Home Forums Discussions General Discussion Medicare Wellness TEMPLATE

hello all. Would anyone have a Medicare Wellness Template that they are using? if so where might i find it.
Also, due to certain screening guidelines during that visit, is there a way to put certain templates in the ble button area where the PHQ9 template is? when i ask tech support they dont seem to understand what I am askin. In other words....is there a way for me to CUSTOMIZE the content in the blue button assessment area or not.

I am sure there are other docs in my boat trying to have a user friendly way to record the ANNUAL WELLNESS VISIT for MEDICARE.

Thanks!!

Dr George - Westlake Louisiana

Dr George,

There are two wellness templates that I have seen on the boards and passed along to other docs.

One was from Boondoc if iirc.

I'll see if I can find it.

WNWD NAD. Affect is normal and appropriate. Mucosa is pink and moist. Pharnx without erythema or injection. PERRLa. TMs and canals are normal bilaterally with normal light reflex and no erythema. Neck is supple without significant lympadenopathy or thyromegaly. Chest CTA with normal I:E. Heart is RRR, nL S1 and S2 without murmers, thrills, or rubs. Abdomen soft & non-tender. No HSM or masses appreciated. Extremities show no cyanosis, clubbing, or edema. Reflexes are normal and 2+ symmetrically of knees and achilles. Gait is WNL.
Timed up and go test 8 seconds

Reviewed Medicare assessment wellness questionnaire
SKIN EVAL - ABCDE
Asymmetry in 2 axes?
Border - irregular?
Colors - 2 differrent?
Diameter >6mm?
Evolution of lesion?all neg
oozing/crusting?

NEURO, FOOT EXAM all wnl

Beck scale is negative
Functional status assessment cognitive, sensory, (hearing vision, speech), and exercise all wnl

medication assessment including otc and herbal done


Advanced care planning - done

Comprehensive pain assessment - negative



just something I use for starters

Here is the thread that I was thinking of ...

http://amazingcharts.com/ub/ubbthreads.php/ubb/showflat/Number/68416/Searchpage/2/Main/7647/Words/wellnes+template/Search/true/Re:_Templates_for_welcome_to_M#Post68416

It's really easy to open templates anyway, just right click in the window, choose the template and insert.

I don't trust the PHQ9 button anyway, it doesn't work most of the time.

the phq9 button is constantly needing to stop and restart services so once done the depression scale will actually save..version 9.2

I've made some updates since that original thread. This is a welcome to medicare visit HPI:

This patient is here for %his Initial Preventive Physical Examination (IPPE) or "Welcome to Medicare" visit. Patient is within one year of his start date for Medicare, as listed on his card for Part B coverage. %FNAME reports being in good health. The essential parts of the IPPE are (A) Aquiring History: rev of PMH and SH, rev of risk factors for depression and other mood disords, rev of functional ability and level of safety' (B) begin examination: exam and end of life planning; (C) Counseling: education and referral on the previous 5 components, education for preventive services.

Vision Test: Left ( ) Right ( )

There is also an Initial Preventive Visit, when they are outside the time limit for the Welcome visit:

This patient is here for %his Initial Annual Wellness visit with Medicare. %He is out of the time limit for the Initial Preventive Exam (Welcome to Medicare). %FNAME reports being in good health.
Other Providers:
Vision Test: Left ( ) Right ( )

Assessment Section:
# Routine general medical examination at a health care facility (Z00.00):
AWV: Initial, peformed. The plan of care is as follows in the plan section.

Cognition: Recall of three words normal.

Depression Score:
Over the past two weeks, have you felt down, depressed, or hopeless?
Over the past two weeks, have you felt little interest or pleasure in doing things?
Functional Ability: Normal Up & Go test, normal ADL screen, normal walk safety screen, normal hearing screen.
Was the patient's timed Up & Go test unsteady or longer than 30 seconds?
Do you need help with the phone, transportation, shopping, preparing meals, housework, laundry, medications, or managing money?
Does your home have rugs in the hallway, lack grab bars in the bathroom, lack handrails on the stairs, or have poor lighting?
Have you noticed any hearing difficulties?
Do you want an EKG? (CPT G0403, G0404, G0405)

All of questions %Mr %LNAME had were answered.
Coding
IPPE G0402 (Welcome to Medicare) age 65 only
Initial G0438, Subsequent G0439 over 65
EKG G0403, G0404, G0405
May at 9921-1 to 5 with modifer -25

Chris,

Thanks for continuing to contribute the collaboration.

Plan Section Template: PPPS (Man)
Personalize Prevention Plan of Service (PPPS) [print this section, give to patient]
Vaccines (PNA once >65, Inf yearly, Hep B med/high risk): [recommended, or list your dates here]
Prostate Ca Screen (annually to 75 yo): [Medicare says offered, but will usually not pay for screening]
Colon CA Screen (to 75 yo):
Glaucoma Screen:
CVS Screening Labs (every 5 years):
DM Education:
DM Screening Labs (every 3 years, prediabetic 6mo):
AAA (once for men 65-75 smoked >100 cigs, anyone with FH of AAA, may be only covered at Welcome Visit):
HIV (inc risk patients): n/a
Smoking Cessation (8 cessions per year): Smokers should quit: this increases risk for lung disease and cancers, early death.
Subsequent AWV: Recommended 1 year.

Plan Section: PPPS (Woman)
Personalize Prevention Plan of Service (PPPS)
Vaccines (PNA once >65, Inf yearly, Hep B med/high risk):
Pap and Pelvic (at least to 70):
Mammogram (biennial 50-74yo):
Colon CA Screen (to 75 yo):
DEXA (biennial after 65, Indicate Risk from Estrogen Def): [Medicare says will pay if estrogen deficient, and they all are, but often the imaging center here rejects this as CMS won't pay. You almost have to be on steroids or HAD fracture already to get his paid]
Glaucoma Screen:
CVS Screening Labs (every 5 years):
DM Education:
DM Screening Labs (every 3 years, prediabetic 6mo):
HIV (inc risk patients): n/a
Smoking Cessation (8 cessions per year): Smokers should quit: this increases risk for lung disease and cancers, early death.
Subsequent AWV: Recommended 1 year.

Commercial Insurance and Self Pay Wellness Patient: ICD10
Man
#1 Caregiver annual health check (Z00.00): Wellness exam performed. He is healthy and all of his questions were answered. We went over all the recommended screening tests, his family history, his risk profile, and the health and wellness topics.
#2 Screening for lipoid disorders (Z13.220): Lab studies were sent for cholesterol evaluation and risk stratification.
#3 Screening for thyroid disorders (Z13.29): Lab studies were sent for evaluation of the thyroid system.
#4 Screening for diabetes mellitus (Z13.1): Lab studies were sent for diabetes screening and blood sugar evaluation.
#4 Special screening for malignant neoplasms of colon (Z12.11): Patient advised to schedule colonoscopy and I explained the importance of screening for colon cancer, as well as various options to complete this.

WOMAN
#1 Caregiver annual health check (Z00.00): Wellness exam performed. She is healthy and all of her questions were answered. We went over all the recommended screening tests as well as health and wellness topics.
#2 Screening for lipoid disorders (Z13.220): Lab studies were sent for cholesterol evaluation and risk stratification.
#3 Screening for thyroid disorders (Z13.29): Lab studies were sent for evaluation of the thyroid system.
#4 Screening for diabetes mellitus (Z13.1): Lab studies were sent for diabetes screening and blood sugar evaluation.
#5 Screening for malignant neoplasms of cervix (Z12.4): A thin-prep pap test was performed and sent with appropriate viral evaluation as indicated. Patient instructed on appropriate screening for cervical pathology.
#6 Breast screening, unspecified (Z12.39): Breast exam performed with healthy appearance. Advised her to perform self breast exams and instructed on how to perform this. Patient has been advised to obtain a screening mammogram and orders have been sent.
#7 Special screening for malignant neoplasms of colon (Z12.11): Patient advised to schedule colonoscopy and I explained the importance of screening for colon cancer, as well as various options to complete this.

ACOG Pap Smear Cessation
It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years.

Disc: Pap Guidelines
USPSTF: Cervical Cancer
Being screening age 21
Ave Risk Women 21-65 Pap every 3 years, but 30-65 Pap and HPV every 5 years (if normal)
>65 Discontinue screening if low risk and prev PAP tests normal.
ACOG Pap Smear Cessation
It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years.

Template: Disc Prostate Screen ***Prostate Screening****
1. The American Cancer Society (ACS) emphasizes the need for involving men in the decision whether to screen for prostate cancer. A handout is provided that is evidenced based and explains the risks and benefits of screening. Most experts now conclude that the harms of screening outweigh the benefits.
2. The American Urological Association (AUA) strongly recommends shared decision making in deciding on PSA screening in men ages 55 to 69. The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening. The AUA stated that a screening interval of two years for men who choose screening may be preferred to annual screening and that screening intervals can be individualized based on baseline PSA level. The guideline noted the lack of evidence for using any tests (eg, PSA derivatives, PSA kinetics, PSA molecular markers, urinary markers, imaging, or risk calculators) other than PSA for triggering a biopsy referral. While the AUA did not recommend a specific threshold for biopsy referral, they did suggest using a threshold of 10.0 ng/mL for men 70 years and older.
3. The United States Preventive Services Task Force (USPSTF) updated its recommendations in 2012 to recommend that men NOT be screened for prostate cancer, concluding that there is moderate certainty that the benefits of such screening do not outweigh the harms. The USPSTF did advise that men requesting screening be supported in making an informed decision.
4. The Canadian Task Force on Preventive Health Care recommends against screening for prostate cancer with PSA or TRUS and states that there is insufficient evidence recommend for or against screening with DRE.
5. The United Kingdom National Screening Committee does not recommend screening for prostate cancer.
6. The Australian Cancer Council states that the evidence does not support population-based screening and recommends a patient-centered approach that individualizes the decision.
7. The European Society for Medical Oncology (ESMO) recommends against population based screening and in favor of an individualized approach using shared decision making.
8. The Clinical Guidelines Committee of the American College of Physicians (ACP) produced a guidance statement in 2013 based on their rigorous review of guidelines developed by other United States organizations, including the American College of Preventive Medicine, the American Cancer Society, the American Urological Association, and the US Preventive Services Task Force [171]. The ACP guidance statement recommends that clinicians inform men ages 50 to 69 about the limited potential benefits and substantial harms of prostate cancer screening and only screen men who express a clear preference for being screened. The guidance statement also recommends against screening for prostate cancer in average-risk men under the age of 50 and against screening in men over the age of 69 or with a life expectancy less than 10 to 15 years.

I have a lot of templates. Ask and you shall receive. Use with your own discretion and medical judgement: I don't know it all, but try to stay evidence based

HPI: Migraine.

I discussed headaches with the patient which appear to be migraines. We went over the following:

International Headache Society
A. At least 5 headaches fulfilling B-D
B. HA lasting at 4-72 hours (untreated or unsuccessfully tx)
C. HA with at least 2 of the following:
1. Unilateral Location
2. Pulsating Quality
3. Moderate to Severe Pain Intensity
4. Aggravated by or causing avoidance of activity
D. During HA at least one of the following:
1. Nausea and/or Vomiting
2. Photophobia or Phonophobia
E. Not attributable to another disorder

Notes:

Differentiating between "Migraine without aura" and "Infrequent episodic tension-type headache may be difficult." Therefore at least 5 attacks are required.

Individuals who otherwise meet criteria for Migraine without aura but have had fewer than 5 attacks should be coded "Probable migraine without aura"

In children, attacks may last 1-72 hours (although the evidence for untreated durations of less than 2 hours in children requires corroboration by prospective diary studies).

When attacks occur on =15 days/month for >3 months, code as "Migraine without aura" and as "Chronic migraine."

Migraine headache is commonly bilateral in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adult life.

Migraine headache is usually frontotemporal. Occipital headache in children, whether unilateral or bilateral, is rare and calls for diagnostic caution; many cases are attributable to structural lesions.

Chris, have you uploaded these to the AC database? It makes it easy to pull them at will from there.

For those who do not know about the template database:
1) Open the template module

2) Click on the the import button with radio button checked for "from Amazing Charts"


This will open a web page the AC Template Repository

3)Click on a category, find a template and click download

4) When you did step 2 it also opened a box asking to select file to import. The file most likely went to your "Downloads" folder.

Pick the file and voila. You have a new template added to your system.

There are a lot of templates, some are good, some are not, some need some tweaking. They can easily serve as the basis of a template to modify to your needs.

5) You can export the same way to share with colleagues. At the time of export it asks you if you want to upload to the AC repository. That's how many of the templates came to be there.

Templates can save time..... but that is a whole other topic.

I have not uploaded many of my templates, because cutting and pasting seems so easy. I have uploaded many in the past, but never thought people really used them.