BCCCP MBCIS Data Webinar. December 7, 2010

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1 BCCCP MBCIS Data Webinar December 7,

2 Featuring Ann Garvin, MS, CNM EJ Siegl, MA, OCN, RN Susan Harris, Ph. D. Cathy Blaze 2

3 Objectives 1. Describe how to document the different types of screening and diagnostic services delivered to program women based on the exam result and work-up plan. 2. Identify 1 example for each of the three exam types (screening, follow-up, surveillance) that are used in documenting program services in MBCIS. 3. Describe at least two unusual circumstances that require specific documentation and/or notification of nurse consultants for providing program services that deviate from the medical protocol. 3

4 Types of Office Visits Annual Screening Office Visit Follow-up Office Visit Breast or Cervical Consult Visit 4

5 Annual Screening Office Visit Purpose: Provide screening services (Clinical Breast Exam (CBE), Pap test (if indicated), Pelvic Exam) to identify a potential breast or cervical problem Scheduled > 365 days from date of last screening Does NOT have to be the same time every year Dates can be extended by a few months if results are normal from previous screening and caseload constraints prevent the woman from enrolling 5

6 Annual Screening Office Visit cont. Office Visits (annual and follow-up) are ALWAYS tied to a service: CBE, Follow-up CBE, Pap test, Follow-up Pap Test, Pelvic Exam Annual screenings are documented as OFFICE Visits (Full or Partial) depending on exams/tests performed. 6

7 Follow-up Office Visits Purpose: Examine the client with an identified breast or cervical abnormality post procedure or post imaging exam Type of visit documented depends on procedures performed Usually coded as partial office visit (follow-up is problem related) Scheduled when needed (some limitations apply as to # of visits, and type of monitoring required) 7

8 Breast or Cervical Consults Purpose: Examine the client with a NEW breast or cervical abnormality based on screening test results to determine appropriate diagnostic testing OR Examine a client post procedure for possible complications 8

9 Documenting Office Visits in MBCIS Annual/Follow-up Office Visits: Partial Office Visit (OV) CBE OR Pap and/or Pelvic (one body part examined) Full OV CBE AND Pap and/or Pelvic (both breast and cervical (2) body parts examined) Follow-up Office Visit entered as either a partial or full office visit following the rules above 9

10 Documenting Consults in MBCIS Breast/Cervical Consults: Billing: Consults CANNOT be billed!! Clinical: If client referred for consult; document the appropriate consult (BREAST or CERVICAL) in MBCIS Consultations are for data entry only, these codes are no longer approved BCCCP codes 10

11 Data Documentation in MBCIS Basic Data Entry Issues Opening/closing cycles based on visit type Enrollment dates Referral dates 11

12 Basic Data Entry Issues No extra spaces, hyphens, or other special characters in any of the data entry text boxes (i.e. Names, Comments, etc.) 12

13 Opening/Closing Cycles Based on Visit Type Open initial cycle for new clients (never screened in program previously) Open anniversary cycle for clients returning for annual screening Open anniversary cycle for clients returning for follow up of new abnormality prior to annual screening 13

14 Enrollment Dates Date the client was enrolled or re-enrolled in the program (i.e. date eligibility information obtained or date woman completed enrollment paperwork) It does not need to match the first date of service This date can be the same as or before the client s first screening service date The enrollment date cannot be after the first date of service 14

15 Referral Dates Date a client was referred by a non-bcccp provider to the program; OR Date that client was first seen by the program To ensure timeliness of care, date of non BCCCP service should not be used as the referral date Document the referral date on the service summary screen 15

16 Exam Types Screening Follow-up/Diagnostic Surveillance 16

17 Screening Exams Performed ONCE yearly NEW CYCLE always opened for screening exams Are NOT a follow-up exam that is monitoring a previously identified abnormality Includes the following EXAM types: CBE, Mammogram-Screening (OR Diagnostic-depending on history) Pap test, Pelvic Exam Office Visit Type: Full (CBE and Pap/Pelvic) or Partial (CBE OR Pap/Pelvic) CAD is not a payable procedure 17

18 Follow-up Clinical Exams Clinical Exam Types: Follow-up Pap Tests performed > 6 months post screening Pap test or post cervical biopsy Follow-up CBE - performed > 2 months from screening CBE Follow-up exams are linked with PARTIAL Office Visits (unless both breast and cervical body parts are examined) 18

19 Follow-up Diagnostic Exams cont. Diagnostic Mammograms A True Diagnostic Mammogram is performed: Post screening mammogram result of ACR 0 - Additional Work-up Required 6 months post ACR 3 - Probably Benign Immediately Post breast biopsy to evaluate clip or wire placement > 2 months post breast biopsy to evaluate status of abnormality 19

20 Other Diagnostic Exams Include the following BCCCP reimbursed services Ultrasound Colposcopy ANY type of Breast or Cervical Biopsy Post biopsy mammogram/clip placement Non-BCCCP Reimbursed services MRI s, Ductograms, etc. Any diagnostic service that determines a final diagnosis 20

21 Surveillance Exams Two types: Mammogram Surveillance and Pap Surveillance Used to distinguish abnormal result requiring follow-up Enter as FIRST exam in a new cycle Surveillance exams are NEVER entered as followup exams in current cycle 21

22 Additional Information Appropriate funding (Federal, State, Non-BCCCP, Other) based on referral source and exam type Most exams should be coded as Funding Federal Screening Mammograms for yr olds should be coded as Funding State Services provided outside of the program should be coded as Funding Non-BCCCP Repeat exams (Mammograms, Pap Tests) Repeat exams are screening exams that have an initial unsatisfactory result the image or labs could not be read properly. The initial exam is coded as unsatisfactory, the second screening exam should be coded as repeat. 22

23 Documenting Follow-up Services Follow-up CBE, Follow-up Pap test, Diagnostic Mammogram Diagnostic LEEP, Diagnostic Cone, Endometrial Biopsy (EMB) 23

24 Documenting Follow-up Exams Documentation Guidelines Normal/benign results requiring no follow-up or short-term follow-up Document in the SAME cycle as screening exams Abnormal results requiring immediate follow-up Open a NEW cycle in MBCIS Code abnormality as Mamm / Pap Surveillance 24

25 Follow-up Pap Test (same for F/U CBE) 25

26 Documenting Follow-up Services: Breast Breast Biopsy (inclusive category) covers ALL BCCCP reimbursed biopsies Ultrasound (US) Diagnostic Mammogram New Exam type: Post Biopsy Mammogram/Clip Placement Appropriate use of Other Diagnostic Procedure Breast: DO NOT USE For questions re: data entry call State Nurse Consultant (NC) 26

27 Follow-up/Diagnostic Mammogram 27

28 Documenting Follow-up Services: Cervical Biopsy types: ECC (endocervical curettage), cervical biopsy Appropriate use of Other Diagnostic Procedure - Cervical?: DO NOT USE Use of subsequent follow-up services: follow-up Pap and/or follow-up colp x1 For questions re: data entry call NC 28

29 Documenting Follow-up Services: Cervical EMB: for AGC Pap result only Not for endometrial cells present in woman >age 40 or any other result Contact NC with MBCIS# and date of EMB NC will enter into MBCIS 29

30 Documenting Follow-up Services: Cervical Diagnostic LEEP and Diagnostic Cone For Pap results of HSIL or AGC only For colp results of CIN1/ not cancer /atypia/unsatisfactory only CIN2+ receives Medicaid for treatment LEEP/Cone are now TREATMENT NC enters into MBCIS: contact w/ MBCIS#, date and type of dx procedure Final dx date: date of dx LEEP or cone 30

31 Documenting Surveillance in MBCIS Mammogram Surveillance Used in the following 4 situations: When a client has an abnormal CBE and is referred for a mammogram When a client is referred from a non-bcccp provider to the program for diagnostic work-up for an abnormal Mammogram To open a new cycle mid-year because the follow-up Diagnostic mammogram is abnormal and requires additional diagnostic tests After radiologist issues final ACR result from a film comparison. 31

32 Use of Mammogram Surveillance Abn STF additional F/U required 32

33 33

34 Use of Mammogram Surveillance: Film Comparison Screening Mammogram result on 12/15/08; Radiologist wants previous films for comparison. What is the result of the Screening Mammogram in this instance? Work-up Plan = Short-term Comparison Film obtained Radiologist amends final result on 1/28/09 to ACR 2 Benign Finding 34

35 Use of Mammogram Surveillance: Film Comparison 35

36 Pap Surveillance Used in the following 3 situations: When a client is referred from a non-bcccp provider (E.g. Family Planning Clients) to the program for diagnostic work-up for an abnormal Pap test To open a new cycle mid-year because the follow-up Pap test is abnormal and requires additional diagnostic tests To document yearly Pap tests for women with a history of CIN 2-3 (20 years) or hysterectomy for dysplasia or cervical cancer ( forever ) 36

37 Use of Pap Surveillance 37

38 NEW Exam Types Post biopsy mammogram/clip placement No Result is Required. DO NOT USE OTHER for this exam Non-Standard Care Used by Nurse Consultants ONLY to document clinical care that deviates from medical protocol 38

39 Appropriate Coding of Final Diagnosis Data/Date Work-up Complete: finished w/ final dx Refused: if patient refuses to have care Put in date and Not Applicable for dx Lost to Follow-up: can t find patient Put in date and Not Applicable for dx Not Applicable Work-up Interrupted: dx in process (left country, other health issues) Put in date and Not Applicable for dx Treatment Start Date Diagnostic LEEP or Cone: treatment started, date of LEEP/Cone, type surgery Surgery, Chemo, etc date of surgery, start of chemo, etc Data Deletion any deletion on the service summary screen will delete the diagnosis and treatment data. You will need to re-enter the diagnosis and treatment data! 39

40 Special Circumstances Multiple Surgical Consults Multiple tests/procedures pre and post biopsy Complications post biopsy Nurse Consultant Approval Exams/ procedures Non-Standard Care Documenting No Treatment for CIN 2 Clients < age 30 40

41 Multiple Surgical Consults Multiple Surgical Consults Breast consults - Reimburse up to 2 surgical consults/office visits per year: Pre breast biopsy, and immediately post breast biopsy. Cervical Consults - Reimburse for consult on DAY of cervical diagnostic procedure. If cancer diagnosed, will reimburse for post biopsy consult/office visit Additional breast and cervical consults beyond guideline above require NC approval; reviewed on case by case basis 41

42 Multiple Tests Procedures Imaging Tests Pre and post biopsy US and US guided biopsy reimbursed ONLY in select circumstances Complications post breast biopsy surgical consults (# dependant on problem) reimbursed to evaluate biopsy induced infection/hematoma 42

43 Nurse Consultant Approval Exams/procedures NC Approval required for: Diagnostic LEEP, Diagnostic Cone, EMB ANY consult/exam/procedure reimbursed by BCCCP that deviates from medical protocol Non-Standard Care -- ANY consult/exam/procedure NOT reimbursed by BCCCP that deviates from medical protocol BUT impacts FINAL diagnosis 43

44 Documenting No Treatment for CIN 2 Clients < age 30 If plan is follow with colp/pap at 6 months Put in treatment, not needed and put in comments Pap/colp in 6 months After 1 st follow-up Pap/colp, if still NO treatment planned, patient returns to care of Family Planning for surveillance (no data in MBCIS) If situation changes (now CIN3/CIS and/or treatment), BCCCP will provide care 44

45 Questions! Ann Garvin MS, CNM Susan Harris, PH. D E.J. Siegl MA, OCN, RN Cathy Blaze

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