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Child and Adolescent Well-Care Visits (WCV)

HEDIS Measure

Child and Adolescent Well-Care Visits (WCV)

Line of business: Commercial Medicaid

Data Collection Method: Administrative

Measure Description

The percentage 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.

Numerator Compliance

One or more well-care visits during the measurement year. 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.

Preventive services may be rendered on visits other than well-child visits.

Visits to school-based clinics with practitioners whom the organization would consider PCPs may be counted if documentation that a well-care exam occurred is available in the medical record or administrative system in the time frame specified by the measure.

Services that occur over multiple visits, as long as all services occur in the time frame specified by the measure, may be counted.

NOTE: Services rendered during an inpatient or ED visit or services that are specific to the assessment or treatment of an acute or chronic condition do not count toward the measure.

Best Practices

  • Take advantage of every visit, including sick visits, to capture the components of this measure
  • Schedule visits within the recommended time frames
  • Use standardized templates in charts and EMRs
  • Set care gap “alerts” in your electronic medical record
  • Consider the parent’s work schedule as a barrier to the visit, and offer extended evening or weekend hours
  • Encourage parents/patients to maintain the relationship with a PCP to promote consistent and coordinated health care
  • Educate parents/patients on the importance of having preventive care visits
  • Consider offering extended practice hours to increase care access
  • Remind patients of their appointment by making calls or sending texts
  • Make outreach calls and/or send letters to advise members of the need for a visit
  • Partner with Horizon Healthy Journey Program to assist with targeted outreach activities

Reference BRIGHT FUTURES

  • A national health promotion and prevention initiative led by the American Academy of Pediatrics (AAP)
  • Provides theory and evidence-based guidance for all preventive care screenings and well-child visits
    brightfutures.aap.org/Pages/default.aspx

Quality Value Set Directory Coding Tips

Well-Care

CPT

  • 99381
  • 99382
  • 99383
  • 99384
  • 99385
  • 99391
  • 99392
  • 99393
  • 99394
  • 99395
  • 99461

HCPCS

  • G0438
  • G0439
  • S0302
  • S0610
  • S0612
  • S0613

ICD10CM

  • Z00.00
  • Z00.01
  • Z00.110
  • Z00.111
  • Z00.121
  • Z00.129
  • Z00.2
  • Z00.3
  • Z01.411
  • Z01.419
  • Z02.5
  • Z76.1

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