Posted in HEDIS Measures, Training

Hedis Measure: the Pharmacotherapy Management of COPD Exacerbation Measure

This measure assesses chronic obstructive pulmonary disease (COPD) exacerbations for adults 40 years of age and older who had appropriate medication therapy to manage an exacerbation.

COPD is a debilitating lung condition that affects one in eight Americans age 45 and older.

A COPD exacerbation is defined as an acute inpatient discharge or emergency department visit with a primary discharge diagnosis of COPD.

There are 2 rates that are reported for this measure:

  • Dispensed a systemic corticosteroid (or there is evidence of an active prescription) within 14 days of the event
  • Dispensed a bronchodilator (or there is evidence of an active prescription) within 30 days of the COPD exacerbation event

Providers are encouraged to have a COPD action plan: that is a personalized patient tool that includes the important steps to help manage COPD. This plan includes medications, exercise, diet, and avoidance of triggers, such as tobacco products and other inhaled irritants.

To achieve this measure providers should follow these helpful steps:

  1. Schedule a f/u appt after the COPD exacerbation event.
  2. Review the list of medications and reconcile the medications that were given to the patient during the discharge
  3. Document any barriers that prevent the patient from obtaining the medications for the COPD
  4. Assure the patient with COPD is up to date with the vaccinations, including flu vaccine and Pnuemoccoccal vaccine.

Posted in Training, Updates

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

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

Proper coding for Comprehensive Diabetes Care HEDIS Measure: retinal eye exams (DRE)

Definition:  Comprehensive Diabetes Care HEDIS® Measure Retinal Eye Exam (DRE) is a percentage of patients between ages 18 to 75, with diabetes (type 1 and type 2), who had a retinal eye exam during the measurement year.


What is new?

The compliance of this measure is good for 2 years. You are allowed to bill the proper codes for the current measurement year, or prior year. This means you can submit the appropriate code at the time of the exam, and it covers both years.


New definition:

Low risk for retinopathy (no evidence of retinopathy in the prior year). The codes can be used to indicate that retinopathy was not present the previous year.

Proper Codes:


Documentation:

Please make sure to document the following measurements in the patient’s medical records:  HbA1c tests and results, retinal eye exam, blood pressure, urine creatinine test and the estimated glomerular filtration rate test.


Important!

DRE exams are an important component of in evaluating the overall health of diabetic patients. Providers should also strive to meet the Comprehensive Diabetes Care HEDIS measure with the following:

  • Hemoglobin A1c (HbA1c) testing
  • HbA1c poor control (>9.0%)
  • HbA1c control (<8.0%)
  • Retinal Eye exam performed
  • Blood Pressure control (<140/90 mm Hg)

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