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CHC Screening & Immunization Schedule

CHC Schedule 2009/10

Check DC registry & Immunize at every visit

Remember Flu for all Children >6mos (Oct-March)

Age

Immunizations

Screening Tests

Birth

Hep B#1- copy for registry & chart

Newborn Metabolic Screen

1-2 Weeks

 

Weight Check (repeat NMS if born in MD)

1 Month

 

Weight Check

2 Months

DTaP #1

Rota #1+

IPV #1

HIB #1

HepB #1/2

Prevnar #1

 

4 Months

DTaP #2

Rota #3

IPV #2

HIB #2

HepB #2 (catch up if needed)

Prevnar #2

 

6 Months

DTaP #3

Rota #3

IPV #3

HIB #3

HepB #3 (if >8wks since #2)

Prevnar #3

 

9 Months

Catch up on Immun if nec.

FDE (Formal Developmental Eval)

12 Months

Varicella #1

MMR #1

Prevnar #4

HepA #1

HIB #4

DTaP#4 (if>4mos since #3)

FDE

PPD (if hi risk/dacare)

Lead

Hgb/Hct

Sickledex (if newborn screen results unknown)

15 Months

DTaP#4 if not given at 12mos

FDE

18 Months

Hep A #2 (if 6 mos from #1)

Autism Screen

 

2 Years

HepA#2 if not given at 18mo

Autism Screen

Lead/Hct

1st Dental Referral

2 ½ Years

 

FDE

3 Years

 

FDE Vision

Cholesterol*

Dental Ref.

PPD/Lead (if high risk)

4 Years

DTaP #5

IPV #4

MMR #2

Varicella #2

PPD

Lead (If high risk)
Cholesterol*

5 Years

 

Vision

Hearing

Cholesterol*

PPD/Lead (If high Risk)

6 Years

 

Cholesterol*

Vision
Hearing

Dental Ref

PPD/Lead (If high Risk)

7 Years

 

Cholesterol*, Dental ref

8 Years

 

Vision/Hearing

Dental Ref

9 Years

HPV may be started at age 9

Cholesterol*,

Dental Ref

10 Years

 

Cholesterol*

Vision

Hearing

Dental ref

11 Years

Menactra
Tdap

HPV for girls

Cholesterol*

Dental Ref

+Rota#1 not started after 14 5/6 weeks, No dose after 8mos 0 days old.  Rotarix (GSK)- 2 doses, Rotateq (Merck)- 3 dose schedule

**HIB at 6mos not needed if 2 prior doses by Merck, 

*Verbal Cholesterol Screen Yearly, Lab test if high risk

Blood lead at age 1 & , yearly verbal screen through age 6

PDE at least once Age 9-18months AND at Age 2-3 years.

 
Developmental Milestones
 (Harriet Lane)
Age Gross Motor Visual-Motor/Problem Solving Language Social/Adaptive
1 mo Raises head from prone position Birth: Visually fixes Alerts to sound Regards face
    1 mo: Has tight grasp, follows to midline    
2 mo Holds head in midline, lifts chest off table No longer clenches fists tightly, follows object past midline Smiles socially (after being stroked or talked to) Recognizes parent
3 mo Supports on forearms in prone position, holds head up steadily Holds hands open at rest, follows in circular fashion, responds to visual threat Coos (produces long vowel sounds in musical fashion) Reaches for familiar people or objects, anticipates feeding
4 mo Rolls over, supports on wrists, and shifts weight Reaches with arms in unison, brings hands to midline Laughs, orients to voice Enjoys looking around
6 mo Sits unsupported, puts feet in mouth in supine position Unilateral reach, uses raking grasp, transfers objects Babbles, ah-goo, razz, lateral orientation to bell Recognizes that someone is a stranger
9 mo Pivots when sitting, crawls well, pulls to stand, cruises Uses immature pincer grasp, probes with forefinger, holds bottle, throws objects Says “mama, dada” indiscriminately, gestures, waves bye-bye, understands “no” Starts exploring environment, plays gesture games (e.g., pat-a-cake)
12 mo Walks alone Uses mature pincer grasp, can make a crayon mark, releases voluntarily Uses two words other than “mama, dada” or proper nouns, jargoning (runs several unintelligible words together with tone or inflection), one-step command with gesture Imitates actions, comes when called, cooperates with dressing
15 mo Creeps up stairs, walks back-ward independently Scribbles in imitation, builds tower of 2 blocks in imitation Uses 4–6 words, follows one-step command without gesture 15–18 mo: Uses spoon and cup
18 mo Runs, throws objects from standing without falling Scribbles spontaneously, builds tower of 3 blocks, turns two or three pages at a time Mature jargoning (includes intelligible words), 7–10 word vocabulary, knows 5 body parts Copies parent in tasks (sweeping, dusting), plays in company of other children
24 mo Walks up and down steps without help Imitates stroke with pencil, builds tower of 7 blocks, turns pages one at a time, removes shoes, pants, etc. Uses pronouns (I, you, me) inappropriately, follows two-step commands, has a 50- word vocabulary, uses 2-word sentences Parallel play
3 yr Can alternate feet when going up steps, pedals tricycle Copies a circle, undresses completely, dresses partially, dries hands if reminded, unbuttons Uses minimum of 250 words, 3-word sentences, uses plurals, knows all pronouns, repeats two digits Group play, shares toys, takes turns, plays well with others, knows full name, age, gender
4 yr Hops, skips, alternates feet going down steps Copies a square, buttons clothing, dresses self completely, catches ball Knows colors, says song or poem from memory, asks questions Tells “tall tales,” plays cooperatively with a group of children
5 yr Skips alternating feet, jumps over low obstacles Copies triangle, ties shoes, spreads with knife Prints first name, asks what a word means Plays competitive games, abides by rules, likes to help in household tasks
From Capute AJ, Biehl RF: Functional developmental evaluation: Prerequisite to habilitation. Pediatr Clin North Am 1973;20:3; Capute AJ, Accardo PJ: Linguistic and auditory milestones during the first two years of life: A language inventory for the practitioner. Clin Pediatr 1978;17:847; and Capute AJ et al: The Clinical Linguistic and Auditory Milestone Scale (CLAMS): Identification of cognitive defects in motor delayed children. Am J Dis Child 1986;140:694. Rounded norms from Capute AJ et al: Clinical Linguistic and Auditory Milestone Scale: Prediction of cognition in infancy. Dev Med Child Neurol 1986;28:762.        
 
Infant Neuro Exam - has many videos of normal & abnormal neuro exams




CHC Billing 2011- Well Child Care (<19 yr)

1) Immunizations

a)       Enter immunizations

b)      Enter vaccine admin. codes (#components)

Vaccine

#

Vaccine Adm. Codes

HPV

1

90460

Influenza

1

90460

Meningococcal

1

90460

Pneumococcal

1

90460

Td

2

90460 & 90461

DTaP or Tdap

3

90460, 90461 x 2 units

MMR

3

90460, 90461 x 2 units

DTaP-Hib-IPV (Pentacel®)

5

90460, 90461 x 4 units

DTaP-HepB-IPV (Pediarix®)

5

90460, 90461 x 4 units

2) PPD placed- code 86580

3) Vision tested-code 99173 and –59 mod

4) Hearing tested- code and  –59 modifier

    OAE- 92587 or Pure Tone- 92551

5) Development (ASQ,MCHAT)code 96110 and –59

8) Additional services (ex- asthma, OM) add CPT code (usually 99212 or 99213) and -25 modifier

CHC Billing 2011- Illness or F/U visit

1) Enter all assessments- Generates ICD9.  For chronic conditions- check box to add to Problem List

2) Enter CPT code E/M for initial or established pt

3) For 99214 or 99215 must be seen by attending AND meet criteria

4) If vaccines are given- Must enter ICD9 code for vaccine administration (not V20.2) and adm. codes

V05.9 immunization against single antigen/illness

V06.8 immunization against combination illnesses

Can also use code for admin of specific vaccine

5) Procedures (ie cerumen removal, cryotherapy) have -25 modifier linked to E& M code (99213)

6) Asthma visits- Use Asthma QI template

Neb = 94640 (units= # of nebs) add -25 to E/M code

Teaching MDI = 94664 with- 59 modifier

7) Counseling: Bill based on time - if > 50% visit is counseling (ie- ADHD, obesity, care coordination)

99214 = 25 minutes and add note in billing section. Remember must be seen by attending 99214/5

8) ADHD- Record interpretation of Vanderbilts and bill Dev test - Code 96110 and –59 mod. 

If >50% counseling- bill E/M based on time

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