BCCCP MBCIS Data Webinar

1. BCCCP MBCIS Data Webinar December 7, 2010

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

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

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

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

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

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

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)

27. Follow-up/Diagnostic Mammogram

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. 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. 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. Documenting Surveillance in MBCISMammogram 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. Use of Mammogram SurveillanceAbn STF – additional F/U required

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. Use of Mammogram Surveillance: Film Comparison

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. Use of Pap Surveillance

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. Appropriate Coding of Final Diagnosis Data/Date “Not Applicable” • 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!

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. 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

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. 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. 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

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