Tag: #HEDIS

Posted in Training, Updates

HEDIS Measure: Well-child visits in first 30 months.

Posted on by KR2Medical Billing

Bringing young children to see the primary care physician, for a well-care visit is extremely important.

These visits track:

Prevention: wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.

Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.

Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.

Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

Description of the measure:

Describes the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months.

The rates are reported as follows:

Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.

Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

In order to receive credit for this measure the following DX should be used:

  • ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2

The following CPT codes should be used:

  • CPT: 99381-99382, 99391-99392, 99461

The following HCPCS should be used:

  • HCPCS: G0438-G0439, S0302

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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Comprehensive Diabetes Care

Posted on by KR2Medical Billing

In this blog post we will explore the Comprehensive Diabetes Care HEDIS measure. .

What is New for 2020?

New measure Kidney Health Evaluation for Patient with Diabetes measure was added in 2020. This is a new measure. It evaluates the percent of members that are between 18 and 85 years of age that have diabetes and who received a kidney health evaluation, including estimated glomerular filtration gate test (eGFR) and a urine albumin-creating ration.

What is Comprehensive Diabetes Care Measure?

Measure that evaluates percentage of adult members between ages of 18 and 75 years of age (looks at both type 1 and type 2 diabetes) and who had each of the following:

  1. HbA1c testing
  2. HbA1c poor control (>9%)
  3. HbA1c control of (<8%)
  4. Retinal Eye Exam performed
  5. Blood Pressure Control (<140/90 mm/Hg)\

Documentation:

Record your efforts: document results of, all of the above mentioned test, in the patient’s medical record.

How to meet this measure?

  • Provide reminders to patients for upcoming appointments and screenings.
  • Draw labs in your office if available or refer patients to a local lab for screenings.
  • Refer patients to participating eye professionals for annual retinal eye exams.
  • Follow up on lab test, eye exams and specialist referrals and document in your chart.
  • Telephone visits, e-visits and virtual check-ins are acceptable settings for blood pressure readings and should be recorded in the chart.
  • Include Category II reporting codes on claims to reduce the burden of HEDIS medical record review.
  • Educate patients on topics (for example, home monitoring of blood sugar and blood pressure, taking medications as prescribed, and other healthy lifestyle education like diet, exercise, and smoking cessation).

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Posted in HEDIS Measures, Training, Updates

HEDIS Measure: Cervical Cancer Screening

Posted on by KR2Medical Billing

Description:

Cervical cancer screening is measured by the percentage of women, 21 to 64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women 21 to 64 years of age who had cervical cytology performed within the last 3 years.
  • Women 30 to 64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing performed within the last 5 years.
  • Women 30 to 64 years of age who had cervical cytology/high-risk human papillomavirus (hrHPV) co-testing within the last 5 years.

Note: Evidence of hrHPV testing within the past five years also captures patients who had co-testing; therefore, additional methods to identify co-testing are not necessary.

Documentation:

  1. For women age 24-64 as of Dec. 31 of the measurement year who had cervical cytology
    during the measurement year or the two years prior to the measurement year, documentation
    in the medical record must include both of the following:
    o A note indicating the date when the cervical cytology was performed
    o The result or finding

2. For women age 30-64 as of Dec. 31 of the measurement year who: 1) had cervical hrHPV
testing during the measurement year or the four years prior to the measurement years, and 2)
were 30 years or older as of the date of testing, documentation must include both:
o A note indicating the date the hrHPV test was performed; generic documentation stating
HPV test counts as evidence of hrHPV test
o The results or findings

Documentation that will not be accepted for this measure:

  1. Biopsies do not count
  2. Lab results that state the sample was inadequate or that no cervical cells were present are
    not acceptable unless it is also stated this finding is consistent with a hysterectomy
  3. Documenting hysterectomy is not sufficient; should note if the hysterectomy resulted in the
    loss of the cervix and include terms like total, complete or radical hysterectomy
Codes that apply to this HEDIS Measure

Exclusions:

1.Women who have had a total, complete or radical vaginal or abdominal hysterectomy with no
residual cervix, cervical agenesis or acquired absence of cervix; prior to Dec. 31 of the
measurement year
2. Hospice or palliative care during measurement years
3. Documentation of vaginal hysterectomy meets criteria for documentation of hysterectomy with
no residual cervix


HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
All summaries of the measures contained herein are reproduced w ith permission from HEDIS MY2020 and MY2021, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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