SM www.bluechoicescmedicaid.com Volume 3, Issue 5 June 2015 Behavioral Pediatric Screening Clinical recommendations, as well as behavioral pediatric screening best practices, indicate that you should administer standardized screenings during Early Periodic Screening, Diagnosis and Treatment (EPSDT) visits as clinical need dictates. This aligns the American Academy of Pediatrics (AAP s) recommendations on screening and age-appropriate development, children s mental health and adolescents in primary care settings. AAP is an independent organization that provides health information on behalf of BlueChoice HealthPlan. Effective January 1, 2015, the South Carolina Department of Health and Human Services (SCDHHS) added current procedural terminology (CPT) code 96127 to break out the services of emotional and behavioral assessments from developmental screenings you report with CPT code 96110. Use CPT code 96110 to report standardized screenings that identify childhood and adolescent developmental levels. A general screening is recommended with follow-up screenings, as needed. This code is limited to two times per date of service for children up to age 18. Documentation must include a copy of the completed screen with the score, as well as documentation per instrument screening tool. Covered standardized screening instruments for CPT code 96110 include but are not limited to: o Ages and Stages, 3 rd Edition o Parents Evaluation of Developmental Status o Modified Checklist of Autism in Toddlers Use CPT code 96127 to report a standardized instrument to assess the patient s emotional and/or behavioral health. A general screening is recommended with follow-up screenings, as needed. This code is limited to four times per date of service for children up to age 18. Documentation must include a copy of the completed screen, scoring and documentation per standardized instrument. Covered standardized screening instruments for CPT code 96127 include but are not limited to: o Ages and Stages Questionnaire: Social Emotional o Pediatric Symptom Checklist or Pediatric Symptom Checklist Youth Report o Modified Patient Health Questionnaire o Self-report for Childhood Anxiety-Related Emotional Disorders o Vanderbilt Diagnostic Rating Scale
Reimbursement Rates for Behavioral Screenings 2015 Codes Description Unit/Frequency Rates 96110 Developmental screening with scoring and documentation per standardized instrument Up to two times per date of service for up to age 18 $7.11 96127 Brief emotional/behavioral assessment with scoring and documentation, per standardized instrument Up to four times per date of service for up to age 18 $7.11 Well-Child Visits: Children 0-15 Months Old This Healthcare Effectiveness Data and Information Set (HEDIS) measure illustrates the percentage of patients who turned 15 months old during the measurement year. In addition, these patients completed at least six well-child visits with a PCP during the measurement time frame. Record your efforts Follow the AAP s Bright Futures Recommendations for Preventive Pediatric Health Care periodicity schedule for well-child visits and services per your state s guidelines. Document each well-child visit in the member s medical record. Complete all six well-child visits by 15 months of life. Make sure your medical records include: o Six well-child visits with a PCP, completed at least two weeks apart o A medical history o Physical and mental developmental histories o A physical exam o Health education and anticipatory guidance Code your services correctly Use these diagnosis and procedure codes to document comprehensive well-child visits: CPT MOD ICD-9-CM Diagnosis 99381, 99382, 99391, 99392, 99461 V20.2, V20.3X, V70.0, V70.3, V70.5, V70.6 If you encounter abnormalities or address a pre-existing problem during a well-child visit and the problem/abnormality is significant enough to require additional work to perform the key components of problem-oriented Evaluation and Management (E&M) services, be sure to bill both the appropriate EPSDT visit code and the appropriate E&M code with modifiers SEP and 25. The codes listed here are for informational purposes only. This information does not guarantee reimbursement. 2
Helpful tips Use your BlueChoice HealthPlan Medicaid member roster to contact patients who are due for an exam or those who are new to your practice. Ask your Provider Relations representative about Gaps in Care reports. Schedule the patient s next visit at the end of his or her appointment. If you use electronic health records (EHRs), consider creating a flag to track patients due or past due for a visit. If you do not use EHRs, consider creating a manual tracking method. Sick visits may be a missed opportunity for your patients to receive a wellness exam. Consider extending your office hours into the evening, early morning or the weekend. G-Code Missed Opportunities The blue bar appearing in this bar graph represents the amount of G-code (G-8496) incentive dollars that were available to all eligible practices during March 2015. The red bar indicates those dollars that were NOT claimed in March 2015 (approximately $25,000). Be sure to file your G-code. If you forgot, you can still take advantage of this. Provider Engagement Program (PEP) PEP is a collaborative effort between BlueChoice HealthPlan Medicaid s Provider Services and Community Outreach departments. Now through December 31, 2015, PEP will engage providers and build membership within target practices. Each month, we will select two provider groups in each region of South Carolina. We will visit those offices and explain in detail what we offer, such as health fairs, wellness days, seasonal festivals and holiday celebrations. Our outreach specialists are also available to talk with members and can set up an outreach table in your waiting area. 3
International Classification of Disease Tenth Revision (ICD-10) Test Site Many providers have asked to test claims in preparation for the October 1, 2015, implementation of ICD-10. If you are interested in this, additional information can be found at: http://www.bluechoicescmedicaid.com/providers/resources/icd10. Infant Car Seat Program BlueChoice HealthPlan Medicaid offers its members a variety of extra benefits, and our car seat program is the most recent one. We know parents are concerned with their children s safety, and we want to help relieve some of that stress. BlueChoice HealthPlan Medicaid members who are expectant mothers now have an opportunity to qualify for a convertible car seat at no cost to them. The available car seats include: Rear-facing car seat for infants ranging from 5-35 pounds Forward-facing car seat for children ranging from 20-40 pounds Successful test ratings for side impacts Four different harness heights, which include a two-piece chest clip, up-front harness adjustment and removable padded-fabric pad Please contact our Customer Care Center at 1-866-781-5094 (TTY: 1-866-773-9634) to request additional information about our car seat program or to request a voucher. 4
Improving Outcomes for Moms and Babies Screening Brief Intervention and Referral to Treatment (SBIRT) is an evidenced-based, integrated and comprehensive approach to the screening, identification, intervention, and treatment of substance abuse (drug and alcohol), domestic violence, depression and smoking. SCDHHS leads the South Carolina SBIRT program. This program targets pregnant and post-partum women and provides a universal approach to early identification and referral for this population. A trained clinician performs SBIRT, which can include a medical doctor, nurse practitioner, physician s assistant, medical advisor, registered nurse or nurse midwife. During the screening, he or she asks the patient eight yes-or-no behavioral health questions, which should take less than five minutes to complete. Document the patient s responses on the SBIRT Integrated Screening Tool form. If the clinician identifies the patient as having a behavioral health problem, the clinician can initiate a brief intervention, which is a 10-minute consultation most often facilitated when using motivational interviewing. Screening results may provide an indication that you should refer the patient for more comprehensive treatment. Then use SBIRT form as a referral and flag to facilitate timely appointments for women who need treatment. These partnering agencies provide treatment: South Carolina Department of Alcohol and Other Drug Abuse Services South Carolina Department of Health and Environmental Control Tobacco Quitline South Carolina Department of Mental Health Domestic Violence Hotline Instructions for billing for SBIRT SBIRT is reimbursable to only OB/GYN physicians. H0002 Billed for completion of screening and reimburses at a $24 rate, once per fiscal year. H0004 Billed for completion of a brief intervention and reimburses at a $48 rate, twice per fiscal year. Effective July 1, 2014, SCDHHS added the HD modifier to the SBIRT codes in these scenarios to set more accurate reporting of the initiative. PROCEDURE Screening POSITIVE SCREEN Brief Intervention BRIEFT INTERVENTION RESULTING IN A REFERRAL CODE H0002 H0002 HD MODIFIER H0004 H0004 HD MODIFIER For more information on the SBIRT program: Contact Allison Lukacic, SBIRT Program Manager, at lukacic@scdhhs.gov or visit the SBIRT webpage at scdhhs.gov/organizations/screening-brief-intervention-and-referral-treatment-sbirt 5
New Website On The Way BlueChoice HealthPlan Medicaid is in the preliminary stage of planning a redesign of our current website, and we need help from our provider community! Our provider relations representatives distributed a website questionnaire during their monthly visits to provider offices throughout South Carolina and through e-blast. We want to know what you think about our current website and any recommendations you might have for our new website. Your comments will help us as we plan our new website. Please continue to send us your website-related feedback by contacting your provider relations representative, or feel free to send your comments to bluechoicehealthplanmedicaid@bcbssc.com. Events Update Date of Event: June 27, 2015 Time: 8 a.m. - 12 p.m. Name of Site/Event: Eat Smart Move More SC - Farmers Market Day Detail of Activities: BlueChoice HealthPlan Medicaid will foster key partnerships within the community to ensure individuals attending the event will gain health, nutrition, wellness and resource information and receive giveaways all in an interactive, fun, festive and safe environment. Location: 200 South Public Square, Laurens, SC 29360 Repack the Back Pack was a huge event with over 500 backpacks distributed. 6
Body Mass Index (BMI) and Obesity: Tips and Tools for Tackling a Growing Issue For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called BMI. BMI is used for most adults since it correlates with an individual s amount of body fat. BMI does not directly measure body fat, however instead, it gives ranges of weight that show what is generally considered healthy for a given height. Correct coding for weight-related conditions and BMI is important since these conditions have a profound effect on patients health. Obesity diagnosis codes are located in the Endocrine, Nutritional and Metabolic Diseases chapter of ICD-9-CM. Apply the codes when documentation supports a clinical diagnosis from physician documentation. A coding instructional note listed with subcategories 278.0x and 782.3x state to code BMI using codes V85.0-V85.54. Assign both the clinical diagnosis and the BMI on your claim. ICD-9 coding guidelines define morbid obesity as BMI greater than 40. Table 1.0 displays the ranges for adult BMI in relation to the corresponding clinical diagnosis per Centers for Disease Control and Prevention (CDC). We also listed the ICD-9 code for weight-related diagnosis. The CDC is an independent organization that provides health information on behalf of BlueChoice HealthPlan. Weight-Related Diagnosis per CDC Adult BMI ranges per CDC ICD-9 Diagnosis Code BMI Code Underweight Less than 18 percent 783.22 V85.0 Healthy Weight 18.5-24.9 percent No dx code V85.0-V85.1 Overweight 25.0-29.9 percent 278.02 V85.2x Obesity 30.0-39.9 percent 278.00 V85.3x Morbid Obesity 40 percent or more 278.01 V85.4x A child s weight status is detemined by using an age- and sex-specific percentile for BMI rather than the BMI categories used for adults since a child s body composition varies based on age and gender. BMI for pediatrics 2-20 years of age is based on the growth charts the CDC publishes. The list shows pediatric BMI in relation to the corresponding clinical diagnosis: BMI Less than fifth Underweight BMI Fifth-less than 85th Healthy weight BMI 85th-less than 95th Overweight BMI At or above 95th Obesity 7
AX-400-Co1 P.O. Box 6170 Columbia SC 29260-6170 PRSRT STD US POSTAGE PAID PERMIT NO 1240 COLUMBIA SC BlueChoice HealthPlan and BlueCross BlueShield of South Carolina are independent licensees of the Blue Cross and Blue Shield Association. Healthy Connections is administered for BlueChoice HealthPlan by WellPoint Partnership Plan LLC, an independent company. Some links in this newsletter lead to third party sites. They are solely responsible for the content and privacy policies on these sites. In this issue Page 1 Behavioral Pediatric Screening Page 2-3 Well-Child Visits: Children 0-15 Months Old G-Code Missed Opportunities Provider Engagement Program (PEP) Page 4-5 ICD-10 Test Site Infant Car Seat Program Improving Outcomes for Moms and Babies Page 6-7 New Website on the Way Events Update Body Mass Index and Obesity: Tips and Tools for Tackling a Growing Issue 17270