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Provider Manual

General Information Regarding HealthCheck Exams at Obstetrician (OB) Visits

Last Updated on August 28, 2018

Medicaid recipients are entitled to HealthCheck exams until age 21. From age 3 to 21, one HealthCheck exam each year is needed. Historically, BadgerCare Plus recipients in their teen years have been unlikely to comply with the HealthCheck exam schedule. This makes it difficult for providers and Security Health Plan to accomplish the 80% compliance requirement the state enforces. Therefore, it becomes imperative that innovative ways are created to capture HealthCheck exams and to ensure this requirement is met.

It is likely that Security Health Plan providers of OB care will see a pregnant member of Security Health Plan’s BadgerCare Plus Program who is younger than 21. This is an excellent opportunity to perform a HealthCheck exam, and it is strongly encouraged.

For an OB visit to be counted as a HealthCheck exam it must be billed correctly. This information is presented in detail in the following two sections. More importantly, the exam must include all required components. The provider must ensure the following are documented:

  • Health & Development History per provider discretion.
  • Unclothed Physical Exam & Growth Assessment per provider discretion.
  • Vision Assessment using a vision chart annually. If the member says he/she has had a vision exam in the past year, document where and when.
  • Hearing Assessment. Up to age 16, a puretone audiometric screen must be conducted every four years. If this has been done, document so. If not, perform the screen. If older than age 16, evaluate for excessive exposure to noise and document dialogue.
  • Oral Assessment. For example, suggesting the member seek regular dental care.
  • Immunizations. Provide any that are needed.
  • Lab Tests to be conducted at the physician’s discretion.

Billing the First OB Visit as a HealthCheck Exam

The first OB visit to determine pregnancy can be billed as a separate visit, for example not a part of a prenatal package or global billing. The visit should be coded with the appropriate level preventive care code. In the event the member needs a referral or follow-up visit for diagnostic or corrective treatment, the “UA” modifier must be attached to the codes in the first modifier slot. For example, the primary diagnosis would be V20.2 (routine child health check), and the secondary diagnosis would be V22.2 (pregnant state, incidental).

If a HealthCheck exam is done as part of the first OB visit in the latter months of a year such as late 2008 and the provider does not submit the claim for the HealthCheck until the patient delivers in the next year, such as early 2009 with the global billing or prenatal package, then the HealthCheck exam will not count toward the previous year’s compliance rate, in this case 2008.

Billing the 6-Week Postpartum Visit as a HealthCheck Exam

Per coding guidelines it is standard to include the 6-week postpartum exam within the scope of the global billing package or postpartum delivery. However, to promote HealthCheck exams at the 6-week visit and with the intent of providing coordinated and “hassle free” care to members, Security Health Plan has decided to pay for HealthCheck exams completed as part of a 6-week postpartum exam.

The visit can be billed as a separate visit (not a part of a global billing). If it is, the visit should be coded with the appropriate level preventive care code. In the event the member needs a referral or follow-up visit for diagnostic or corrective treatment, the “UA” modifier must be attached to the above codes in the first modifier slot. For example, the primary diagnosis should be listed as V20.2 (routine child health check, age 18 or younger) or V70.0 (routine check, age 18-20). The secondary diagnosis would be V24.2 (routine postpartum follow-up).

There may be instances when a pregnant BadgerCare Plus member is (for instance) age 18 at the time of the first prenatal visit, but age 19 at the time of the 6-week postpartum visit. In such an instance, both visits may be billed as a HealthCheck exam if all appropriate components are completed. This will allow the provider, clinic, and Security Health Plan to capture an 18-year old and a 19-year-old HealthCheck exam for this member in a more efficient manner.

For coding questions please refer to the ForwardHealth Portal.