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Care for Older Adults (COA)

HEDIS Measure

Care for Older Adults (COA)

Line of business: Medicare

Data Collection Method: Administrative and Hybrid

Measure Description

The percentage of adults 66 years and older who had each of the following during the measurement year:

  • Medication review
  • Functional status assessment
  • Pain assessment

Numerator Compliance

Medication review - Any of the following meets criteria during the same visit during the measurement year where the provider type is a prescribing practitioner or clinical pharmacist:

  • At least one medication review
  • Presence of a medication list in the medical record
  • Transitional care management services during the measurement year

Documentation must come from the same medical record and must include one of the following:

  • A medication list in the medical record, and evidence of medication review by a prescribing practitioner or clinical pharmacist and the date when it was performed.
  • Notation that the member is not taking any medication and the date when it was noted.

NOTE: Review of side effects for a single medication at the time of prescription alone is not compliant.

Functional status assessment - At least one functional status assessment during the measurement year.

Documentation in the medical record must include evidence of a complete functional status assessment and the date when it was performed.

Any of the following will meet compliance:

  • Activities of Daily Living (ADL) were assessed or that at least five of the following were assessed: bathing, dressing, eating, transferring, using toilet, walking
  • Instrumental Activities of Daily Living (IADL) were assessed or at least four of the following were assessed: shopping for groceries, driving or using public transportation, using the telephone, cooking or meal preparation, housework, home repair, laundry, taking medications, handling finances
  • Result of assessment using a standardized functional status assessment tool

NOTE: Functional status assessment limited to an acute or single condition, event or body system is not compliant.

The functional status assessment may take place during separate visits within the measurement year.

Pain assessment - At least one pain assessment during the measurement year.

Documentation in the medical record must include evidence of a pain assessment and the date when it was performed.

Any of the following will meet compliance:

  • Documentation that the patient was assessed for pain (positive or negative findings for pain
  • Result of assessment using a standardized pain assessment tool

NOTE: Pain management plan alone and screening for chest pain are not compliant.

Any services provided in an acute inpatient setting are excluded

Best Practices

  • Complete the medication review, functional status assessment and pain assessment during the same visit
  • Ensure a medication list is present in the medical record
  • Document in the medical record if the member is not taking any medication
  • Incorporate a standardized template to capture these measures for members 66 years of age and older
  • Complete a functional status assessment and pain assessment at every face to face visit
  • Complete a functional status assessment and pain assessment during every telehealth visit

Quality Value Set Directory Coding Tips

Functional Status Assessment

CPT

  • 99483

CPT-CAT-II

  • 1170F

HCPCS

  • G0438
  • G0439

SNOMED CT US Edition

  • 304492001
  • 385880002

Medication List

CPT-CAT-II

  • 1159F

HCPCS

  • G8427

SNOMED CT US Edition

  • 428191000124101
  • 432311000124109

Medication Review

CPT

  • 90863
  • 99483
  • 99605
  • 99606

CPT-CAT-II

  • 1160F

SNOMED CT US Edition

  • 719327002
  • 719328007
  • 719329004
  • 461651000124104

Pain Assessment

CPT-CAT-II

  • 1125F
  • 1126F

SNOMED CT US Edition

  • 225399009
  • 370778008
  • 408952002
  • 408955000
  • 423184003
  • 445719003
  • 445790003
  • 445806009
  • 445812004
  • 445996003
  • 446009008
  • 446790006
  • 715322001
  • 770637008

Transitional Care Management Services

CPT

  • 99495
  • 99496