Clinical Corner - Second Biopsy Case

Question: We have a 44 year old that had multiple suspicious masses that were noted as microcalcifications on her mammogram report. Her ultrasound reports noted 5 hypoechoic masses with irregular margins and a Birads-5 result. Patient proceeded to have two left ultrasound guided core breast biopsies and a left breast ultrasound guided lymph node biopsy. Now that WWC will reimburse for a second breast biopsy on the same day, what should we enter in eCaST for proper reimbursement on this case?

Clinical Corner - Cervical Expansion Case Study #1

Question: We had a 37 year old with self-reported history of abnormal Paps 9 years ago, but no documented follow-up. Current Pap was NILM and HPV genotyping 16 positive. I referred her for a colposcopy. The patient presented for a scheduled colposcopy with a different provider. This provider advised her the recommendation was to co-test in one year. The patient presented 6 months later with irregular bleeding and questions about the colposcopy. Her colposcopy was rescheduled, but through scheduling error, was scheduled with the provider who advised against colposcopy. My understanding is that if the Pap was normal, but HPV 16 or 18 were identified, that colposcopy is recommended per 2012 guidelines. Could you please clarify?

Clinical Corner: IDC vs. DCIS

Question: What is the difference between IDC and DCIS?

Clinical Corner - WWC table for abnormal cervical results

Question: The ASCCP algorithms for following up after abnormal Pap and HPV results are sometimes difficult to understand, particularly for our new staff members. Is there a cheat sheet of some kind that could assist us with training new staff?

Clinical Corner - Normal CBE & No Screening Mammogram? What do you do!

Question: We have a client who had a normal clinical breast exam (CBE) and did not present with any symptoms or history of breast cancer. She is 54 years old and her last screening mammogram was in 2011. We provided education about a referral to another screening mammogram. She did not complete the screening mammogram. We attempted to contact her without success. Should this person be closed out as “Lost to Follow-up” in eCaST or “Follow Routine Screening?"

How to document suspicious vs. non-suspicious CBE findings in WWC

Non-suspicious (normal) includes:

• Benign exam- clinical breast exam (CBE) findings are not a concern for cancer (tenderness, cyclic pain, or fibrocystic may fall into this category)
• Normal or negative exam
• Discrete lump, previously diagnosed as benign. Non-suspicious lumps should still be included in documentation since this is helpful in evaluating change or lack of change at future visits.

Suspicious or abnormal includes:

• Discrete palpable lump (suspicious)
• Bloody, clear or serous nipple discharge
• Nipple or areolar scaliness, rash or color change
• Skin dimpling or nipple retraction
• Inflammation 
• Suspicious breast pain (non-cyclic or pain/tenderness determined by provider to need further diagnostics)

All clients with an abnormal CBE finding should be referred for further diagnostic testing. The provider should indicate whether or not, based on the CBE and patient report, they would like to see additional diagnostics in cases of breast pain or tenderness. If the provider recommends further diagnostic testing in these cases, the CBE results should be documented as “suspicious."

Clinical Corner: Evaluating clients with a past history of breast cancer

Question: Currently, we are allowed to reimburse for evaluation of clients with a past history of breast cancer after treatment is complete. What are the parameters and/or time periods allowed for "after completing treatment?"

Could clients with Medicare Part B qualify for WWC services as underinsured?

Question: Clients with only Medicare Part A qualify for WWC clinical services. Could clients with Medicare Part B qualify as underinsured if they are unable to pay their co-pay/co-insurance?

Answer: Clients who have Medicare Part B as health insurance are not eligible for WWC clinical services. If they are under 65, however, they can be enrolled in WWC care coordination.

In general, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Medicare Part B cover two types of services, medically necessary services and preventive services. Part B will cover a screening mammogram once every 12 months and diagnostic mammography when medically necessary in women 40 or older. Part B also covers Pap tests, pelvic exams, and clinical breast exams every 24 months for all women and every 12 months for those considered high risk for cervical cancer.

Additional information can be found here: https://www.medicare.gov/coverage/your-medicare-coverage.html.

Clinical Corner - Cryotherapy Reimbursement

Question: We have a patient that has a history of persistent CIN I and the provider wants to do cryotherapy instead of a LEEP. The provider states that a LEEP is too invasive and cryotherapy is more appropriate. Can we use WWC funds for this procedure?

Answer: Cryotherapy is considered treatment for this patient and WWC funds cannot be used for treatment. WWC reimburses for diagnostic LEEPs only. WWC would not cover the LEEP if it is for treatment purposes.

If you have a clinical question that you would like answered, please email Angela.FellersLeMire@state.co.us.

Does your agency have a new WWC clinical provider? Are you a new WWC clinical provider?

Welcome to WWC! As a new WWC clinical provider, you will want to become familiar with the Provider Resources web page and Part 4: Clinical Services of the WWC toolkit. These sections of the toolkit include the clinical policies and guidelines that both WWC Clinical Services and WWC Care Coordination programs must follow. 

Webinar: Breast Cancer. Genetic Counseling. A Firsthand Account

Date and time: Wed, Nov 11, 2015 12:30 PM - 2:00 PM MST

"I was diagnosed in June 2013 when my son was 18 months old. After I stopped breastfeeding one of my breasts did not go down, which is abnormal, so I got my mammogram. I was devastated when I got my diagnosis of breast cancer." 

Join the Office of Minority Health Resource Center and Dr. Lori Wilson, Howard University Hospital & College of Medicine Surgical Oncologist and Surgery Residency Program Director, for a presentation on her personal experience with cancer. PPEs will learn about Dr. Wilson's unique firsthand experience with cancer as an oncologist and a patient. Nicole Thompson, genetic counselor, will provide lessons on genetic counseling. Both will be available to address all questions.

Register now.

Webinar recording: CCADV's Intimate Partner Violence

Family Planning and Colorado Coalition Against Dometic Violence (CCADV) have graciously agreed to share Amy Pohl's archived version of CCADV's Intimate Partner Violence webinar with WWC staff.

Amy Pohl wanted staff to know that they can access the Batterer 101 Training on CCADV’s Online Learning Center for FREE for 90 Days (until December 31) if they would like some follow up training on the issue of domestic violence (DV). Email Amy Pohl with your interest, and she will follow up with you directly.

Amy provided this description of the course “Understanding Batterers:”

Who are batterers? Why do batterers hurt others? Does alcohol cause physical violence? This course explores the reasons why batterers hurt the important people in their lives, lists the types of battering most often used against victims, dissects the myths and facts about battering, and much more. This course will enhance the participant’s skills around safety planning and advocacy with victims/survivors of domestic violence by increasing the participant’s knowledge and understanding of batterers as well as Colorado requirements for offender management. Course review provided by Cheryl Davis, Program Manager of the Colorado Domestic Violence Offender Management Board (DVOMB). Time Frame: approx. 1.5 hours.

Contact information:

Amy Pohl
Communications and Membership Director
Colorado Coalition Against Domestic Violence
1120 Lincoln Street, Suite 900
Denver, CO  80203
(303) 962-0936 ▪ Tollfree: (888) 778-7091 x824
www.ccadv.org ▪ apohl@ccadv.org

Clinical Corner - 3D Mammography Reimbursement

Question: Does WWC reimburse for 3D mammography (i.e. tomosynthesis)? What are the tomosynthesis CPT codes we should be aware of?