Title: Annual Wellness Exam EPSDT
1Annual Wellness ExamEPSDT
- Paula LeSueur MSN, CFNP
- SBHC Medicaid Consultant
- Envision NM
- 2007
2EPSDT Early Periodic Screening, Diagnosis and
Treatment
- Objectives for our SBHCs
- Provide comprehensive preventive health care.
- Identify students assets, risk behaviors and
health risks.
3Components 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.
4Preventive 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).
5Developmental/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.
6Sensory 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.
7Physical 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.
8Lab 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.
9 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.
10High 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.
11High 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.
12High 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.
13Immunizations
- 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).
14Procedure 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?
15Procedures, 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.
16Procedures, 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.
17Encounter Form/ Billing form
18Coding
- 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.
19Notification
- 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.
20Documentation 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.
21Medical 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.
22Strategies
- 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.
23Strategies
- 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.