99381, 99382: Initial preventive medicine evaluation 99391, 99392: Periodic preventive medicine re-evaluation

Transcription

1 Age Birth - 24 months 2-11 s M/ M/ Preventive medicine, re-, or office visit/ 8 visits within the first 24 months of life (As part of preventive medicine or re-, Hemoglobin, hematocrit, or CBC for those age 6 months to 2 s/maximum 5 tests Urinalysis/1 procedure per calendar Preventive medicine, re-, or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Healthy You! Wellness Procedures 99381, 99382: Initial preventive medicine 99391, 99392: Periodic preventive medicine re , 99383: Initial preventive medicine 99392, 99393: Periodic preventive medicine re- V20.2: Routine infant or child health check Developmental testing of infant or child, Immunizations appropriate for age, Routine vision and hearing testing 5 V20.31: Health supervision for newborn under 8 days old V20.32: Health supervision for newborn 8 to 28 days old at a health care facility ; Routine vision and hearing testing 5 V20.2: Routine infant or child health check Developmental testing of infant or child, Immunizations appropriate for age, Routine vision and hearing testing 5 at a health care facility ; Routine vision and hearing testing 5 Z Health check for newborn under 8 days Z Health check for newborn 8 to 28 days old Z Encounter for routine child health with Z Encounter for routine child health without Z Encounter for routine child health with Z Encounter for routine child health without Lipid Profile/1 procedure per calendar (only for high-risk individuals 1 ) Urinalysis/1 procedure per calendar Glucose/1 procedure per calendar (only for high-risk individuals 2 ) 80061: Lipid Profile Z Encounter for lipoid disorders 1 See page 10 for additional lipid screening guidelines 2 See page 10 for additional glucose screening guidelines 5 Routine vision and hearing testing is not reimbursed as a separate procedure but is considered a component of the preventive medicine or re- 1

2 Age s s M/ Preventive medicine, re-, or office visit/ 1 visit per calendar (As part of preventive medicine or re-, If female, include breast exam if appropriate for stage of development/1 procedure per calendar Urinalysis/1 procedure per calendar Lipid Profile/1 procedure per calendar (only for high-risk individuals 1 ) If female and sexually active, include pap smear and pelvic exam/1 procedure per calendar Glucose/1 procedure per calendar (only for high-risk individuals 2 ) Preventive medicine, re-, or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Healthy You! Wellness Procedures 99384: Initial preventive medicine 99394: Periodic preventive medicine re : Lipid Profile , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148: Pap smear 99385: Initial preventive medicine 99395: Periodic preventive medicine re- V20.2: Routine infant or child health check Developmental testing of infant or child, Immunizations appropriate for age, Routine vision and hearing testing 5 at a health care facility ; Routine vision and hearing testing 5 V76.19 Other screening breast V72.31: Routine gynecological V76.47: Special screening for malignant neoplasm, vagina V76.2: Special screening for malignant neoplasm, cervix at a health care facility Z Encounter for routine child health with Z Encounter for routine child health without Z Encounter for gynecological (general) (routine) with Z Encounter for gynecological (general) (routine) without Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.4 Encounter for screening for malignant neoplasm of cervix medical without medical with abnormal 1 See page 10 for additional lipid screening guidelines 2 See page 10 for additional glucose screening guidelines 5 Routine vision and hearing testing is not reimbursed as a separate procedure but is considered a component of the preventive medicine or re- 2

3 Age s (continued) s Breast exam/1 procedure per calendar Urinalysis/1 procedure per calendar Pap smear and pelvic exam/1 procedure per calendar Lipid profile/1 procedure per calendar Glucose/1 procedure per calendar (only for high-risk individuals 2 ) Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Breast exam/1 procedure per calendar Urinalysis/1 procedure per calendar Healthy You! Wellness Procedures , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148: Pap smear 99385: Initial preventive medicine 99395: Periodic preventive medicine re- V76.19 Other screening breast V72.31: Routine gynecological V76.47: Special screening for malignant neoplasm, vagina V76.2: Special screening for malignant neoplasm, cervix at a health care facility V76.19 Other screening breast Z Encounter for gynecological (general) (routine) with Z Encounter for gynecological (general) (routine) without Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.4 Encounter for screening for malignant neoplasm of cervix medical without medical with abnormal 2 See page 10 for additional glucose screening guidelines 3

4 Age s (continued) s M Pap smear and pelvic exam/1 procedure per calendar Lipid profile/1 procedure per calendar Mammogram/1 procedure per calendar Glucose/1 procedure per calendar (only for high-risk individuals 2 ) Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Urinalysis/1 procedure per calendar Lipid profile/1 procedure per calendar Glucose/1 procedure per calendar (only for high-risk individuals 2 ) Healthy You! Wellness Procedures , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147,G0148: Pap smear 77051, 77052, 77055, 77056, 77057, G0202, G0204, G0206: Mammography All mammography codes can be filed with modifier 26 for the interpretation of the mammogram : Initial preventive medicine 99395: Periodic preventive medicine re- V72.31: Routine gynecological V76.47: Special screening for malignant neoplasm, vagina V76.2: Special screening for malignant neoplasm, cervix V76.10: Breast screening, unspecified V76.11: Screening mammogram for high-risk patient V76.12: Other screening mammogram at a health care facility Z Encounter for gynecological (general) (routine) with Z Encounter for gynecological (general) (routine) without Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.4 Encounter for screening for malignant neoplasm of cervix Z12.31 Encounter for screening mammogram for malignant neoplasm medical without medical with abnormal 2 See page 10 for additional glucose screening guidelines 4

5 Healthy You! Wellness Procedures Age s Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Breast exam/1 procedure per calendar 99386: Initial preventive medicine 99396: Periodic preventive medicine re- at a health care facility V76.19 Other screening breast medical without medical with abnormal Urinalysis/1 procedure per calendar Pap smear and pelvic exam/1 procedure per calendar Lipid profile/1 procedure per calendar Mammogram/1 procedure per calendar Stool for occult blood/1 procedure per calendar Glucose/1 procedure per calendar , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148: Pap smear 77051, 77052, 77055, 77056, 77057, G0202, G0204, G0206: Mammography All mammography codes can be filed with modifier 26 for the interpretation of the mammogram , 82274, G0328: Blood, occult, feces, 1-3 simultaneous determinations V72.31: Routine gynecological V76.47: Special screening for malignant neoplasm, vagina V76.2: Special screening for malignant neoplasm, cervix V76.10: Breast screening, unspecified V76.11: Screening mammogram for high-risk patient V76.12: Other screening mammogram V76.41: Special screening for malignant neoplasm, rectum V76.51: Special screening for malignant neoplasms, colon Z Encounter for gynecological (general) (routine) with Z Encounter for gynecological (general) (routine) without Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.4 Encounter for screening for malignant neoplasm of cervix Z12.31 Encounter for screening mammogram for malignant neoplasm Z12.11 Encounter for screening for malignant neoplasm of colon Z12.12 Encounter for screening for malignant neoplasm of rectum 5

6 Age s 50 s and older M Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Urinalysis/1 procedure per calendar Prostate specific antigen with digital rectal exam (only for high-risk individuals 3 ) Lipid profile/1 procedure per calendar Stool for occult blood/1 procedure per calendar Glucose/1 procedure per calendar Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re- Breast exam/1 procedure per calendar Baseline Bone Density of hips or spine/1 procedure per lifetime Urinalysis/1 procedure per calendar Healthy You! Wellness Procedures 99386: Initial preventive medicine 99396: Periodic preventive medicine re , G0102, G0103: Prostate specific antigen , 82274, G0328: Blood, occult, feces, 1-3 simultaneous determinations 99386, 99387: Initial preventive medicine 99396, 99397: Periodic preventive medicine re : Dual-energy x-ray absorptiometry at a health care facility V76.44: Special screening for malignant neoplasm, prostate V76.41: Special screening for malignant neoplasm, rectum V76.51: Special screening for malignant neoplasms, colon at a health care facility V76.19 Other screening breast V82.81: Screening for osteoporosis medical without medical with abnormal Z12.5 Encounter for screening for malignant neoplasm of prostate Z12.11 Encounter for screening for malignant neoplasm of colon Z12.12 Encounter for screening for malignant neoplasm of rectum medical without medical with abnormal Z Encounter for screening for osteoporosis 3 See page 10 for additional cancer screening guidelines 6

7 Age 50 s and older (continued) 50 s and older M Pap smear and pelvic exam/1 procedure per calendar Lipid profile/1 procedure per calendar Mammogram/1 procedure per calendar Stool for occult blood/1 procedure per calendar lexible sigmoidoscopy/1 procedure every five s or colonoscopy/1 procedure every ten s 4 Glucose/1 procedure per calendar Preventive medicine, re- or office visit/ 1 visit per calendar (As part of preventive medicine or re-, Urinalysis/1 procedure per calendar Healthy You! Wellness Procedures , 88147, 88148, 88150, , , 88174, 88175, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148: Pap smear 77051, 77052, 77055, 77056, 77057, G0202, G0204, G0206: Mammography All mammography codes can be filed with modifier 26 for the interpretation of the mammogram , 82274, G0328: Blood, occult; feces, 1-3 simultaneous determinations 45330, 45331, 45333, 45338, 45346, G0104, G6022: Sigmoidoscopy, flexible 44388, 44389, 44392, 44394, 44401, 45378, 45380, 45381, 45384, 45385, 45388, G0105, G0121, G6019, G6024: Colonoscopy 99386, 99387: Initial preventive medicine 99396, 99397: Periodic preventive medicine re , , 85041, G0306, V72.31: Routine gynecological V76.47: Special screening for malignant neoplasm, vagina V76.2: Special screening for malignant neoplasm, cervix V76.10: Breast screening, unspecified V76.11: Screening mammogram for high-risk patient V76.12: Other screening mammogram V76.41: Special screening for malignant neoplasm, rectum V76.51: Special screening for malignant neoplasms, colon V77.1: Screening for at a health care facility Z Encounter for gynecological (general) (routine) with Z Encounter for gynecological (general) (routine) without Z12.72 Encounter for screening for malignant neoplasm of vagina Z12.4 Encounter for screening for malignant neoplasm of cervix Z12.31 Encounter for screening mammogram for malignant neoplasm Z12.12 Encounter for screening for malignant neoplasm of rectum Z12.11 Encounter for screening for malignant neoplasms of colon medical without medical with abnormal 4 See page 10 for additional cancer screening guidelines 7

8 Healthy You! Wellness Procedures Age 50 s and older (continued) M Lipid profile/1 procedure per calendar Prostate specific antigen with digital rectal exam/1 procedure per calendar 3 Stool for occult blood/1 procedure per calendar lexible sigmoidoscopy/1 procedure every five s or colonoscopy/1 procedure every ten s 4 Glucose/1 procedure per calendar 84153, G0102, G0103: Prostate specific antigen , 82274, G0328: Blood, occult; 1-3 simultaneous determinations 45330, 45331, 45333, 45338, 45346, G0104, G6022: Sigmoidoscopy, flexible 44388, 44389, 44392, 44394, 44401, 45378, 45380, 45381, 45384, 45385, 45388, G0105, G0121, G6019, G6024: Colonoscopy V76.44: Special screening for malignant neoplasm, prostate V76.41: Special screening for malignant neoplasm, rectum V76.51: Special screening for malignant neoplasms, colon Z12.5 Encounter for screening for malignant neoplasm of prostate Z12.12 Encounter for screening for malignant neoplasm of rectum Z12.11 Encounter for screening for malignant neoplasms of colon 3 See page 10 for additional cancer screening guidelines 4 See page 10 for additional cancer screening guidelines 8

9 9 Healthy You! Preventive/Wellness Diagnosis Codes (The diagnosis codes listed in the table below should be used to report preventive/wellness s.) Use diagnosis codes V20.2, V20.31, V20.32, V70.0, or V72.31 whenever preventive/wellness and management (E/M) services are reported on the claim (other services may also be reported on the claim). Use diagnosis codes V03.5 through V06.6 to report preventive/wellness s when the only service performed during the encounter is the administration of immunizations. Use diagnosis codes V76.10, V76.11, V76.12, V76.19, V76.2, V76.41, V76.44, or V76.51 to report special screenings for a specific disease (e.g., breast or prostate cancer). Diagnosis code V72.60, V72.62, or V72.69 should be used by independent labs only to report routine preventive laboratory testing. NOTE: The type of immunization administered is not indicated in the ICD-10 diagnosis codes. Code Z23 is used for all immunizations. ICD-9-CM Code Code Text ICD-10-CM Code Code Text V03.50 Diphtheria alone Z Encounter for immunization V03.60 Pertussis alone Z Encounter for immunization V03.70 Tetanus toxoid alone Z Encounter for immunization V03.81 Hemophilus influenza, type B (Hib) Z Encounter for immunization V03.82 Streptococcus pneumoniae (pneumococcus) Z Encounter for immunization V03.89 Other specified vaccination Z Encounter for immunization V04.00 Poliomyelitis Z Encounter for immunization V04.20 Measles alone Z Encounter for immunization V04.30 Rubella alone Z Encounter for immunization V04.60 Mumps alone Z Encounter for immunization V04.81 * May use this code for coding seasonal influenza vaccine and for coding Influenza A novel (H1N1) Monovalent vaccine Influenza Z Encounter for immunization V04.89 Need for prophylactic vaccination, other viral diseases Z Encounter for immunization V05.30 Viral hepatitis Z Encounter for immunization V05.40 Varicella (Chickenpox) Z Encounter for immunization V05.80 Other unspecified disease Z Encounter for immunization V06.10 Diphtheria-tetanus-pertussis, combined (DTP) Z Encounter for immunization V06.30 Diphtheria-tetanus-pertussis with poliomyelitis (DTP + polio) Z Encounter for immunization V06.40 Measles-mumps-rubella (MMR) Z Encounter for immunization V06.50 Tetanus-diphtheria (Td) Z Encounter for immunization V06.60 Streptococcus pneumoniae (pneumococcus) and influenza Z Encounter for immunization Routine infant or child health check Z Encounter for routine child health with Developmental testing of infant or child, V20.2 Immunizations appropriate for age, Routine vision and hearing testing * Z Encounter for routine child health without * Routine vision and hearing testing is not reimbursed as a separate procedure but is considered a component of the preventive medicine or re-.

10 Healthy You! Preventive/Wellness Diagnosis Codes ICD-9-CM Code Code Text ICD-10-CM Code Code Text V20.31 Health supervision for newborn under 8 days old Z Health for newborn under 8 days old V20.32 Health supervision for newborn 8 to 28 days old Z Health for newborn 8 to 28 days old V70.00 Routine general medical at a health care facility Health checkup V72.31 Routine gynecological Z Z Z Z V72.60 Laboratory, unspecified Z V72.62 Laboratory ordered as part of a routine general medical Encounter for general adult medical without abnormal Encounter for general adult medical with abnormal Encounter for gynecological (general) (routine) with Encounter for gynecological (general) (routine) without Encounter for general adult medical without abnormal Encounter for general adult medical without abnormal V72.69 Other laboratory Z Encounter for other specified special s V76.10 Breast screening, unspecified Z Encounter for other V76.11 Screening mammogram for high-risk patient Z Encounter for screening mammogram for malignant neoplasm V76.12 Other screening mammogram Z Encounter for screening mammogram for malignant neoplasm V76.19 Other screening breast Z Encounter for other V76.20 Special, cervix Z Encounter for of cervix V76.41 Special, rectum Z Encounter for of rectum V76.44 Special, prostate Z Encounter for of prostate V76.47 Special, vagina Z Encounter for of vagina V76.51 Special s, colon Z Encounter for of colon V77.10 Screening for Z Encounter for screening for V77.91 Screening for lipid disorders Z Encounter for screening Z V82.81 Screening for osteoporosis Z Encounter for screening for osteoporosis 10

11 11 Healthy You! Codes for Immunizations and Skin Test Please use the appropriate code(s) when filing wellness claims which include immunizations or skin testing. CPT Code CPT Code Text CPT Code CPT Code Text G0008 Administration of influenza virus vaccine Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use G0009 Administration of pneumococcal vaccine Human Papilloma Virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use, ages 9-26, once per lifetime (includes Gardasil). G0010 Administration of hepatitis B vaccine Human Papilloma Virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule (0, 1, 6 mos.), for intramuscular use, for females 10-25, once per lifetime (includes Cervarix). G Influenza A (H1N1) immunization administration (includes physician counseling the patient/family) * Effective 09/01/2009 Immunization administration through 18 s of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/ toxoid component (New 01/01/2011) Immunization administration through 18 s of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure.) (New 01/01/2011) Immunization administration under 8 s of age (percutaneous, intradermal, subcutaneous, or intramuscular injection) when the physician counsels the patient/ family; first injection (Deleted 12/31/2010) Immunization administration under 8 s of age (percutaneous, intradermal, subcutaneous, or intramuscular injection) when the physician counsels the patient/ family; each additional injection (Deleted 12/31/2010) H1N1 immunization administration (intramuscular, intranasal), including counseling when performed (Effective 09/28/2009) * Rubella Screening for Women of Childbearing Age: If patient is not pregnant and vaccination history is unknown, provide vaccination. Serology is not recommended prior to vaccination for non-pregnant women. If patient is pregnant, serology is recommended. If serology is negative, provide vaccination after delivery. ** lumist is recommended for patients 2-49 s of age. lumist is not recommended for patients who are pregnant, immunocompromised, actively wheezing, less than 5 s of age and currently wheezing, have a history of Guillain-Barre syndrome, or have asthma or other underlying medical condition that predisposes them to influenza complications Immunization administration; one vaccine Immunization administration; each additional vaccine Human Papilloma Virus (HPV) vaccine, types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent, 3 dose schedule, for intramuscular use, for females 9-26, once per lifetime (Gardasil 9). Influenza virus vaccine, split virus, preservative free, 6-35 months dosage, for intramuscular or jet injection use Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 s and older, for intramuscular use Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use Influenza virus vaccine, split virus, when administered to individuals 3 s and older, for intramuscular use Influenza virus vaccine, live, for intranasal use (lumist ) ** Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use Hepatitis A vaccine, adult dosage, for intramuscular use Pneumococcal conjugate vaccine, 7 valent, for intramuscular use Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use Pneumococcal conjugate vaccine, 13 valent, for intramuscular use Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use Influenza virus vaccine, quadrivalent, live, for intranasal use Hepatitis A and B vaccine (HepA-HepB), adult dosage, for intramuscular use Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use intramuscular use Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use

12 Healthy You! Codes for Immunizations and Skin Test Please use the appropriate code(s) when filing wellness claims which include immunizations or skin testing. CPT Code CPT Code Text CPT Code CPT Code Text Influenza virus vaccine, split virus, preservative free, when administered to individuals Varicella virus vaccine, live, for subcutaneous use 3 s of age and older, for intramuscular use Influenza virus vaccine, split virus, when administered to individuals 3 s of age and older, for intramuscular use Diphtheria, tetanus toxoids, acellular pertussis vaccine and polio virus vaccine, inactive (DTaP-IPV), when administered to children 4 s through 6 s of age, for intramuscular use Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hemophilus influenza B and polio virus vaccine, inactivated (DTaP-Hib-IPV) for intramuscular use Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTap) when administered to individuals younger than 7 s, for intramuscular use Diphtheria, tetanus toxins, and whole cell pertussis vaccine (DTP), for intramuscular use Diphtheria and tetanus toxoids (DT) absorbed when administered to individuals younger than 7 s, for intramuscular use Tetanus and diphtheria toxoids (Td) absorbed, when administered to individuals 7 s or older, for intramuscular use Diphtheria toxoid, for intramuscular use Tetanus toxoid absorbed, for intramuscular use Mumps virus vaccine, live, for subcutaneous use Measles virus vaccine, live, for subcutaneous use Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use Diphtheria, tetanus toxoids, acellular pertussis vaccine and Hemophilus influenza B vaccine, inactivated (DTaP-Hib) for intramuscular use Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and polio virus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 s or older, for subcutaneous or intramuscular use Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, (tetravalent), for intramuscular use Zoster (shingles) vaccine, live, for subcutaneous injection. Zostavax vaccine for shingles for individuals age 50 and older, once per lifetime. Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use Rubella virus vaccine, live, for subcutaneous use * Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use * Hepatitis B vaccine, pediatric/adolescent dosages (3 dose schedule), for intramuscular use Measles and rubella virus vaccine, live, for subcutaneous use * Hepatitis B vaccine, adult dosage, for intramuscular use Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use * Hepatitis B vaccine, dialysis immunosuppressed patient dosages (4 dose schedule), for intramuscular use Poliomyelitis vaccine, inactivated, (IPV), for subcutaneous or intramuscular use Hepatitis B and Hemophilus influenza B vaccine (HepB-Hib), for intramuscular use Tetanus and diphtheria toxoids (Td) absorbed, preservative free, when administered to individuals 7 s or older, for intramuscular use Skin test; tuberculosis, intradermal Tetanus, diphtheria toxoids and acellular pertussis vaccine (TdaP), when administered to individuals 7 s or older, for intramuscular use * Rubella Screening for Women of Childbearing Age: If patient is not pregnant and vaccination history is unknown, provide vaccination. Serology is not recommended prior to vaccination for non-pregnant women. If patient is pregnant, serology is recommended. If serology is negative, provide vaccination after delivery. 12

13 Healthy You! Counseling Recommendations You should provide preventive counseling on the following topics to patients of the appropriate age or stage of development. Preventive counseling and risk assessment are an integral part of preventive medicine s and re-s. Preventive counseling should also be provided as appropriate during other patient encounters. Topic Counseling to promote physical activity Counseling to promote a healthy diet and healthy weight Counseling to prevent or stop smoking / tobacco use Counseling to promote achievement of developmental milestones and healthy cognition Counseling to promote healthy emotional and social well-being Counseling to prevent chronic health disease related to personal or family health risk factors Counseling to prevent motor and sports vehicle injury to include speed and use of car seats, seat belts and helmets Counseling to prevent household and recreational injuries Counseling to prevent lead exposure and identify exposure risk Counseling to prevent alcohol / drug abuse Counseling to prevent unintended pregnancy Counseling to prevent sexually transmitted diseases Age(s) to Consider Counseling for Patient and/or Parent All ages All ages Ages 9 and up infancy-adolescence All ages All ages All ages All ages 6 months - 6 s Ages 9 and up As appropriate based on stage of development and sexual activity As appropriate based on stage of development and sexual activity Additional Screening Guidelines for Cholesterol, Glucose and Cancer: 1 Lipid profile screenings are available to high-risk individuals between ages 2 and 17. High-risk individuals should have their first lipid profile screening before age 11. A fasting lipid profile is the recommended screening method. If values are within the normal reference range, the patient should be retested in 3-5 s. High-risk is defined as a family history of high lipids or early CVD; or unknown history; or other CVD risk factors such as overweight, obesity, hypertension or diabetes. 2 Annual glucose screenings are available for high-risk individuals between the ages of High-risk individuals are defined as follows: amily history of diabetes (i.e., parents or siblings with diabetes) Obesity Blood pressure of 135/80 or greater Race/ethnicity (i.e., African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, or Pacific Islanders) Previously identified pre-diabetic or diagnosed diabetic Low HDL cholesterol or high triglycerides History of gestational diabetes 3 Prostate cancer high-risk individuals are defined as follows: Between the ages of and are African American, or have a father or brother diagnosed with prostate cancer at a young age. 4 lexible sigmoidoscopy and colonoscopy information: Consultations are not covered under Healthy You!. Additional screenings (flexible sigmoidoscopy, colonoscopy) for individuals considered to be at high risk for colorectal cancer, as outlined below, may be covered under the appropriate medical portion of your health plan. High-risk individuals in this category are defined as follows: Strong family history of colorectal cancer or polyps (in first-degree relative younger than 60 or two first-degree relatives of any age). A first-degree relative is defined as a parent, sibling or child. Known family history of colorectal cancer syndromes Personal history of colorectal cancer polyps Please note: The Healthy You! benefit covers only one of these visits per calendar for patients. If a patient is referred to another provider to complete the wellness screening test(s) or for a consultation visit, only the wellness screening test(s) will be covered under the Healthy You! wellness benefit. Subsequent office visits and/or consultations are not covered under the Healthy You! wellness benefit. 13