Practice Management

Instructions for Completion of the New York State School Health Examination EHR Compatible Form

The instructions above have been approved by the Department of Education.  This documents can be used to develop an EMR compatible form.  Once developed, physicians can use EMR generated forms instead of using the form that the DeD developed which requires manual entry of all the data fields.
NYS SCHOOL HEALTH EXAMINATION FORM


PPE Letter to the AAP, August, 2020


Advanced Primary Care (APC) is a NY State DOH program that helps providers succeed in value-based payments.  Free assistance is given to gain skills that will enable you to engage in payer quality programs.  See the flyer for more information or go to the website.


Concussion Survey


As documented in the August 2016 issue of Medicaid Update, Medicaid FFS would pay for maternal depression screening in the infant’s chart and Medicaid Managed Care would cover the service as of November 2016.  The guidance can be found here: https://www.health.ny.gov/health_care/medicaid/program/update/2016/aug16_mu.pdf and is reproduced below:

Postpartum Maternal Depression Screening Updated Billing Guidance: This article supersedes the billing guidance for postpartum maternal depression screening that was published in the July 2015 Medicaid Update. Effective September 1, 2016 for Medicaid Fee-for-Service (FFS) and effective November 1, 2016 for Medicaid Managed Care (MMC) Plans, the New York State Medicaid program will allow providers of infant healthcare to bill for postpartum maternal depression screening under the infant’s Medicaid identification number. Also, the current CPT code used for maternal depression screening (99420) will be replaced with the following:

• G8431 (with HD modifier) – Screening for clinical depression is documented as being positive and a follow-up plan is documented • G8510 (with HD modifier) – Screening for clinical depression is documented as negative, a follow-up plan is not required

Postpartum maternal depression screening using a validated screening tool may be reimbursed up to three times within the first year of the infant’s life.  This reimbursement is in addition to the payment for an Evaluation and Management (E&M) service.  Screening can be provided by the mother’s healthcare provider and/or by the infant’s healthcare provider following the birth of the baby.  This service can be integrated into the well-child care schedule.  If the mother screens positive for depression, then she must be further evaluated for diagnosis and treatment.  Medical practices that do not have the capacity to evaluate and treat mothers who screen positive for depression must have a referral process in place for these beneficiaries.  Women with current depression or a history of major depression warrant particularly close monitoring and evaluation.  The current standard of care for pregnant women requires that all pregnant women receive depression screening as part of their routine antepartum care.  Maternal depression screening that occurs antepartum is considered to be included in the payment for the E&M service.  A maternal healthcare provider is defined as a: physician, midwife, nurse practitioner, physician assistant, or other healthcare practitioner acting within his or her lawful scope of practice.  The infant’s healthcare provider is defined as a: physician, nurse practitioner, physician assistant, or other healthcare practitioner acting within his or her lawful scope of practice.

I hope that this information is of value to you in your practice. Implementing maternal depression screening is not difficult and helps insure the health of the mother-infant dyad.  If you have further questions about this coding issue or others please email me.  Please note that many private payers are not currently paying for maternal depression screening, and it is one of our priorities to advocate for this and all the other services recommended in Bright Futures.  Our recommendation is to bill all insurers for the service when provided even if they do not currently pay.  The realization by insurers that this is a valuable service may take some time


Below are a number of links that will help in the management of your Pediatric practice:

Billing:

Coding:

Other:


The National Center for Medical Home Implementation (NCMHI) in the American Academy of Pediatrics (AAP) is pleased to announce the launch of its new and improved Web site, www.medicalhomeinfo.org.

The Web site provides pediatric medical home information, tools, and resources for practices and clinicians, specifically pediatricians. Visit the Web site to learn about the following:

  • Education and training opportunities
  • Tools and resources for pediatric medical home implementation
  • Evidence supporting the pediatric medical home model
  • Information about pediatric medical home initiatives in 50 states and the District of Columbia