Tag: #PCMH

Posted in Training, Updates

AMP HEDIS Measure -metabolic monitoring for children and adolescents on antipsychotics

Posted on by KR2Medical Billing

What is AMP HEDIS Measure?

1. The percentage of patients 1 to 17 that had two or more antipsychotic prescriptions and had both of the following in the measurement year:

+Had at least one test for blood glucose: blood glucose test, or HbA1c test

+ Had At least one cholesterol test, or LCL-C test

Eligible population ages: 1 to 17 years of age as of December 31 of the measurement year.

Qualifying Numerator codes that can be found on NCQA website.

Below is a partial list:

September 2020 – OLU_Newsletter_FINAL for remediation

How to successfully meet this measure:

  • Use NCQA coding tips to actively reflect care rendered. Routinely tell members who are on an antipsychotic medication to have their blood glucose or cholesterol tested at least annually.
  • Follow up with the parents of your patients to discuss and educate on lab results.
  • Coordinate care with the behavioral health specialists treating your patients.
Source: Aetna September 2020 Provider Communications
Advertisement
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.