Preventive Services

1. Preventive Services From Well Baby to Geriatric Assessments Creating Value Before You Identify a Problem Documentation that insurers will pay for

2. Learning Objectives • What the frame of a Preventive Service visit includes & excludes • What insurers want to see documented • Content of GTFC Preventive Service paper templates • How to document Preventive Services in ezSOAP • Documentation of “separate identifiable services” • Practice over next month

3. Defining Preventive Services • Age/gender specific history & exam to detect asymptomatic disease • Counseling for all recommended screening tests and immunizations – order/referral if appropriate • Review of Symptoms • Monitoring of controlled conditions that do not require additional service, e.g. Mild osteoarthritis doing well with regular exercise and acetaminophen • Identification, patient education, and plan for newly recognized “insignificant or trivial” problems not requiring additional work • Counseling for risk reduction

4. Defining “Separate Identifiable Services” • “significant enough to require additional work to perform the key components of . . . an E/M service” • Examples • Detection of new problem requiring Rx • Evaluation of new problem requiring testing (not included in age/gender preventive services) & follow up • Renewal of Rxes for chronic condition(s) at target • Change of Rxes for chronic condition not at target

5. What to document? • Visit if for purpose of primary prevention – even if that is not the first CC patient gives! • Status of all recommended services – all that are “due” are either done, counseled for, or ordered • ROS, PFSH update • Age/gender exam to detect asymptomatic disease • List of insignificant and trivial diagnoses as well as chronic at target diagnoses • Counseling done • Plan for F/U of other important conditions

6. What do we use at GTFC? • Missouri’s “Healthy Children & Youth Screening Guide” • Expert Panel – doesn’t distinguish strength of evidence • Supplemented by “Denver PDQ” developmental screens through age 5 • Must be used for all Missouri Medicaid patients per age • Adult prevention flow sheets “based upon US Preventive Services Task Force recommendations through March, 2003”

7. Documenting Prevention in ezSOAP • Good to document Chief Complaint: Prevention although other phrases, Well Child, Annual, Well Woman are acceptable • Document recommended services covered per check list • ROS, PFSH must be recorded • PE – Note CMS requirements for details of female exam are in Normal check lists. • Naked diagnoses acceptable • Must document counseling & follow up!

8. Documentation of “Separate Identifiable Services” • Complete documentation of Preventive history first • New Chief Complaint(s) & HPI(s) • Physical exam does not have to be separated out! • Separate Assessments – must not be “naked” • It helps to double-space after Preventive Plan to make it clear what the MDM of the Separate Identifiable Service is.

9. Practice for next month • Make sure you use all the documentation forms provided for each young Medicaid Well Child visit • Document others in ezSOAP • Reflect on strengths and weaknesses of each approach to documentation • Document appropriately separately identifiable services, even if that insurance does not permit billing them.