Annual Wellness Exam EPSDT

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Annual Wellness ExamEPSDT

• Paula LeSueur MSN, CFNP
• SBHC Medicaid Consultant
• Envision NM
• 2007

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EPSDT Early Periodic Screening, Diagnosis and
Treatment

• Objectives for our SBHCs
• Provide comprehensive preventive health care.
• Identify students assets, risk behaviors and
  health risks.

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Components of Complete EPSDT Screen

• A comprehensive health and developmental history,
  including an assessment of both physical and
  mental health development.
• A comprehensive, unclothed physical exam.
• Appropriate immunizations, according to age and
  health history, unless medically contraindicated
  at the time.
• Laboratory tests, including an appropriate lead
  blood level assessment (at 1 and 2 yrs of age).
• Health education, including anticipatory guidance.

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Preventive Health Guidelines for Children and
Adolescents

• EPSDT recommended every year from birth to age
  20.
• Physical exam and developmental / behavioral
  health assessment.
• Nutrition screening.
• Measurements include ht, wt, BMI percentile, and
  blood pressure (from age 2 to 20).

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Developmental/Behavioral Health Assessment

• Utilize the Recommended Developmental and
  Behavioral Health Assessment for ages birth to 21
  (HEADSS).
• The OSAH Student Health Questionnaire provides
  the required information. Use appropriate SHQ
  for Elementary School, Middle School or High
  School.

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Sensory Screening

• VisionSnellen eye chart
• at age 3 through age 12,15 18.
• Hearing/speech
• at age 4 through age 12, 15 18.
• use audiometer, under earphones, at 1000, 2000
  and 4000 Hertz at 20 decibels.

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Physical Exam includes

• Complete unclothed physical exam.
• External genital exam and Tanner staging is
  required. Document in chart if student declines
  the exam (e.g. deferred at patient request).
  Tanner staging may be done by self report.
• Provide education re testicular and breast
  self-exam as appropriate.

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Lab Screenings

• Urinalysis - to be performed at age 5 and 15.
  May use Chemstrip 9.
• Hematocrit/hemoglobin - to be done at 9 months
  and age 13. If indicated, may repeat after
  menarche in females.

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High Risk Factor Screenings

• Tuberculin Test -
• Screen all teens for high-risk factors.
• Test if high individual risk.
• Risk factors include immigration or travel to
  areas of high prevalence, IV drug use,
  incarceration, homelessness, HIV infection or
  living with person with HIV, working or
  volunteering in health care setting.

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High Risk Factor Screenings

• Pelvic exam -
• To be done with all sexually active females, with
  their consent, or initial exam at age 18 to 21.
• DOH Family Planning Division protocol states
  pelvic exam should be performed within 6 months
  of contraceptive use and PAP test should be
  performed after 3 years of sexual activity or age
  21, whichever comes first.
• May complete the GYN or FP exam and schedule a
  return visit for the remainder of the EPSDT.

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High Risk Factor Screenings

• STD Screen all sexually active youth
• Urine chlamydia/gonorrhea .
• HIV test if high risk- positive contact with
  known partner at risk, past STDs, multiple
  partners, IV drug use or sex in exchange for
  money or drugs.
• For males sex with other males.
• For syphilis only test if reside in areas of
  prevalence. NM is not in an area of prevalence.

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High Risk Factor Screenings

• Cholesterol -
• Perform or refer for the test if high risk.
• Testing is based on individual risk,i.e.
  familial hyperlipidemia, family history of early
  onset of cardiovascular disease in parents or
  grandparents at age 55 or less, obesity,
  diabetes, high blood pressure or cigarette
  smoker.

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Immunizations

• Tetanus Booster - Tdap done between ages 12-15.
  Required for 7th grade entry for 2007-08.
• MMR, varicella and HepA - assess, give if
  indicated and not previously given.
• HepB - series should be completed in early
  childhood or by 7th grade.
• Influenza for high risk groups.
• HPV (3 doses).
• Immunizations should be given according to the
  most current Advisory Committee of Immunization
  Practice (ACIP) schedule. (www.cdc.gov/nip).

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Procedure for SBHCs (how to make appointments)

• Who are the students served?
• Means test what is the screening question?
• Do you have a PCP?
• Have you had a physical exam within the past
  year?
• Will you need a sports physical exam (SPE) some
  time this year?

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Procedures, cont.

• Who and when will EPSDTs be scheduled? Who will
  do vital signs, ht., wt., BMI and lab tests?
  Who does the exam, the counseling and the
  education?
• Instruct student to be prepared for unclothed
  exam, come wearing t-shirt and gym shorts or
  boxers. Have gowns or drapes.
• Student to complete Student Health Question-naire
  for the Annual EPSDT and present the health
  history form for the SPE, if needed.

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Procedures, cont.

• Schedule annual exam (EPSDT) in SBHC for all
  students registered who have a signed parent
  consent form.
• Include components of Sports Physical and
  complete form, if needed.
• Complete EPSDT, submit claim to Salud if an
  approved Medicaid-SBHC provider.
• Provide referrals for lab tests or procedures as
  necessary. Document referral.

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Encounter Form/ Billing form
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Coding

• Schedule return visit for STD/Family Planning
  services. Use EM code, as indicated.
• Reminder - If student refuses genital or any
  other part of the exam, including screening
  tests, document and state reason.
• Chaperone may be required for genital exam of the
  opposite sex, which should be allowed upon
  student request.

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Notification

• Inform parents of results of the exam, including
  any screening tests or lab results, except
  confidential information. Present results per
  phone or written report.
• Notify Primary Care Provider that Annual
  Exam/EPSDT was performed by use of the New Mexico
  SBHC Services Notification Form. Include any
  pertinent findings.
• Schedule follow-up appointments for confidential,
  behavioral health or other health care services.

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Documentation to support billing

• ICD-9 code is V20.2 for youth to age 17.
• ICD-9 code is V70.0 for youth 18 or older.
• Use of Modifier 25
• When the principal reason for the visit is an
  EPSDT and during the visit another separate
  identifiable health condition requires additional
  evaluation and management above and beyond the
  other service, then a 25 modifier can be attached
  to the secondary CPT.

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Medical Chart Documentation

• No required state forms, but documentation must
  be an auditable form (a single sheet) in the
  medical chart.
• Recommend use of OSAH Progress notes for
  elementary, middle or high school students.

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Strategies

• Perform Sports Physicals and then provide the
  remainder of the EPSDT during a scheduled
  appointment at the SBHC, in a timely manner.
• Perform Family Planning/STD screening exams and
  then reschedule for the remainder of the EPSDT
  visit.

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Strategies

• Attend team/parent meetings to provide
  information about the annual exam and sports
  physicals.
• Meet with School Athletic Department to schedule
  appointments in conjunction with their needs.
• Routinely schedule EPSDTs - e.g., first
  appointment of the morning or the afternoon.