Please contact the Chapter's Nutrition Coordinator, Kylia Crane, RD, LD, with any questions regarding the information on this site at
Georgia WIC Program
A Physician's Reference
WHAT IS WIC?
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a short-term intervention program designed to influence nutrition and health behaviors in a targeted, high-risk population.
WHO IS ELIGIBLE TO PARTICIPATE?
Pregnant, breastfeeding, or postpartum women, infants and children under five years of age who meet the following:
• Resident of GA
• Income level ≤185% of poverty guidelines, or enrolled in Medicaid, TANF, or Food Stamps
• Nutrition risk must be documented
Those eligible may receive WIC services even if they are working, are under the care of a private physician, and/or have private insurance. To determine eligibility, clients must provide proof of ID, proof of residency and proof of income or Medicaid/food stamp enrollment.
CURRENT INCOME ELIGIBILITY GUIDELINES
(Effective for 2012 until further notice)
185% of Federal Poverty Guidelines
Persons in Family or Household size
Each Add'l Member Add..................
WHAT DO PARTICIPANTS RECEIVE?
• Quality Nutrition Education Services
• Breastfeeding Promotion and Education
• A Monthly Food Prescription - Nutritious foods tailored to supplement the dietary needs of participants
• Infants- formula/medical food, infant cereal, baby food fruits & vegetables (and infant meats if exclusively breastfed)
• Children- milk, cheese, tofu, eggs, juice, cereal, beans/peas or peanut butter, fruits & vegetables, and whole grain bread or alternative.
• Women- milk, cheese, tofu1 eggs, juice, cereal, beans/peas or peanut butter, fruits & vegetables, whole grain bread or alternative, and fish
• Referrals to other public health programs
• Referrals to healthcare and community services
WHEN AND HOW DOES THE PARTICIPANT RECEIVE WIC VOUCHERS?
The participant receives monthly food vouchers from their local health departments. These vouchers specify which foods the recipient is to receive. The vouchers are then redeemed by the participant through an approved vendor.
HOW LONG WILL PARTICIPANTS RECEIVE WIC SERVICES?
• Prenatal women can stay on the WIC program throughout their pregnancy until six weeks postpartum.
• Postpartum women may continue (if still eligible) until six months postpartum.
• Breastfeeding women may remain on the program for up to one year after delivery (if they continue to breastfeed).
• Infants may remain on the WIC program until their first birthday.
• Children may be eligible for WIC up to five years of age. They must be reassessed for eligibility every six months.
HOW DO I REFER MY PATIENTS OR PROVIDE A WIC PRESCRIPTION?
Please use Georgia WIC Referral Form and Medical Documentation for Special Food Substitution (FORM 2) for referrals. To access the GA WIC referral and medical documentation forms, and other WIC resources:
• Please visit http://wic.ga.gov/hcprovider.asp
• Contact the State WIC Office at 1-800-228-9173
• Contact your closest health department/WIC clinic, visit the WIC website at http://health.state.ga.us/wic_clinics/clinic_lookup.aspx
 Medical documentation must be provided for the substitution of extra cheese, tofu, or soy milk.
 Canned tuna or salmon for exclusively breastfeeding women
Physicians Outreach Campaign - Public Health Programs & Services
What are we doing?
Goal: To maximize utilization of public health programs services through a collaborative partnership between primary care physicians and public health.
The Georgia Chapter of the American Academy of Pediatrics and the Georgia WIC Program have established a statewide physicians outreach campaign to educate physicians and their office staff about WIC benefits/referral process and help address infant and child feeding issues, which can be supported by physicians and WIC staff to improve the nutrition status of women, infants and children. Education is provided to pediatricians, family physicians and obstetricians/gynecologist and their office staff on:
• WIC & Nutrition Services
• Breastfeeding support including the Peer Counselor & EPIC Breastfeeding Programs
• Folic Acid
• Expert Committee Recommendations on Prevention, Assessment & Treatment of Childhood Obesity
• Iron Deficiency Anemia Prevention
• New HealthCheck TB Screening Guidelines
• Georgia Lead Poisoning Prevention Guidelines and Referral Process
• USDA initiative of Value Enhanced Nutrition Assessment (VENA)
• Birth to Five (front door system)
• Children 1st – Single Point of Entry
• Universal Newborn Hearing Screening & Intervention (UNSHI)
• Newborn Metabolic Screening
• State Electronic Notifiable Disease Surveillance System (SENDSS)
• Developmental Surveillance & Screening and Referrals to Children 1st
• Health assessments for children in foster care
• Babies Can’t Wait and primary care physician participation
• High Risk Infant Follow-up
• Children’s Medical Services
• Medical Home
What do we want to achieve:
Implementation and evaluation of the effectiveness of the WIC Physicians Education model to assist physicians and office staff to effectively utilize WIC referrals, WIC benefits and nutrition in the following geographical areas of the State:
We are providing education to the primary care physicians, physician’s office staff and health department staff in each district using 3 different mediums of communication:
• Lunch and Learn Workshops
• Office Visits
• Educational Mailings
Georgia’s WIC Awards New Rebate Formula Contract to Nestlé Infant Nutrition
Georgia’s WIC has announced that Nestlé Infant Nutrition (Nestlé) has won the bid to be the rebate contractor of infant formula for Georgia’s WIC. The newly awarded contract will transition to Nestlé from Abbott Nutrition. The contract with Nestlé will go into effect October 1, 2010 through September 30, 2013.
Approximately every three years, WIC State agencies are required by law to seek competitive bids for the provision of contract infant formulas. WIC State agencies receive a rebate for each can of contract infant formula purchased by WIC participants. Having a formula contract maximizes resources such as nutrition services for WIC clients and the patients we serve. As a result of awarding the contract to a new formula manufacturer, there will be changes to Georgia’s WIC approved formulas.
In addition to the infant formula contract process, Georgia’s WIC provided a public comment period in the form of a survey this summer. This survey allowed our medical community the opportunity to provide suggests, feedback, and/or concerns in an effort to improve Georgia’s WIC services. Also, we were encouraged to provide feedback to the prescribing process regarding Georgia’s WIC special formulas and medical documentation forms.
With the new contract, the following standard cow’s milk and soy contract formulas will not require a prescription:
• Gerber Good Start Gentle PLUS
• Gerber Good Start Gentle PLUS 2 (age 9-11 months)*
• Gerber Good Start Soy PLUS
• Gerber Good Start Soy PLUS 2 (age 9-11 months)*
*No prescription required for issuance age 9-11 months. Issuance to a child, i.e. above 1 year requires medical documentation.
Similac Advance EarlyShield, Similac Sensitive Isomil Soy (formerly Isomil Advance with Iron), Similac Go & Grow EarlyShield Milk-Based and Similac Go & Grow EarlyShield Soy-Based will no longer be approved for Georgia’s WIC (even with a prescription) due to the change of contract.
The complete listing of all Georgia's WIC approved formulas and medical foods requiring medical documentation can be found at www.wic.ga.gov under the Health Care Provider link.
This new contract will be effective October 1, 2010; however, low risk WIC participants can receive up to three months of formula vouchers. Therefore, members are reminded that participants could receive Nestlé vouchers with a first day to use in October, starting in August 2010.
Please remember that we share the vision to encourage and support WIC mothers to breastfeed as the optimal source of nutrition. WIC eligible moms that decide not to breastfeed should be given a WIC contracted formula or an alternative formula that is medically indicated.
The Chapter will continue to provide your practice with information and resources via The Georgia Pediatrician, and on our website www.gaaap.org. If you have any questions regarding this information, please contact Kylia Crane, RD, LD, Nutrition Coordinator at (404) 881-5093 or via email at
Stanley Cohen, MD, FAAP
Chairman, Committee on Nutrition
Changes to the Georgia WIC Food Packages 2009
On October 1, 2009, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) significantly changed the food packages that participants receive. The changes to the WIC food packages are designed to improve the nutrition and health of pregnant women, breastfeeding and non breastfeeding postpartum women, infants and children up to age five. The new food packages promote and support the establishment of successful, long-term breastfeeding, provide WIC participants with a wide variety of foods including fruits, vegetables, and whole grains, and provide greater flexibility in tailoring food packages to accommodate the cultural food preferences of WIC participants.
Why are these changes occurring?
On December 6, 2007, the interim rule revising the WIC food package was published in the Federal Register. The revisions largely reflect recommendations made by the Institute of Medicine (IOM) of the National Academies in its report, “WIC Food Packages: Time for a Change”. The last revisions to the WIC food packages occurred in 1980. IOM’s final report contained recommendations to have the food packages align with the 2005 Dietary Guidelines for Americans and infant feeding practice guidelines of the American Academy of Pediatrics.
Highlights of the NEW Food Package
• Addition of baby foods - fruits and vegetables for all infants and meat for exclusively breastfed infants
• Modified infant formula amounts to reflect varying needs at different ages
• Addition of a fruit and vegetable voucher (Fresh / Frozen / Canned)
• New Whole Grain Options for Women and Children (Bread / Brown Rice / Whole Grain Tortillas)
• Whole Grain Cereals- At least half of the cereals on the Approved Food List MUST be Whole Grains
• Required issuance of low fat milk for children over 2 years of age and women
• Soy Milk and Tofu allowed
• Reduced quantities of milk, eggs, and juice and cheese for women and children
Reinforces Nutrition Education Messages
The new food packages are consistent with the nutrition education messages provided to participants:
• Eat more fruits and vegetables
• Decrease saturated fat
• Increase whole grains and fiber
• Drink less sweetened beverages and juice
• Babies are meant to be breastfed
Provides greater consistency with infant feeding practice guidelines
Modifies infant formula amounts based on age and feeding method. Infant foods are added and juice eliminated in the packages for older infants in order to promote healthy dietary patterns.
Provides culturally diverse foods
The new food packages provide more participant choice and a wider variety of foods than the previous food packages. Foods such as tortillas, brown rice, soy-based beverage, canned salmon, and a wide choice of fruits and vegetables will provide State agencies increased flexibility in prescribing culturally appropriate food packages.
The food packages for the breastfeeding infant-mother dyad provide stronger incentives for continued breastfeeding, including providing limited formula to partially breastfed infants during the first month of life. Additional quantities and types of food are provided to breastfeeding mothers.
How does this impact my practice?
Approximately 51% of Georgia infants and children qualify for the WIC program, which means a significant number of your patients are receiving WIC benefits. These changes will not only affect the choices of foods that your patients can receive but it will also require you to individualize the package based off your patient’s unique medical needs. Significant changes have been made for the process for writing WIC prescriptions for special formulas & medical foods.
Medical documentation ensures that you have approved the issuance of special formulas & medical foods that are appropriate for your patient’s specific medical needs. The goal of the new medical documentation requirements is to improve communication and coordination of care between WIC, the family, and the medical home. This will also ensure that there is appropriate justification for the use of special formulas & medical foods.
• Medical documentation is required in the following situations:
• Any infants receiving non-contract/exempt or specialty infant formula or WIC eligible medical food
• Allowable supplemental foods to be provided in addition to the formula, for those participants receiving exempt or specialty infant formula or WIC eligible medical food
• Children receiving milk substitutions of soy beverage, tofu, or extra cheese
Note: Medical documentation is not required for the following GA WIC contract formulas:
• Similac Advance EarlyShield & Isomil Advance with Iron
• The new requirements for GA WIC approved special formulas and medical foods include:
• Name of authorized WIC formula or WIC-eligible medical food. Must be prescribed in ounces (reconstituted fluid) per day
• Qualifying condition(s) for issuance of WIC formula prescribed and/or supplemental food authorized and ICD-9/ICD-10 code
• Length of time (1-6 months) the prescribed WIC formula and/or supplemental food is required by the participant
• Original signature, date and contact information of the requesting health care provider. No signature stamps will be accepted
• Must specify foods allowed for all clients on special formulas (age 6 months & older)
• Can ONLY be signed by a physician, physician assistant, or nurse practitioner
• Physician must authorize the issuance of any tofu or soy milk to children
• Examples of Non-Specific Diagnoses that will not be accepted for special formulas and medical foods include: colic, milk allergy, milk/formula intolerance, feeding problems, poor appetite, inadequate intake, and digestive disturbances
• New Medical Documentation Forms have been created to make it easier to document the specific information required by the United States Department of Agriculture regulations. Using the GA WIC Medical Documentation Forms (Form #1 and Form #2) and completing them appropriately will save your practice valuable time and effort.
• Use Form #1 to prescribe special formulas and/or medical foods and to approve the WIC foods allowed based on a patient’s medical condition(s). Instructions and resources for form completion are included.
• Use Form #2 to provide referral data and to authorize special food substitutions for children
These fillable forms can be saved, printed, signed and then faxed to the local WIC clinic or provided to the WIC participant.
The Georgia WIC Program has developed a webpage for healthcare providers to access GA WIC forms and resources ( Medical Documentation forms 1 & 2, WIC Formula Guide, WIC Approved Food List, and Medical Community Video)
Please visit the following link to view this information
Frequently Asked Questions (FAQs) – New Georgia WIC Medical Documentation
Q. Can providers use their own prescription pads for formula/medical food prescriptions?
The GA WIC Program will allow you to use the doctor's prescription pad for WIC special formulas and approved WIC foods, but it must have ALL of the following information:
1. Patient's first & last name
2. Patient's Date of Birth
3. Parent/Caregiver's first & last name
4. Qualifying diagnosed medical condition and applicable ICD-9 or ICD-10 code
5. Name of formula/medical food requested
6. Prescribed amount of special formula per day (oz/day)
7. Form of special formula (powder, concentrate, or ready-to-feed)
8. Planned length of use for special formula (1-6 months)
9. WIC Foods- Patient may receive supplemental foods appropriate to their WIC participant category in addition to the approved special formula. If you have no restrictions to WIC Supplemental Foods- It must say "No Supplemental Food Restrictions." If there are restrictions, you must list which food that should not be issued to participant. Infants 6-11 mo. (infant cereal, baby food fruits & vegetables), Children >12 mo. & women (milk, beans/peas, vegetables, fruits, juice, cheese, peanut butter, whole grains, canned fish, cereal, & eggs)
10. Must have provider's name, title, provider's original signature/credentials, and date
11. Medical Office Name, street address, city, zip code, phone number, and fax number
Due to the amount of detailed information that has to be included for documentation, it is highly recommended that providers use the Medical Documentation Form 1.
Q. How often do WIC participants need to provide new medical documentation paperwork?
Medical Documentation must be renewed at least every 6 months. New copies must also be provided at every certification, recertification, or mid-certification appointment if the date the authorized health care provider signed the most recent medical documentation form is more than 30 days old at the time of the certification appointment.
Q. Can WIC accept a verbal order for medical documentation?
Yes, WIC must document all details of the verbal order in the participant’s WIC record and sign & date the documentation. Only one month of vouchers may be issued to the participant. The WIC clinic must receive written medical documentation within 2 weeks of the verbal order. No additional voucher may be issued until written medical documentation is received (e.g., cannot accept a 2nd verbal order).
Q. Which infants ages 6-11 months are eligible to receive more formula if they cannot tolerate solid foods?
Only infants who have a qualifying medical condition and who are receiving an “exempt infant formula” or a “medical food” are eligible to receive additional formula in place of solid foods, if medically indicated. Infants ages 6-11 months who are receiving a standard “infant formula” cannot receive additional formula even if they are unable to consume solid foods (e.g., are being tube-fed a standard infant formula).
Q. What are examples of qualifying conditions for issuing tofu, soy milk, or extra cheese on Form #2?
Tofu or Soy Milk = Lactose intolerance, vegan / vegetarian diet, milk protein allergy, religious / cultural reasons (e.g., Russian Orthodox). Extra Cheese = Lactose intolerance, underweight per BMI, inadequate weight gain during pregnancy, increased calorie needs due to a medical condition or illness.
Q. What are examples of non-specific medical diagnoses that cannot be accepted on Form #1?
Colic, milk allergy, multiple food allergies, spitting up, milk intolerance, formula intolerance, feeding problems, feeding difficulties, picky eater, poor appetite, inadequate intake, constipation, cramps, digestive disturbances, fussiness, gas. The following diagnoses must have another underlying medical condition present and documented: “underweight,” “inadequate / poor weight gain,” “inadequate / poor growth,” and “feeding disorder.” The Georgia WIC Program cannot accept any of these diagnoses alone – a more specific, primary medical condition must be present and listed among the diagnoses (e.g., Cerebral Palsy, Failure To Thrive, Oral-Motor Feeding Disorder, Prematurity, Dysphagia, etc.).
Q. What if the number of ounces of formula prescribed per day on Form #1 is more or less than WIC can issue to a participant?
If the health care provider prescribes more than the maximum monthly allowance of special formula or medical food for any participant, WIC can only issue the maximum monthly amount allowed by WIC policy. The participant should be educated about the maximum monthly allowance of formula based upon the participant category, age, feeding method, etc.
If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for an infant, WIC must still issue the maximum monthly allowance based on age and feeding method. This is to ensure that the full nutritional benefit is provided and to account for infant age changes and corresponding formula maximum allowance changes that may occur during the 1-6 month time period during which the medical documentation is valid.
If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for a child or woman, WIC must only issue the amount prescribed by the health care provider in addition to any authorized supplemental foods.
Q. Can WIC accept a range of ounces for the formula prescribed per day on Form #1?
Yes. Ranges of formula can be accepted. However, the amount of special formula or medical food issued to the participant can never exceed the maximum monthly allowance based on WIC policy.
Q. Can the health care provider write “up to,” “ad lib,” “PRN,” or “WIC maximum” for the amount of formula prescribed per day on Form #1?
No. An actual quantity of formula must be listed.
Q. What is the cutoff for accepting medical documentation based on the date it was signed by the provider?
Medical documentation must have been signed by the health care provider no more than 30 days prior to when it is received by the WIC clinic.
Georgia WIC Program Qualifying Medical Diagnoses Guide for Special Formulas & Medical Foods
Examples of Qualifying Medical Conditions
• Premature birth
• Low birth weight
• Failure to thrive
• Inborn errors of metabolism & metabolic disorders
• Gastrointestinal disorders
• Malabsorption syndromes
• Immune system disorders
• Severe food allergies requiring the use of an elemental formula
• Other life-threatening disorders, diseases, or medical conditions that impair the ingestion, digestion, absorption or utilization of nutrients that could adversely affect the participant’s nutritional status
Examples of Non-Qualifying / Excluded Medical Conditions
• Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying condition
• Non-specific formula intolerance or food intolerance
• Participant preference, parental preference, or food dislikes
Examples of Non-Specific Medical Diagnoses That CANNOT Be Accepted by the Georgia WIC Program
• Milk Allergy
• Multiple Food Allergies
• Spitting up
• Milk intolerance
• Formula intolerance
• Feeding problems
• Feeding difficulties
• Poor appetite
• Inadequate intake
• Digestive disturbances
Diagnoses Requiring An Underlying Medical Condition
• Feeding disorder
• Inadequate or poor weight gain
• Inadequate or poor growth
These diagnoses cannot be used alone.
An allowed underlying medical condition must be present and documented in the diagnosis area if any of these diagnoses are used (e.g., Cerebral Palsy, Failure To Thrive, Oral-Motor Feeding Disorder, Prematurity, Dysphagia)
September is National Childhood Obesity Awareness Month!!! AAP has posted a Take Action Alert this month for members to contact your legislators to support healthy school meal policies, specifically the Hunger-Free Kids Act. As you may recall, this legislation passed but received lots of media attention when changes to the bill allowed pizza sauce to count as a vegetable and certain potatoes to remain on school lunch menus. The AAP is urging members during this important month to take action and encourage members of congress to support the implementation of the bill. Please see AAP information below.
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|September is National Childhood Obesity Awareness Month, and as children across the country head back to school and as Congress prepares to return to Washington next week after a month-long August recess, AAP is calling on our nation’s leaders to support strong school lunch policies. New School Year, New School LunchesFor more than half a century, the National School Lunch and Breakfast Programs have alleviated hunger and malnutrition for our nation’s school children.In 2010, Congress passed the Healthy, Hunger-Free Kids Act, a law championed by AAP, which directs the United States Department of Agriculture to update the nutrition standards for school meals.As part of the law’s ongoing implementation, new school lunch nutrition standards will go into effect this school year, providing 32 million children with nutritious lunches containing more servings of fruits, vegetables and whole grains, a shift to low-fat or nonfat milk, and age-based limits on calories, sodium and unhealthy fat. This represents the first change in school lunches in 15 years, and marks a substantial shift toward healthier, more nutritious meal options for children.Despite the law’s progress, schools will need support to fully implement this school meal policy. Last year, Congress approved language to undermine strong school nutrition standards by allowing pizza to count as a vegetable and allowing certain potatoes to remain on school lunch menus. In addition, the new law makes schools eligible to receive an additional six cents per school lunch served if they can provide healthy meals that meet the new standards. It is important that Congress continues to support schools as they update food preparation facilities and equipment necessary to provide healthier options. Children consume up to half of their daily calories at school; nutritious school lunches can play an important role in fighting childhood obesity. Take Action: During National Childhood Obesity Awareness Month, please urge your senators and representative to support the implementation of new school meals standards and help keep our children healthy. Learn More:
Expert Committee Recommendations
The Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity were released in June 2007, with the writing papers published in the December Supplement of Pediatrics. The committee, made up of representatives from fifteen health professional organizations including the American Academy of Pediatrics, was convened by the American Medical Association (AMA) and co-funded in collaboration with the Department of Health and Human Services' Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).
The AMA, HRSA and the CDC, recognizing that obesity is a major public health problem, assembled an expert committee of representatives from organizations involved in medicine, nutrition, mental health, epidemiology and psychology to update the 1997 recommendations for the care of overweight and obese children. The National Initiative for Children’s Healthcare Quality (NICHQ), together with key partners, has created an Implementation Guide to accompany the newly released Obesity Recommendations.
Message from the Chair of the Chapter's Committee on Nutrition
The Committee on Nutrition of the Georgia Chapter, American Academy of Pediatrics is committed to decreasing the prevalence of obesity in the children of this state. You are probably familiar with the statistics. The newest studies are even more frightening. Preliminary data indicates that in Georgia, eighteen percent of eighth graders and twenty five percent of 4th graders are over the 95th percentile for weight.
The task will not be easy, but it is obviously important. We are asking the pediatricians of Georgia to help evaluate these children and guide their families.
The following materials should be helpful to you in evaluating your patients:
1) Parents: Nutritional Help for you and your children is a listing of recommendations from the Georgia Chapter’s Committee on Nutrition that you can give to your patients. You are welcome to adapt this to your practice and substitute your own practice name if you wish.
2) Instructions for calculating the Body Mass Index (BMI) for your patients, and the appropriate charts for converting these raw numbers into a meaningful percentile for age (please remember these scores may not be entirely accurate for active athletes).
• Body Mass Index (BMI)
How do you measure overweight and obesity in children?
Expert Committee Recommendations on obesity evaluation and treatment suggest using Body Mass Index (BMI)/ Age Percentile as the main tool to assess weight in children age 2-20. BMI is a single number that evaluates an individual's weight status in relation to height.
Why use BMI?
Use of BMI/Age Percentile to assess children provides a consistent measure across age groups. It correlates with measures of body fatness in children and adolescents. BMI is the standard measure used by the Centers for Disease Control and Prevention in the revised U.S. growth charts that were released in May 2000 and are available at the following website: www.cdc.gov/growthcharts or order from the American Academy of Pediatrics.
How do I calculate BMI using handheld calculator:
• Metric [Weight in kilograms ÷ Height in cm ÷ Height in cm] x 10,000
• English [Weight in pounds ÷ Height in inches ÷ Height in inches] x 703
There are various computer and palm pilot applications available to calculate BMI. You will enter the child’s age, height and weight and it will calculate the BMI.
Palm Pilot: http://www.keepkidshealthy.com/pediatricpilotpage/mathpad.html
How do I define overweight & obesity in my patients?
A child that has a body mass index above the 95th percentile for his or her age is considered obese. A child with a body mass index above the 85th percentile for his or her age is considered overweight.
3) A list of ICD-9 Codes that may be appropriate in billing for your services. (see below)
We hope this will help in your care of obese children and those at risk. Thank you for efforts to combat the obesity epidemic in Georgia.
Stanley A. Cohen, MD
Chair, Nutrition Committee
Obesity Reimbursement and Coding
The AAP Committee on Nutrition (CON) with other AAP committees and sections has recognized the difficulties in getting reimbursement for obesity treatment and prevention. Until the Centers for Medicare and Medicaid Services recognize obesity as a disease, coverage and reimbursement will be denied. AAP is addressing this issue to advocate for improved coverage and reimbursement by managed care plans and private and public insurers.
Correct diagnosis coding rules stipulate that the code for the diagnosis, condition, problem or other reason for an encounter shown in the medical record to be chiefly responsible for the services provided be reported. Additional codes can and should be reported describing any coexisting conditions that require or affect patient care treatment or management during a particular visit. If these conditions are not addressed during the course of a particular visit, they would not be reported. History codes (V10 – V19) may be used as secondary codes if the patient or family history impacts current care or influences treatment. These reported codes must be shown by documentation that the condition requires or affects patient care or management.
At times there are no other problems, history or diagnoses that can be reported in addition to the diagnosis of obesity (278.00) or morbid obesity (278.01).
Obesity related conditions or diagnoses that are commonly treated and addressed include:
780.71 Chronic fatigue syndrome
780.79 General fatigue
780.57 Sleep apnea
701.2 Acanthosis nigricans
277.7 Dysmetabolic syndrome X
V18.0 Family history diabetes
V18.1 Family history endocrine/metabolic disturbance
732.4 Blount’s Disease
313.81 Oppositional behavior disorder
V61.20 Parent-child dysfunction
259.1 Early pubertal development
The AAP has created an obesity and related co-morbidities coding fact sheet for primary care pediatricians.
SHAPE Act Pilot Project Underway in 5 School Systems
The Georgia Student Health and Physical Education (SHAPE) Act was passed in the 2009 Georgia legislative session and is now Official Code of Georgia 20-2-777. Beginning in the 2011-2012 school year, each local school district is to conduct an annual fitness assessment program for all students in grades 1 - 12 enrolled in Georgia public school physical education classes taught by certified physical education teachers.
Georgia Dept. of Education (DOE) had begun a pilot program, which includes training and testing within five school systems (about 200 schools) being conducted during the 2010 school year in grades 4-12. The school systems who have agreed to participate in the pilot program are Gwinnett, Bibb, Hall, Lowndes, and White. Statewide implementation will be conducted during the 2011-2012 school year.
Activities of the pilot include:
Testing: Fitness testing includes cardio-flexibility test, muscular strength endurance and body composition. Fitness testing will be done on students in grade 1-12 but data will be recorded on grade 4-12 (except for body composition that will be recorded on grade 1-12 as well).
• Training teachers
• Data collection and reporting by schools
• Evaluation of training, data accuracy, fitness testing accuracy
• Acquire teachers’ feedback, including student and parent response
Standardized fitness testing is a useful tool for all schools to monitor trends and changes, collect data, and improve programs, curriculum and policy. Just like academic testing, standardized testing for physical education classes provides these same benefits and opportunities for improvement. Participating schools will not just be in compliance of the law, but they will also receive rewards and recognition incentives. Additionally, this will allow Georgia schools to monitor data from the testing to improve their physical education programs.
The Chapter will continue to share this information from the Georgia Department of Education and the Georgia SHAPE Partnership as this information is made available.
Click on the links below for Georgia DOE SHAPE Resources:
• Frequently Asked Questions
• Talking Points
(as of March 2011)
New School Program Designed to Improve Nutrition & Physical Activity
Fuel Up To Play 60
What is Fuel Up to Play 60?
Created in partnership by National Dairy Council (NDC) and the National Football League (NFL), the Fuel Up to Play 60 program empowers youth to take actions to improve nutrition and physical activity at their school and for their own health.
The ultimate goal is to ensure changes made at school are sustainable, making it possible for children to have more opportunities to be physically active and to eat tastier options of nutrient-rich foods like low-fat and fat-free milk, fruit, whole grains and vegetables throughout the school campus. By making changes in the school environment, students are more likely to meet the government recommendations for daily physical activity of 60 minutes and eat the appropriate number of servings from the food groups youth need most.
The U.S. Department of Agriculture (USDA) has joined Fuel Up to Play 60, along with multiple health organizations and several major corporations. Fuel Up to Play 60 is funded with an initial private sector financial commitment of $250 million over five years by America’s Dairy Farmers. Funding is expected to grow as government, business, communities and families join this effort. More than 58,000, or 60 percent, of the nation’s 96,000 private and public schools are currently enrolled in Fuel Up to Play 60.
This effort is needed now, more than ever. It is possible that today’s children could become the first American generation with a shorter life expectancy than their parents. One-third of American children are overweight or obese. The obesity prevalence is about three to four times that of just one generation ago, according to the Centers for Disease Control and Prevention.2,
How does the program work?
Fuel Up to Play 60 leverages the excitement of the NFL and applies social marketing principles to influence actions and behaviors and motivate youth to invest in their own health and take action to improve their school. The program lets students take the lead to develop nutrition and physical activity action strategies and engage the whole student body in the program.
Fuel Up to Play 60 has fun action strategies for students to plan, implement and participate in for themselves and their school. Students help lead and design the strategies to create more options for being physically active and eating more healthy foods.
Social Marketing Campaign
Interactive Web site (www.FuelUpToPlay60.com) where students can sign up and take the pledge, play games and track healthy behaviors.
Promotions include social media sites, in-school pep rallies, promotional displays, local events with NFL players (in some areas) rewards and prizes.
Support Systems for Adult Program Advisors
Free Fuel Up to Play 60 Wellness Activation Kit for schools. Available at wwwFuelUpToPlay60.com, the kit includes healthy eating and physical activity programs and tools, such as posters, healthy habits pledge cards and tracking sheets. These resources will help students and adult advisors in co-creating and leading tailored Fuel Up to Play 60 efforts in their schools.
Grants to facilitate schools making lasting improvements in nutrition and physical activity are also available in select areas (on a competitive basis).
 Kluger, J. How America’s children packed on the pounds. TIME, June 23, 2008; 68.
 Ogden, CL, Carroll, MD, Flegal, KM. High body mass index for age among US children and adolescents, 2003-2006. Journal of the American Medical Association. 2008; 299 (20): 2401-2405.
Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, Prevalence of Overweight Among Children and Adolescents: United States, 2003-2004.
This information was provided by the Southeast United Dairy Industry Association, Inc.
Breastfeeding-Best for Baby and Mother
Breastfeeding is acknowledged as the preferred method of infant feeding by the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the National Association of Pediatric Nurse Practitioners, The National Healthy Mother/Healthy Babies and others.
Scientific research overwhelming indicates that breastfeeding is the superior method of feeding. Breastfeeding significantly lower rates of diarrhea ear infections and lowers respiratory illness. There are a number of studies that show a protective effect of human milk feeding against necrotizing enterocolitis, sudden infant death syndrome, allergic disease, early childhood caries, insulin-dependent diabetes, and obesity. Developmentally, breastfed infants have better visual acuity, and evidence suggests that their cognitive development is very good!
Benefits to Mom:
- Women who breastfeed have less vaginal bleeding and less risk of hemorrhage after birth.
- Milk production requires 500-1000 calories a day. One-half of the calories from body fat stored during pregnancy. Women who breastfeed lose pregnancy weight more easily than women who formula-feed.
- Breastfeeding reduces the risk of breast cancer in young women. The longer you breastfeed, the lower your risk.
- Breastfeeding reduces the risk of uterine cancer and ovarian cancer.
- Breastfeeding improves bone density and reduces the risk of hip fractures in older women.
- Breastfeeding requires no mixing, no measuring, and no clean-up, making nighttime feedings quick and easy.
- Breast and babies are portable.
- Breastfeeding promotes a special relationship between a mother and her baby.
- Parents who breastfeed save more than $1000 in infant feeding cost during the first year alone
- Benefits to Baby:
- Human milk is nutritionally perfect for human infants.
- Human milk changes to meet the needs of a growing baby.
- Human milk is easily digested, so breastfed babies have less gas, colic and spitting up.
- Human milk contains important nutrients as well as special protective factors that we listed earlier: Less diarrhea, fewer urinary tract infections, fewer ear infections etc.
- Breastfeeding gives babies a chance to touch, to smell, to hear, to see, to taste, to know their mother from the first moment of birth.
Barriers to Breastfeeding:
Special attention should be given to barriers to breastfeeding for all women especially African American and other minority women. Below are several barriers to breastfeeding that where identified in focus group findings.
- Lack of social support
- Worried about not enough milk
- Lack of support at work or school
- Worried about having to eat well
Studies show that mothers who receive advice, information and encouragement from their physicians to breastfeed are more likely to breastfeed than those who do not receive such advice.
The American Academy of Pediatrics Policy Statement outlines physicians roles in the promotion and protection of breastfeeding. (Pediatrics, Vol. 100 No. 6 December 1997, Pgs. 1035-1039) or view it on the web by accessing www.aap.org/policy/re9729.html
We can work together to increase breastfeeding in Georgia!
How WIC can help you support Breastfeeding
- WIC encourages all pregnant women to breastfeed their infants unless contraindicated for health reasons.
- Breastfeeding women receive nutrition counseling and a greater variety and quantity of food than non-breastfeeding, postpartum women.
- Breastfeeding women are taught to hand express breast milk, however in most districts, women can be provided with a manual and/or electric pump.
- Breastfeeding women are taught the signs of adequate intake for breastfed infants:
- Nursing 8-12 times per 24 hours.
- Wet diapers at least 6 times per 24 hours.
- Several stools per 24 hours, in first month.
- Softening of the breast after feeding.
- Visual and audible signs of swallowing.
- Weight gain over time.
Each health district has a Breastfeeding Coordinator that plans, directs and coordinates the breastfeeding promotion, education and support for breastfeeding women in their districts.
Please see the American Academy of Pediatrics recent policy statement, which highlights the need for important collaboration between Pediatricians and local WIC Programs to ensure that infants and children receive high-quality, cost-effective health care and nutrition services. (Pediatrics, Vol. 108 No. 5 November 2001, pgs. 1216-1217) or view it on the web by accessing: www.aap.org/policy/re0066.html
Breastfeeding Handout: The Georgia Physician Breastfeeding Advisory Committee (PBAC) is a collaborative effort among Family Physicians, OB/GYNs, Pediatricians, and lactation experts to promote breastfeeding in the state. We have developed a patient handout, which you are encouraged to copy and distribute, to assist our patients in initiating breastfeeding successfully and continuing to nurse for a significant time period. You can access the handout by visiting: http://www.gaaap.org/duringpregnancyhandout.pdf)
The AAP has created a coding fact sheet, Supporting Breastfeeding and Lactation: The Primary Care Pediatricians' Guide to Getting Paid.
- Are you looking for local breastfeeding and lactation resources? This helpful guide provides you with resources specific to your area.
- Georgia Lactation Resources and Support Directory
- American Academy of Pediatrics Breastfeeding Section http://www.aap.org/breastfeeding/
- Georgia Breastfeeding Coalition, http://georgiabreastfeedingcoalition.freewebspace.com/
- Healthy Mothers Health Babies of Georgia Powerline; (770) 451-0020 and 1-800-822-2539
- Georgia Poison Control Center; Grady Memorial Hospital, Atlanta, GA.; (404) 616-9000 or (800) 282-5846
- Answers to questions on Drugs and Lactation
- The National Women's Health Information Center http://www.4woman.gov/breastfeeding/; 1-800-994-WOMAN
Books and Manuals:
- Breastfeeding: A guide for the Medical Profession, by Ruth Lawrence C.V. Mosby Co., St. Louis, MO. 1999.
- Breastfeeding: A Parent’s Guide, Amy Spangler; Abby Drue Inc., U.S. 2000.
- Breastfeeding and Human Lactation, by Jan Riordan and Kathleen Auerbach; Jones & Barlett, Publishers, Boston, MA. 1999.
- The Breastfeeding Answer Book, by La Leche League International; La Leche League International, Franklin Park, IL. 1991.
- Medication and Mothers’ Milk, by Thomas Hale; Pharmasoft Medical Publishing, Amarillo, TX. 2008.
Breastfeeding: A Special Relationship (also available in Spanish)
Breastfeeding Education Resources, Raleigh, NC.
Handouts are available with the video
Breastfeeding the WHY To (great for lending to patients)
VIDA Health Communication, Cambridge, MA.
- American Academy of Pediatrics www.aap.org
- AAP's Parenting Website www.healthychildren.org
- Georgia's Nutrition And Physical Activity Initiative http://health.state.ga.us/nutandpa/
- United States Department of Agriculture/ Food Nutrition and Consumer Services - USDA/FNS
- Healthy Mothers, Healthy Babies Coalition of Georgia - http://www.hmhbga.org/
- Centers for Disease Control and Prevention - CDC
- American Dietetic Association - ADA
- Georgia Coalition for Physical Activity and Nutrition - GPAN
- Bright Futures - Bright Futures
- Southeast United Dairy Industry Association, Inc - SUDIA
Examples of Non-Qualifying / Excluded Medical Conditions
- Solely for the purpose of enhancing nutrient intake or managing body weight without an underlying condition
- Non-specific formula intolerance or food intolerance
- Participant preference, parental preference, or food dislikes
Examples of Non-Specific Medical Diagnoses
That CANNOT Be Accepted by the Georgia WIC Program
- Milk Allergy
- Multiple Food Allergies
- Spitting up
- Milk intolerance
- Formula intolerance
- Feeding problems
- Feeding difficulties
- Picky eater
- Poor appetite
- Inadequate intake
- Digestive disturbances
Diagnoses Requiring An Underlying Medical Condition
- Feeding disorder
- Inadequate or poor weight gain
- Inadequate or poor growth - These diagnoses cannot be used alone.
An allowed underlying medical condition must be present and documented in the diagnosis area if any of these diagnoses are used (e.g., Cerebral Palsy, Failure To Thrive, Oral-Motor Feeding Disorder, Prematurity, Dysphagia)