Year of Publication

2019

College

Public Health

Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Dr. Sarah Wackerbarth

Committee Member

Dr. Rick Ingram

Committee Member

Dr. John Lyons

Abstract

The number of policy statements from the AAP presents pediatricians with an increasing amount of advice related to prevention, yet the definition of prevention and well-child visits has not changed for outpatient office visits. Outpatient office visits are the primary means by which preventive care is administered. The objective of this study is to quantify and characterize the prevention policy recommendations that pediatricians are expected to provide patients/guardians beyond the well-child visit. Secondarily, an analysis was completed to demonstrate which prevention policies make recommendations that can be coded for reimbursement as part of a well-child prevention visit.

METHODS The author coded 544 AAP policy statements that are contained in the American Academy of Pediatrics’ Clinical Practice Guidelines and Policies, 18th Edition and identified 103 policies related to prevention. These 103 policies were divided into categories based on the type of prevention advice and Current Procedural Terminology (CPT) codes used for well-child and prevention health visits.

RESULTS Sixty-two (60.2%) of the 103 prevention policies were coded as anticipatory guidance (AIG). One (1%) was coded as all inclusive (ALL), two (1.9%) were coded as dental prevention (DEN), 4 (3.9%)were coded as disease prevention (DIS), 7 (6.8%) were coded as primarily focused on an environmental (ENV) component, 9 (8.7%) were related to immunizations (IMM), 8 (7.8%) were related to the maternal-fetal component of prevention, 2 (1.9%) were related to pregnancy prevention (PPV), and 8 (7.8%) were focused on substance abuse (SUB). 100% of the ALL and PPV policies were coded yes for the potential to apply additional CPT codes beyond the baseline prevention CPT codes. Results in the other categories varied. 88% of the IMM policies were coded yes, only 17% of the ANG policies were coded as yes.

CONCLUSIONS It is expected that anticipatory guidance is provided at every well-child visit and all of the other elements of preventive care are delivered as outlined in the Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule). Without additional CPT codes to recognize these efforts, the structure and inclusion of anticipatory guidance and other non-clinical prevention recommendations, is impractical and unrealistic. Additional studies must be conducted to generate evidence for the effective delivery of non-clinical preventive care, like anticipatory guidance, in order for the AAP to effectively advocate for more CPT codes or a new CPT coding structure for pediatric preventive health care.

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