Category: HEDIS Measures

Posted in HEDIS Measures, Training, Updates

BCBS Empire NY Medicaid: Summary of changes for HEDIS Measures from NCQA (2020/2021)

Posted on by KR2Medical Billing

Source: Empire Health Plus Plan (NY Managed Medicaid Plan)

Revised measures:

  • The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well‑Child Visits in the First 30 Months of Life (W30). It includes two indicators:
    • Well-child visits in the first 15 months — children who turned 15 months during the measurement year with six or more well-child visits
  • Well-child visits for ages 15 to 30 months — children who turn 30 months during the measurement year with two or more well-child visits
  • The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):
    • The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Key measure changes:

  • Controlling High Blood Pressure (CBP and CDC-CBP)
    Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.
  • Telehealth updates
    NCQA has updated telehealth guidance in 40 HEDIS® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:
    • Support increased use of telehealth caused by the pandemic.
    • Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.

Posted in HEDIS Measures, MIPS, MU Stage 2 and 3, NY Medicaid EHR incentive program, Training

HEDIS Measure- Controlling High Blood Pressure

Posted on by KR2Medical Billing

Definition: The percentage of patients that are ages 18 to 85 years old, who have had a diagnosis of hypertension (HTN) and whose blood pressure was adequately controlled (<140/90 mm Hg) during the measurement period.

What is Accepted:

DOCUMENT YOUR EFFORTS! Blood pressure and DX of HTN (high blood pressure).

DX code:  I10

Medical Billing and coding:

Code Description
3077F Systolic is greater than/ equals to 140
3074F, 3075F Systolic is less than 140
3080F Diastolic is greater than/equal to 90
3079F Diastolic 80-89
3078F Diastolic less than 80
93784,93788,93790,99091,99453,99454,99457 Remote  Blood Pressure Monitoring codes
98966, 98967,98968,99441,99442,99443 Telephone visits
95, GT      Telemedicine Modifiers/ POS 02 (place of service)

Patients that have BP adequately controlled include:

+Patients 18 to 85 years old who had a diagnosis of HTN and whose BP was adequately controlled during the measuring period

+ Patients who had a most recent BP reading during the measurement period year or had a BP measurement after the second diagnosis of HTN.

If no BP is recorded during the measuring period year, than it is assumed that BP is not controlled.

Exclusions:

1. Patients with ESRD

2. Patients with Nephrectomy or Kidney transplant

3.Pregnant patient

4.Nonacute inpatient stay

5. Patients aged 66 to 80 years old with frailty and advanced illness

6. Patients 81 years old and above with frailty

What is not accepted in this measure:

– If BP was taken on same day as a diagnostic test or procedure  was done or for a change of diet or medication regiment

– If BP was taken a day before or on the same day of any test or procedure

– BP taken during an acute inpatient stay or at the emergency department.