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BCCCP MBCIS Data BCCCP MBCIS Data WebinarWebinar

December 7, 2010

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Featuring

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

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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.

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Types of Office Visits

Annual Screening Office Visit Follow-up Office Visit Breast or Cervical Consult Visit

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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

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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.

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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 proceduresperformed

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)

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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

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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

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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

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Data Data Documentation in MBCIS in MBCIS

Basic Data Entry Issues

Opening/closing cycles based on visit type

Enrollment dates

Referral dates

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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.)

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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

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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

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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

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Exam Types Types

Screening Follow-up/Diagnostic Surveillance

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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

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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)

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Follow-up Diagnostic Exams cont. Diagnostic MammogramsA “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

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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

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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 follow-

up exams in current cycle

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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 40 – 49 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.

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Documenting Follow-up Services Follow-up Services

Follow-up CBE, Follow-up Pap test, Diagnostic Mammogram

Diagnostic LEEP, Diagnostic Cone, Endometrial Biopsy (EMB)

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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

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

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Documenting Follow-up Services: 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)

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Follow-up/Diagnostic Mammogram

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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

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Documenting Follow-up Services: Follow-up Services: CervicalCervical

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

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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

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Documenting Surveillance in MBCISMammogram SurveillanceUsed 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.

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Use of Mammogram SurveillanceAbn STF – additional F/U required

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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

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Use of Mammogram Surveillance: Film Comparison

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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”)

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Use of Pap Surveillance

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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

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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 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!

““NotNotApplicable”Applicable”

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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

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Multiple Surgical ConsultsMultiple 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

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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

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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

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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 1st 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

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Questions!

Ann Garvin MS, CNM 517-335-9087 garvina@michigan.gov

Susan Harris, PH. D. 517-324-7306 sharris@mphi.org

E.J. Siegl MA, OCN, RN 517-335-8814 sieglej@michigan.gov

Cathy Blaze 517-241-0109 blazec@michigan.gov