Pediatrics/Adolescents Management
Based on current NCQA HEDIS recommendations, your TO-DO LIST for pediatric and adolescent patients should include:
- Administer immunizations based on age-recommended guidelines.
- Complete a well-child visit at the age-recommended intervals.
- Evaluate body mass index (BMI) percentile, counseling for nutrition and counseling for physical activity every year at the age-recommended well-visits.
- Order a capillary or venous lead blood test by child’s 2nd birthday.
- Screen female young adults for chlamydia starting at age 16.
Why should you complete your TO-DO LIST?
It is an evidence-based, best practice and these actions are used to measure your quality performance.
Immunizations
Child hood Immunization Status (CIS) HEDIS Measure:
Population Defined for Child hood Immunization Status (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
- Members who turn 2 years of age during the measurement year
- Line of Business: Commercial, Medicaid
| DESCRIPTION: | REQUIREMENT: |
| The percentage of children 2 years of age who had all of the recommended vaccines on or before their second birthday | |
| 4 Diphtheria, Tetanus, and Acellular Pertussis (DTaP) | Administer four DTaP vaccinations with different dates of service on or before the child’s second birthday. Vaccinations administered prior to 42 days after birth do not count. |
| 3 Polio (IPV) | Administer three IPV vaccinations with different dates of service on or before the child’s second birthday. Vaccinations administered prior to 42 days after birth do not count |
| 3 Haemophilus Influenza Type B (HiB) | Administer three HiB vaccinations with different dates of service on or before the child’s second birthday. Vaccinations administered prior to 42 days after birth do not count |
| 4 Pneumococcal Conjugate (PCV) | Administer four pneumococcal conjugate vaccinations with different dates of service on or before the child’s second birthday. Vaccinations administered prior to 42 days after birth do not count |
| 1 Chicken Pox (VZV) | Administer one VZV vaccination with a date of service on or between the child’s first and second birthdays or documented history of varicella zoster illness on or before the child’s second birthday. |
| 1 Hepatitis A (HepA) | Administer one hepatitis A vaccination with a date of service on or between the child’s first and second birthdays or documented history of hepatitis A illness on or before the child’s second birthday. |
| 2 Influenza (Flu) | Administer two influenza vaccinations, with different dates of service, on or before the child’s second birthday. Vaccinations administered priorto 6 months(180 days) afterbirth do notcount.One of the two vaccinations can be an LAIV vaccination administered on the child’ssecond birthday.Do not count an LAIV vaccination administered before the child’s second birthday. |
| 3 Hepatitis B (HepB) | Administer three hepatitis B vaccinations with different dates of service, on or before the child’s second birthday or documented history of hepatitis B illness on or before the child’s second birthday. One of the three vaccinations can be a new born he patitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. |
| 2-dose/3-dose Rotavirus (RV) | Administer any of the following on or before the child’s second birthday meet criteria: At least two doses of the two-dose rotavirus vaccine on different dates of service. At least three doses of the three-dose rotavirus vaccine on different dates of service. At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine all on different dates of service Vaccinations administered prior to 42 days after birth do not count. |
| 1 Measles, Mumps, Rubella (MMR) | Any of the following meet criteria: Administer one MMR vaccination (Measles, Mumps and Rubella) on or between the child’s first and second birthdays. Administer one measles and rubella vaccination on or between the child’s first and second birthdays and one of the following: Administer one mumps vaccination on or between the child’s first and second birthdays. History of mumps illness any time on or before the child’s second birthday. Note:All 3 criteria below must be met for compliance: Administer one measles vaccination on or between the child’s first and second birthdays or history of measles illness anytime on or before the child’s second birthday. Administer one mumps vaccination on or between the child’s first and second birthdays or history of mumps illness anytime on or before the child’s second birthday. Administer one rubella vaccination on or between the child’s first and second birthdays or history of rubella illness anytime on or before the child’s second birthday. |
| Combination 4 (DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA) | Children who are numerator compliant for the following indicators: DTaP, IPV, MMR, HiB, HepB, VZV, PCV, and HepA |
| Combination 10 (DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA, RV, Flu) | Children who are numerator compliant for the following indicators: DTaP, IPV, MMR, HiB, HepB, VZV, PCV, HepA, RV, and Flu |
Immunizations for Adolescents(IMA) HEDIS Measure:
Population Defined for Immunizations for Adolescents (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
Members who turn 13 years of age during the measurement year
Line of Business: Commercial, Medicaid
| DESCRIPTION: | REQUIREMENT: |
| The percentage of adolescents 13 years of age who had all of the recommended vaccines by their 13th birthday. The measure calculates a rate for each vaccine and two combination rates. | |
| Tdap | Administer one Tetanus, Diphtheria Toxoids and Acellular Pertussis (Tdap) vaccine on or between the member’s 10th and 13th birthdays. |
| Meningococcal serogroups A,C,W,Y | Administer one Meningococcal serogroups A, C, W, Y vaccine on or between the member’s 11th and 13th birthdays. |
| HPV | Administer three HPV vaccines with different dates of service on or between the member’s 9th and 13th birthdays or administer two HPV vaccines with dates of service at least 146 days apart on or between the member’s 9th and 13th birthdays. |
| Combination 1 (Menigococcal,Tdap) | Adolescents who are numerator compliant for both the Meningococcal serogroups A, C, W, Y and Tdap indicators |
| Combination 2 (Meningococcal,Tdap,HPV) | Adolescents who are numerator compliant for all three indicators Meningococcal serogroups A, C, W, Y, Tdap, and HPV |
Well-Child visits
Well-Child Visits in the First 30 Months of Life (W30) HEDIS Measure:
Population Defined for Well-Child Visits in the First 30 months of Life (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
- Members who turn 15 and 30 months old during the measurement year
- Line of Business: Commercial, Medicaid
| DESCRIPTION: | REQUIREMENT: |
| The percentage of members who had the appropriate number of well-child visits with a PCP during the last 15 months. The following rates are reported: Well-Child Visits in the First 15 Months.Children who turned 15 months old during the measurement year. Well-Child Visits for Age 15 Months–30 Months.Children who turned 30 months old during the measurement year. | Perform the indicated number well-child visits with evidence of all of the following:
|
| Well-Child Visits in the First 15 Months | Six or more well-child visits on different dates of service on or before the 15-month birthday. |
| Well-Child Visits for Age 15 Months–30 Months | Two or more well-child visits on different dates of service between the child’s 15-month birthday plus 1 day and the 30-month birthday. |
Well-Visit Recommendation:
- The recommended well-visit intervals for the first 15-months of life include the following: Newborn, 3-5 days, by 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, and 15 months1.
- The recommended well-visit intervals for age 15 months-30 months of life include the following: 18 months, 24 months, 30 months1.
Child and Adolescent Well-Care Visits (WCV) HEDIS Measure:
Population Defined for Child and Adolescent Well-Care Visits (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
Members who turn 3-21 years of age as of December 31 of the measurement year
Line of Business: Commercial, Medicaid
|
DESCRIPTION: |
REQUIREMENT: |
|
Percent of members 3-21 years of age who had at least one comprehensive well-care visit with a PCP or an Ob/Gyn practitioner during the measurement year |
Perform at least one comprehensive well-care visit with a PCP or Ob/Gyn practitioner during the measurement year with documentation evidence of all of the following:
The well-care visit must occur with a PCP or an OB/GYN practitioner, but the practitioner does not have to be the practitioner assigned to the member. |
Recommendations:
- The recommended well-visit intervals for 3-21 years of life include one annual well-visit1.
Counseling
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) HEDIS Measure:
Population Defined for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
- Members who turn 3-17 years of age as of December 31 of the measurement year Line of Business: Commercial, Medicaid
| DESCRIPTION: | REQUIREMENT: |
| BMI Percentile(WCC-B): Percent of members 3-17 years of age who had an outpatient visit with a PCP or Ob/Gyn and who had evidence of BMI percentile during the measurement year | Documentation must include height, weight and BMI percentile during the measurement year. The height, weight and BMI percentile must be from the same data source.
|
| Counseling for Nutrition(WCC-N): Percent of members 3-17 years of age who had an outpatient visit with a PCP or Ob/Gyn and who had evidence of counseling for nutrition during the measurement year | Documentation must include a note indicating the date and at least one of the following:
|
| Counseling for Physical Activity (WCC-P): Percent of members 3-17 years of age who had an outpatient visit with a PCP or Ob/Gyn and who had evidence of counseling for physical activity during the measurement year | Documentation must include a note indicating the date and at least one of the following:
|
Screenings
Lead Screening in Children (LSC) HEDIS Measure:
Population Defined for Lead Screening in Children (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
- Members who turn 2 years of age during the measurement year
- Line of Business: Medicaid
| DESCRIPTION: | REQUIREMENT: |
| The percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning by their second birthday | Perform one or more capillary or venous lead blood tests on or before member’s second birthday. |
Chlamydia Screening in Women (CHL) HEDIS Measure:
Population Defined for Chlamydia Screening in Women (NCQA HEDIS guidelines, Measurement Year (MY) 2020 & MY 2021)
- Members who turn 16-24 years of age during the measurement year
- Line of Business: Commercial, Medicaid
| DESCRIPTION: | REQUIREMENT: |
| Percent of women 16-24 years of age who were identified as sexually active* and who had at least one test for chlamydia during the measurement year *Sexually active as determined by one of the following: claim/encounter for pregnancy test and/or dispensed prescription contraceptives | Perform at least one chlamydia test during the measurement year. |
Table CHL-A: Prescriptions to Identify Contraceptives
| DESCRIPTION: | PRESCRIPTION: | |
| Contraceptives |
|
|
| Diaphragm |
|
|
| Spermicide |
|
|
How does your completion of the TO-DO LIST get recorded?
- Refer to Coding Tables.
Resources available for you and your patients:
- 1Recommendations for Preventive Pediatric Health Care, Bright Futures/American Academy of Pediatrics
- CDC Immunization Vaccine Schedule
- New Blood Lead Level Information,Centers for Disease Control and Prevention
References:
- Child hood Immunization Status, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- Immunizations for Adolescents, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- 1Recommendations for Preventive Pediatric HealthCare, Bright Futures/American Academy of Pediatrics
- Well-Child Visits in the First 30 Months of Life, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- Child and Adolescent Well-Care Visits, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents,
- NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- Lead Screeningin Children, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
- Chlamydia Screeningin Women, NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Tech Specifications
Coding Tables
Childhood Immunization Status (CIS) HEDIS Measure Billing Codes:
| IMMUNIZATION: | CODES: |
| DTaP DTaP Vaccine Administered | CPT®: 90698, 90700, 90723 CVX: 20, 50, 106, 107, 110, 120 SNOMED CT: 170395004, 170396003, 170397007, 170399005, 170400003, 170401004, 170402006, 310306005, 310307001, 310308006, 312870000, 313383003, 390846000, 390865008, 399014008, 412755006, 412756007, 412757003, 412762002, 412763007, 412764001, 414001002, 414259000, 414620004, 415507003, 415712004, 770608009, 770616000, 770617009, 770618004, 787436003, 787438002, 428251000124104, 571571000119105, 572561000119108, 16290681000119103, 16298561000119108 |
| HepA Hepatitis A Vaccine Administered Hepatitis A illness | CPT®: 90633 CVX: 31, 83, 85 SNOMED CT: 170378007, 170379004, 170380001, 170381002, 170434002, 170435001, 170436000, 170437009, 243789007, 312868009, 313188000, 313189008, 314177003, 314178008, 314179000, 394691002, 412742005, 412743000, 571511000119102 ICD10CM: B15.0, B15.9 SNOMED CT: 16060001, 18917003, 25102003, 40468003, 43634002, 79031007, 111879004, 165997004, 206373002, 278971009, 310875001, 424758008, 428030001, 105801000119103 |
| IMMUNIZATION: | CODES: |
| HepB Hepatitis B Vaccine Administered Hepatitis B illness Newborn Hepatitis BVaccine Newborn Hepatitis B Vaccine Administered | CPT®: 90723, 90740, 90744, 90747, 90748 CVX: 08, 44, 45, 51, 110 HCPCS: G0010 SNOMED CT: 16584000, 170370000, 170371001, 170372008, 170373003, 170434002, 170435001, 170436000, 170437009, 312868009, 396456003, 770608009, 770616000, 770617009, 770618004, 786846001, 787438002, 572561000119108 ICD10CM: B16.0, B16.1, B16.2, B16.9, B17.0, B18.0, B18.1, B19.10, B19.11 SNOMED CT: 1116000, 13265006, 26206000, 38662009, 50167007, 53425008, 60498001, 61977001, 66071002, 76795007, 111891008, 165806002, 186624004, 186626002, 186639003, 235864009, 235865005, 235869004, 235871004, 271511000, 313234004, 406117000, 424099008, 424340000, 442134007, 442374005, 446698005, 153091000119109 ICD9PCS: 99.55 SNOMED CT: 170370000, 426980004 ICD10: 3E0234Z |
| HiB HiB Vaccine Administered | CPT®: 90644, 90647, 90648, 90698, 90748 CVX: 17, 46, 47, 48, 49, 50, 51, 120, 148 SNOMED CT: 127787002, 170343007, 170344001, 170345000, 170346004, 310306005, 310307001, 310308006, 312869001, 312870000, 414001002, 414259000, 415507003, 415712004, 770608009, 770616000, 770617009, 770618004, 786846001, 787436003, 787438002 |
| Flu Influenza Immunization Administered Influenza Virus LAIV Immunization Administered: | CVX: 88, 140, 141, 150, 153, 155, 158, 161 HCPCS: G0008 CPT®: 90655, 90657, 90661, 90673, 90685, 90686, 90687, 90688, 90689 SNOMED CT US Edition: 786847005, 787016008, 86198006 CVX: 111, 149 CPT: 90660, 90672 |
| IPV Inactivated Polio Vaccine Administered | CPT®: 90698, 90713, 90723 CVX: 10, 89, 110, 120 SNOMED CT: 396456003, 414001002, 414259000, 414619005, 414620004, 415507003, 415712004, 416144004, 416591003, 417211006, 417384007, 417615007 |
| Measles Measles Vaccine Administered Measles illness | CPT®: 90705 CVX: 05 SNOMED CT: 47435007, 170364006, 572481000119103 ICD10CM: B05.0, B05.1, B05.2, B05.3, B05.4, B05.81, B05.89, B05.9 SNOMED CT: 14189004, 28463004, 38921001, 60013002, 74918002, 111873003, 161419000, 186561002, 186562009, 195900001, 240483006, 240484000, 371111005, 406592004, 417145006, 105841000119101 |
| MMR MMR Vaccine Administered Measles and Rubella Immunization | CPT®: 90707, 90710 CVX: 03, 94 SNOMED CT: 38598009, 170433008, 432636005, 433733003, 150971000119104, 571591000119106, 572511000119105 CPT®: 90708 CVX: 04 |
|
IMMUNIZATION: |
CODES: |
|
Mumps Mumps Vaccine Administered Mumps illness |
CPT®: 90704 CVX: 07 SNOMED CT: 50583002
ICD10CM: B26.0, B26.1, B26.2, B26.3, B26.81, B26.82, B26.83, B26.84, B26.85, B26.89, B26.9 SNOMED CT: 10665004, 17121006, 31524007, 31646008, 36989005, 40099009, 44201003, 63462008, 72071001, 74717002, 75548002, 78580004, 89231008, 89764009, 111870000, 161420006, 235123001, 236771002, 237443002, 240526004, 240527008, 240529006, 371112003, 105821000119107 |
|
PCV Pneumococcal Conjugate Vaccine Administered |
CPT®: 90670 CVX: 133, 152 HCPCS: G0009 SNOMED CT: 434751000124102 |
|
RV Rotavirus Vaccine Administered |
CPT®: 90681 (2 Dose Schedule) CVX: 119 (2-Dose) SNOMED CT: 434741000124104 CPT®: 90680 (3 Dose Schedule) CVX: 116, 122 (3-Dose) SNOMED CT: 434731000124109 |
|
Rubella Rubella Vaccine Administered Rubella illness |
CPT®: 90706 CVX: 06 SNOMED CT: 82314000
ICD10CM: B06.00, B06.01, B06.02, B06.09, B06.81, B06.82, B06.89, B06.9 SNOMED CT: 10082001, 13225007, 19431000, 36653000, 51490003, 64190005, 79303006, 84611003, 111867004, 128191000, 161421005, 165792000, 186567003, 186570004, 192689006, 231985001, 232312000, 240485004, 253227001, 406112006, 406113001, 1092361000119109, 10759761000119100 |
|
VZV Varicella Zoster Vaccine Administered Varicella Zoster illness |
CPT®: 90710, 90716 CVX: 21, 94 SNOMED CT: 425897001, 428502009, 473164004, 571611000119101
ICD10CM: B01.0, B01.11, B01.12, B01.2, B01.81, B01.89, B01.9, B02.0, B02.1, B02.21, B02.22, B02.23, B02.24, B02.29, B02.30, B02.31, B02.32, B02.33, B02.34, B02.39, B02.7, B02.8, B02.9 SNOMED CT: 4740000, 10698009, 21954000, 23737006, 24059009, 36292003, 38907003, 42448002, 49183009, 55560002, 87513003, 111859007, 111861003, 161423008, 186524006, 186525007, 195911009, 230176008, 230198004, 230262004, 230536009, 232400003, 235059009, 240468001, 240470005, 240471009, 240472002, 240473007, 240474001, 309465005, 371113008, 397573005, 400020001, 402897003, 402898008, 402899000, 410500004, 410509003, 421029004, 422127002, 422446008, 422471006, 422666006, 423333008, 423628002, 424353002, 424435009, 424801004, 424941009, 425356002, 426570007, 428633000, 713250002, 713733003, 713964006, 715223009, 723109003, 12551000132107, 12561000132105, 12571000132104, 331071000119101, 681221000119108, 15678761000119105, 15678801000119102, 15680201000119106, 15680241000119108, 15685081000119102, 15685121000119100, 15685201000119100, 15685281000119108, 15936581000119108, 15936621000119108, 15989271000119107, 15989311000119107, 15989351000119108, 15991711000119108, 15991791000119104 |
Immunizations for Adolescents (IMA) HEDIS Measure Billing Codes:
| IMMUNIZATION: | CODES: |
| HPV Immunization Vaccine Procedure | CVX: 62, 118, 137, 165, SNOMEDCT US Edition: 428570002, 428741008, 428931000, 429396009, 734152003, 734154002, 99501000119107, 140611000119104, 16300531000119107 CPT®: 90649, 90650, 90651 |
| Meningococcal Immunization Vaccine Procedure | CVX: 108, 114, 136,147, 167 SNOMED CT US Edition: 390892002 CPT®: 90734 |
| Tdap Immunization Vaccine Procedure | CVX: 115 SNOMED CT US Edition: 428251000124104 CPT®: 90715 |
Well-Child Visits in the First 30 Months of Life (W30) HEDIS Measure Billing Codes:
| CPT®: | HCPCS: | ICD10CM: |
| 99381-99385, | G0438, G0439, | Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, |
| 99391-99395, 99461 | S0302 | Z02.5, Z76.1, Z76.2 |
| SNOMED CT US Edition: |
| 103740001, 170099002, 170107008, 170114005, 170123008, 170132005, 170141000, 170150003, 170159002, |
| 170168000, 170250008, 170254004, 170263002, 170272005, 170281004, 170290006, 170300004, 170309003, |
| 171387006, 171394009, 171395005, 171409007, 171410002, 171416008, 171417004, 243788004, 268563000, |
| 270356004, 401140000, 410620009, 410621008, 410622001, 410623006, 410624000, 410625004, 410626003, |
| 410627007, 410628002, 410629005, 410630000, 410631001, 410632008, 410633003, 410634009, 410635005, |
| 410636006, 410637002, 410638007, 410639004, 410640002, 410641003, 410642005, 410643000, 410644006, |
| 410645007, 410646008, 410647004, 410648009, 410649001, 410650001, 442162000, 783260003, |
| 444971000124105, 446301000124108, 446381000124104, 669251000168104, 669261000168102, |
| 669271000168108, 669281000168106 |
Child and Adolescent Well-Care Visits (WCV) HEDIS Measure Billing Codes:
| CPT®: | HCPCS: | ICD10CM: |
| 99381-99385, | G0438, G0439, | Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, |
| 99391-99395, 99461 | S0302 | Z02.5, Z76.1, Z76.2 |
| SNOMED CT US Edition: |
| 103740001, 170099002, 170107008, 170114005, 170123008, 170132005, 170141000, 170150003, 170159002, |
| 170168000, 170250008, 170254004, 170263002, 170272005, 170281004, 170290006, 170300004, 170309003, |
| 171387006, 171394009, 171395005, 171409007, 171410002, 171416008, 171417004, 243788004, 268563000, |
| 270356004, 401140000, 410620009, 410621008, 410622001, 410623006, 410624000, 410625004, 410626003, |
| 410627007, 410628002, 410629005, 410630000, 410631001, 410632008, 410633003, 410634009, 410635005, |
| 410636006, 410637002, 410638007, 410639004, 410640002, 410641003, 410642005, 410643000, 410644006, |
| 410645007, 410646008, 410647004, 410648009, 410649001, 410650001, 442162000, 783260003, |
| 444971000124105, 446301000124108, 446381000124104, 669251000168104, 669261000168102, |
| 669271000168108, 669281000168106 |
Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) HEDIS Measure Billing Codes:
| SCREENING: | CODES: |
| BMIPe rcentile: | ICD10CM: Z68.51, Z68.52, Z68.53, Z68.54 LOINC: 59574-4, 59575-1, 59576-9 |
| Nutrition: | CPT®: 97802, 97803, 97804 |
| HCPCS: G0270, G0271, G0447, S9449, S9452, S9470 | |
| ICD10CM: Z71.3 | |
| SNOMED CT US Edition: 11816003, 61310001, 183059007, 183060002, 183061003, | |
| 183062005, 183063000, 183065007, 183066008, 183067004, 183070000, 183071001, | |
| 226067002, 266724001, 275919002, 281085002, 284352003, 305849009, 305850009, | |
| 305851008, 306163007, 306164001, 306165000, 306626002, 306627006, 306628001, | |
| 313210009, 370847001, 386464006, 404923009, 408910007, 410171007, 410177006, | |
| 410200000, 429095004, 431482008, 443288003, 609104008, 698471002, 699827002, | |
| 699829004, 699830009, 699849008, 700154005, 700258004, 705060005, 710881000, | |
| 428461000124101, 428691000124107, 441041000124100, 441201000124108, | |
| 441231000124100, 441241000124105, 441251000124107, 441261000124109, | |
| 441271000124102, 441281000124104, 441291000124101, 441301000124100, | |
| 441311000124102, 441321000124105, 441331000124108, 441341000124103, | |
| 441351000124101, 445291000124103, 445301000124102, 445331000124105, | |
| 445641000124105 | |
| Physical Activity: | HCPCS: G0447, S9451 |
| ICDCM: Z02.5, Z71.82 | |
| SNOMEDCT USEdition: 103736005, 183073003, 281090004, 304507003, 304549008, | |
| 304558001, 310882002, 386291006, 386292004, 386463000, 390864007, 390893007, | |
| 398636004, 398752005, 408289007, 410200000, 410289001, 410335001, 429778002, | |
| 435551000124105, 710849009 |
Lead Screening in Children (LSC) HEDIS Measure Billing Code:
| CPT®: | LOINC: | SNOMED CT US Edition: |
| 83655 | 10368-9, 10912-4, 14807-2, 17052-2, 25459-9, 27129-6, 32325-3, 5671-3, 5674-7, 77307-7 | 35833009, 8655006 |
Chlamydia Screening in Women (CHL) HEDIS Measure Billing Codes:
| CPT®: | LOINC: | SNOMED CT US Edition: |
| 87110, | 14463-4, 14464-2, 14467-5, 14474-1, 14513-6, | 104175002, 104281002, 104282009, 104290009, |
| 87270, | 16600-9, 21190-4, 21191-2, 21613-5, 23838-6, | 117775008, 121956002, 121957006, 121958001, |
| 87320, | 31775-0, 31777-6, 36902-5, 36903-3, 42931-6, | 121959009, 122173003, 122254005, 122321005, |
| 87490, | 43304-5, 43404-3, 43405-0, 43406-8, 44806-8, | 122322003, 134256004, 134289004, 171120003, |
| 87491, | 44807-6, 45068-4, 45069-2, 45075-9, 45076-7, | 285586000, 310861008, 310862001, 315087006, |
| 87492, | 45084-1, 45091-6, 45095-7, 45098-1, 45100-5, | 315094009, 315095005, 315099004, 390784004, |
| 87810 | 47211-8, 47212-6, 49096-1, 4993-2, 50387-0, 53925-4, | 390785003, 395195000, 398452009, 399193003, |
| 53926-2, 557-9, 560-3, 6349-5, 6354-5, 6355-2, 6356-0, 6357-8, 80360-1, 80361-9, 80362-7, 91860-7 | 407707008, 442487003, 707982002 |
Supplemental Data Requirements
CIS
- Immunization record, documentation from NJIIS, or progress notes with dates of administration on or before child’s second birthday
IMA
- Immunization record, documentation from NJIIS, or progress notes with dates of administration on or before child’s 13th birthday
WCC
- BMI: Documentation of weight, height and BMI Percentile, or BMI percentile plotted on age-growth BMI chart.
- Nutrition Counseling: Documentation must include a note indicating the date and nutritional counseling in the measurement year
- Physical Activity Counseling: Documentation must include a note indicating the date and physical activity counseling in the measurement year
LSC
- Lab report, progress note, or NJIIS form indicating lead test, date, and result by the patient’s second birthday
CHL
- Dated lab report or progress note showing screening performed in measurement year
General Notes
The most accurate method to submit data for clinical quality gap closure is through correct coding. Supplemental data submission can be used for gap closure when information is not received through coding. All supplemental data must be signed and dated by a treating physician, nurse practitioner or physician assistant. All dates must include month, day and year.
Patient name and birthdate needs to be on all supplemental documentation. If birthdate is not officially on a report, it needs to be either written on the document and signed by the physician, or a demographic cover sheet should be included as an additional page with the submission.
To learn more about your practice’s current HEDIS performance for this or other measures, or for assistance in compliance with the HEDIS guidelines, please call 1-844-754-2451.
Reference: NCQA HEDIS Measurement Year (MY) 2020 & MY 2021 Technical Specs CPT® is a registered trademark of the American Medical Association.