TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > THSteps Medical and Dental Administrative Information

43.1.7.4 Medical Check Up, First 6 Days of Life

To encourage early check ups for high-risk but healthy newborns, providers may bill a THSteps medical check up in the first six days of life as an exception to periodicity. A physical examination is important if the client has been discharged early from the hospital or if the infant was born outside of a hospital. A home visit may be especially helpful for first-time mothers. The first regular check up on the periodicity schedule should still be scheduled at 1 to 2 weeks of age, is also reimbursable, and should include the second newborn screen.

The exception-to-periodicity check up performed in the first six days of life may be performed in a clinic, provider's office, or the family's home. If the check up is performed in the home, the provider must be designated by the discharging physician or the medical home physician before discharge and must provide a timely report of findings and recommendations to the infant's medical home.

Refer to: "Medical Home Concept" .

A THSteps medical check up in the first six days of life, billed as an exception to periodicity, must include the following documentation:

•Neonatal and family history.

•Review of systems.

•Height, weight, and head circumference.

•Physical and nutritional assessment.

•Vision and hearing screening.

•Age-appropriate immunization.

•Assessment of the mental health status of the infant and mother.

•Anticipatory guidance.

The metabolic screening should only be obtained if not obtained before discharge from the hospital. The repeat metabolic screening should be completed at the one- or two-week visit. If a potential or confirmed medical problem requires monitoring, it is recommended that the infant be seen in a clinic or medical provider's office, and the Texas Medicaid Program should be billed using codes for an acute care visit.