Tag: #HEDIS

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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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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HEDIS Measure: Use of Imaging Studies for Low Back Pain

Posted on by KR2Medical Billing

HEDIS Measures get updated every year. In this post we will discuss the proper coding and billing for HEDIS Measure: Use of Imaging Studies for Lower Back Pain; and list the changes for the upcoming 2022 year. This measure applies to all types of insurances: Medicare, Commercial, and Medicaid.

Background:

One out of every four patients you see in your office has low back pain. The Centers for Disease Control and Prevention (CDC) reports that in the last three months, 25% of U.S. adults report having low back pain, making it second only to the common cold as a cause for lost work time and a primary reason for a doctor’s visit.  Back pain will usually go away on its own. About 90 percent of patients with low back pain recover within six weeks.

What causes back pain?

HEDIS Measure: Use of Imaging Studies for Low Back Pain Definition-
Members 18-50 years of age with a new primary diagnosis of low back pain in an outpatient or ED visit who did not have an x-ray, CT or MRI within 28 days of the primary diagnosis. A higher score indicates appropriate treatment of low back pain (i.e., the proportion for whom imaging studies did not occur)

Proper Medical Coding:

CPT codes for imaging Studies-

List of Proper DX codes:

Measure Exclusions:

Exclusions include cancer, recent trauma, IV drug abuse, neurologic impairment, HIV, spinal infection, major organ transplant and prolonged use of corticosteroids.

Proper Exclusions Coding:

Improve the score for this HEDIS Measure:

-Avoid ordering diagnostic studies within 30 days of a diagnosis of new-onset back pain in the absence of red flags (e.g., cancer, recent trauma, neurologic impairment,
or IV drug abuse).
• Provide patient education on comfort measures, e.g., pain relief, stretching exercises, and activity level.
• Use correct exclusion codes if applicable (e.g., cancer).
• Look for other reason for visits for low back pain (e.g., depression, anxiety, narcotic dependency, psychosocial stressors, etc.).
• Document and code/bill all comorbidities (e.g. MVA, fall, trauma, etc.

HEDIS Measure: Use of Imaging Studies for Low Back Pain 2022 Changes:

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