1. 1 BCCCP MBCIS Data Webinar December 7, 2010

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

3. 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.

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

5. 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

6. 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.

7. 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)

8. 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

9. 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

10. 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

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

12. 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.)

13. 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

14. 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

15. 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

16. 16 Types Exam Types Screening Follow-up/Diagnostic Surveillance

17. 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

18. 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)

19. 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

20. 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

21. 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 follow- up exams in current cycle

22. 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 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.

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

24. 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

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

26. 26 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)

27. 27 Follow-up/Diagnostic Mammogram

28. 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

29. 29 Follow-up Services: Cervical 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

30. 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

31. 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.

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

33. 33

34. 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

35. 35 Use of Mammogram Surveillance: Film Comparison

36. 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”)

37. 37 Use of Pap Surveillance

38. 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

39. 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 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! “NotApplicable”

40. 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

41. 41 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

42. 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

43. 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

44. 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

45. 45 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