not required)
  • D1206 Topical fluoride varnish application
  • Documentation should indicate that varnish was
    applied
  • Allows for additional reimbursement
  • MA Fee schedule 14.00

21
Coding for CTC
  • V20.2 Routine infant or child health check
  • Recommend using V20.2 for the primary dx on the
    claim regardless of the age of the patient
  • Some healthplans have an edit for CTC claims
    requiring the V20.2

22
Billing for CTC
  • The appropriate alpha referral code must be used
    on the claim in box 24 H next to each procedure
    code on the claim related to the CTC
  • NU No referral made
  • ST Referral to another provider for diagnostic or
    corrective treatment, scheduled for another
    appointment for at least one health problem
    identified during an initial or periodic
    screening service (does not include dental ref)
  • S2 Patient is currently under treatment for
    referred diagnostic or corrective health problem
  • AV Patient refused referral

23
Billing for CTC
  • Alpha Referral Codes Examples
  • No referral made for any services.Use NU
  • No referral made for some services but referral
  • made for other services.. Use ST
  • When more than one referral is made Use
    ST
  • No referral made, but patient is currently
  • under treatment for an existing condition.
    Use S2
  • When 1 or more referrals are made and pt
  • refused 1 or more of the referrals. Use
    AV
  • When above situation is present AND the pt is
  • currently under treatment for an existing
    condition.. Use AV
  • When a verbal prev. dental referral is given.
    Use NU

24
Billing for CTC
  • For the alpha referral codes, the same 2-digit
    code must be used on all lines of the claim (even
    if more than one referral code situation exists)

25
Billing for CTC
  • S0302 Completed EPSDT service
  • Bill this code in addition to other codes when a
    complete CTC is performed for all carriers
    except for DHS
  • If this code is submitted to DHS, the entire
    claim will deny
  • UPDATE
  • As of 3/1/08, CTC providers can use S0302 on
    their CTC claims to DHS
  • When submitting informational only code S0302 to
    DHS only use a 0.00 charge

26
Billing for CTC
  • S0302 Completed EPSDT service
  • Addtl reimbursement for a complete CTC will be
    made on this code for PMAP carriers
  • If all components are reported to DHS, lump
    payment will be made for a complete CTC

27
Billing for CTC
  • If components of a CTC are provided on more than
    one date of service, all components must be
    billed together on the same claim form
  • If non-CTC services are performed at a CTC,
    those services should not be billed on the same
    claim form as the CTC

28
Billing for CTC
  • Q If only one component was not completed and
    documented, can we still report the visit as a
    complete CTC?
  • A_______________________________________
  • _________________________________________
  • _________________________________________

29
Billing for CTC
  • If all required components are not completed and
    documented, the service cannot be reported as a
    complete CTC
  • 3 Exceptions
  • Child is restless and uncooperative
  • A true precaution or contraindication to
    providing the component
  • Parent or guardian refusal of a component
  • Reason why the component could not be completed
    must be documented

30
Billing for CTC
  • BCBS, HP, MHP, Prime West and UCare allow for the
    unsuccessful attempt to still be billed as if it
    were completed
  • Medica does not allow for billing of the
    unsuccessful attempt unless some result was
    accomplished
  • Use modifier 52

31
CTC Challenges / Solutions
  • Identification of eligible patients
  • Language barriers
  • Transient population
  • Urgent care use / no primary care clinic
  • Lead Screens
  • Lab not on site and patients often do not show
    for outside blood draw
  • Some reference labs do not bill for the test
  • Obvious differences in payer billing requirements
  • This is becoming less of a problem (AUC)

32
CTC Challenges / Solutions
  • Identification of eligible patients
  • Make sure front desk staff are familiar with the
    ID numbers of eligible patients with PMAP
    coverage
  • Have front desk staff check for eligibility
    regularly
  • Issues with Somali population (DOB, names)

33
CTC Challenges / Solutions
  • Language barriers
  • It is important to have professional interpreters
    at clinic visits when there is a language barrier
  • Patients who are eligible for CTC have coverage
    for interpreter services during health care
    appointments regardless if they are on
    fee-for-service through DHS or have PMAP coverage

34
CTC Challenges / Solutions
  • Transient population/Urgent care use/
    No primary care clinic
  • One way to reduce incorrect, outdated pt contact
    info is to verify this info at every visit
  • Place emphasis on the benefits/use of preventive
    care

35
CTC Challenges / Solutions
  • Transient population/Urgent care use/
    No primary care clinic cont.
  • Complete the CTC when the pt presents for an ill
    visit (difficult to do)
  • Flag charts for patients overdue for CTC
  • Use data provided by PMAP healthplans
  • When patients are calling to schedule an ill
    visit, check whether patient is due for a checkup
    (chart or patient account could already be
    flagged) and allow additional time slot get the
    CTC done at the ill visit

36
CTC Challenges / Solutions
  • Lead screens
  • Must be done at 12 and 24 months
  • Providers should be encouraged to think blood
    lead at all CTC visits from age 9 mo 5 yrs
  • Provide Lead brochures (available on the DHS
    website www.health.state.mn.us) which outlines
    the risk that this population is exposed
  • The clinic can do the blood draw and mail the
    blood sample to a certified lab eliminating the
    risk of a no-show at an outside lab
  • Highly recommend that the clinic bill for the
    blood lead sent to an outside lab
  • Report 83655 with the 90 modifier to indicate
    that the test was performed at a reference lab

37
CTC Challenges / Solutions
  • Differences in payer billing requirements
  • Utilize a separate billing form for CTC which
    includes codes for all components and alpha
    referral codes
  • Allow for manual or special billing processes
  • Becoming less of a problem (AUC)
  • Be aware of billing differences in your denial
    management processes

38
CTC Challenges / Solutions
  • Sharing of other solutions that clinics have
    tried and have found to be successful

39
JoAnne M. Wolf, RHIT, CPCCoding Manager
  • Coding Consultation Services
  • (612) 813-5972
  • Joanne.Wolf_at_ChildrensMN.org
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