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 Addition of NEW CPT codes to the service file to code for progesterone supplementation for preterm birth prevention (PTB) in women with specific pregnancy.

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Presentation on theme: " Addition of NEW CPT codes to the service file to code for progesterone supplementation for preterm birth prevention (PTB) in women with specific pregnancy."— Presentation transcript:


2  Addition of NEW CPT codes to the service file to code for progesterone supplementation for preterm birth prevention (PTB) in women with specific pregnancy conditions.  Update on the 439 E-Report/Update on the Prenatal Log reporting  Update on MCH Core Assurance Coordination

3 DPH recognizes the current ACOG recommendations regarding progesterone and preterm birth prevention and strongly recommends the use of progesterone as listed in the ACOG Committee Opinion Number 130. ACOG Recommendations:  A woman with a singleton gestation and a prior spontaneous preterm singleton birth should be offered progesterone supplementation starting at weeks of gestation, regardless of transvaginal ultrasound cervical length.  Vaginal progesterone is recommended as a management option to reduce the risk of preterm birth in asymptomatic women with a singleton gestation without a prior preterm birth with an incidentally identified very short cervical length less than or equal to 20 mm before or after 24 weeks of gestation.  Progesterone treatment does not reduce the incidence of preterm birth in women with twin or triplet gestations and therefore is not recommended as an interventions to prevent preterm birth in women with multiple gestations. Reference: American College of Obstetricians and Gynecologists Committee Opinion. Prediction and Prevention of Preterm Birth: ACOG Committee Opinion Number

4  New CPT codes/modifiers are established for LHDs to use to code for specific progesterone use for patients participating in the Public Health Prenatal Program.  Reimbursement to the LHD will be through the Public Health Block Grant Funds.  If progesterone is used for preterm birth prevention – code to Cost Center 803. The appropriate ICD, CPT, modifier and provider class as listed in Table 1 should be entered into the PSRS.

5  ICD9 Codes: › V Supervision of a high-risk pregnancy with a history of pre-term labor › – Complications related to pregnancy: cervical shortening antepartum condition or complication  The forms of progesterone listed in Table 1 are available commercially or through FDA certified compounded pharmacies; the rate listed per dose is comparable to those rates.

6 Service Description ICD CodeCPT CodeModifier Provider Class Rate/Dose Progesterone, 100 mg vaginal capsule, compounded formulary V2341 or W0120M1 10, 20, 30 $5.00 Progesterone, 200 mg vaginal capsule, compounded formulary V2341 or W0120M2 10, 20, 30 $5.00 Prometrium, 100 mg vaginal capsule, commercial formulary V2341 or W0121M1 10, 20, 30 $5.00 Prometrium, 200 mg vaginal capsule, commercial formulary V2341 or W0121M2 10, 20, 30 $5.00 Hydroxyprogesterone Caproate, 250 mg injection, compounded formulary V2341 orJ $10 Progesterone injections shall be administered under the direct supervision of the prescribing physician.

7 The “Unit” field - enter the number of doses administered (CPT J1725) or the quantity issued on prescription (CPT W01201 or W01202) during that service date. CPT CodeEmpidDiagnosisChrg/QtyUnitsReimbursement Rate W0120M V2341 $5.0030$ W0120M $5.0030$ W0121M V2341 $5.0030$ W0121M $5.0030$ J V2341$101

8  Obstetric Panel (CPT Code 80055) › Often noted in contracts, currently not listed in the Service File  Questions….

9  The current 439 E – Report “Positive Pregnancy Test is being revised and will be replaced with the “Prenatal” 439 E-Report.  The new Prenatal 439 E-Report: › Include additional data elements and the removal of one current data field that is in the current 439 E-Report “Positive Pregnancy Test”. Removed - “Other Services” (CPT, ICD, Visit Date) › Format will be a CSV file – open as an excel spreadsheet. Enable LHD and DPH to filter data, assist LHD in tracking patients and enable DPH to link data and track outcomes. › Be a cumulative monthly report; only the data fields for the First Prenatal Visit will remain static. › Will auto populate with the data entered in the Bridge and Portal Systems. There will no longer be a Prenatal Log. › Each LHD will be able to view the report for their HD.

10  Purpose – Assist LHD and DPH: 1. Assure women are linked to prenatal services and attend first prenatal visit. 2. Review prenatal process for effectiveness and efficiency. (Budgeting, QI, PE, etc.) 3. Improve birth outcomes through the review and linkage of data.

11  HD ID/HD Name  Pt Name (Last, First, Maiden) – new (Maiden Name)  Pt DOB  Pt Social Security # or ID #  Pt Race  Pt Ethnicity - new  Payor Code - new  Target Date of PE expiration - new  Date of Positve Pregnancy Test  EDC - new  First Prenatal Visit (Date, ICD9, CPT) - new  Prenatal Provider Code – new  Progesterone CPT - new  Date of Delivery – new  Birth Weight - new

12  MCH Coordinator Tasks: 1. Download the “Prenatal” 439 E-Report each month and save to a folder/computer 2. Identify women with missing data (maiden name, SS or ID number, etc.) 3. Collect/verify the missing data and assure it is entered in the system prior to next reporting period 4. Confirm each woman has attended first prenatal visit 5. Identify women with expired PE and verify if they have applied/received Medicaid If no, then instruct on application process. If denied Medicaid, instruct on application process for the Public Health Prenatal Program.

13 There are two options on how this data can be entered and auto populate the 439 E-Report. 1. If the patient is on WIC, then it would be entered on those WIC screens and auto populate the report. 2. During an office visit, a code with the applicable date for the EDC and the delivery date can be entered in the Override section on the Encounter screen. Below are the codes for each and then an example of how it would be entered in the Encounter screen is provided. EDC - Enter a G with the 8 digit EDC date. Example below: CPT prov ICD9 REF Chrg/Qty Unt Override (99215)(C1001)( ) ( )( ) ( ) (G ) Delivery Date – Enter a B with the Delivery date. Example below. CPT prov ICD9 REF Chrg/Qty Unt Override (99215)(C1001)( ) ( )( ) ( ) (B )

14  When entering patients in the system, please enter their Maiden Name. There is a field for this, but is a soft edit. Do not by pass this for pregnant women. › This field is located on the Edit Patient Page, under Patient Information.  The data will only be available if it is entered in the Portal or Bridge system. Please discuss with clerks, nurses, and MCH Coordinators about data entry.

15  Heath Departments should be assisting pregnant women with obtaining PE. › If you refer a woman to a provider outside of the HD such a OB office, FQHC, other….please be sure they will sign these women up for PE or else it should be done at the HD before they are referred. › Pregnant women should sign up for PE prior to signing up for full Medicaid.

16 For more information or questions, please contact: Division of Maternal and Child Health Trina Miller RN, BSN Perinatal Nurse Consultant/Prenatal Program Coordinator Department for Public Health Division of Maternal and Child Health (502) ext Fax (502)

17  Cost Center NEW!  The MCH CAC is responsible for: › The coordination of healthcare services and linking patients to community resources to assure optimal patient outcomes.  The MCH CAC is similar in nature to the role of a social worker in the health department.

18 This funding will supplement salary support for an MCH Core Assurance Coordinator (MCH CAC) at each local health department in order to fulfill the existing core functions for the following MCH program function codes:  Prenatal- 121  Pediatric- 122  Child Fatality Review and Injury Prevention- 123  Childhood Lead Poisoning Prevention- 124  General MCH/Building Systems of Care- 129

19 Key Documents:  Guidance Document - revised 01/25/13  FAQs - NEW!  Example list of approved/non-approved activities - coming soon!  Quarterly Newsletter - coming soon!

20 For more information, please contact: Division of Maternal and Child Health Emily A. Anderson, RN, BSN CFHI QI/MCH Coordinator/Infant Mortality Program 275 East Main Street HS2W-A Frankfort, KY

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