HEDIS Measurement Year (MY) 2023 Provider Tips for Optimizing HEDIS Results
MY 2023 Quality Coding Tips
Eligible Populations, Quality Administrative Value Set Directory Codes and Documentation Requirements
One of the most widely used tools for improving quality and measuring health care plan performance in the United States is the Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS was developed and is maintained on an annual basis by the National Committee for Quality Assurance (NCQA).
Our participating physicians and other health care professionals play an important role in HEDIS. The care you deliver to your patients, our members, is assessed by the HEDIS quality measures.
Listed below are some key HEDIS measures and corresponding quality coding tips codes and documentation requirements. Please use the codes, as you determine appropriate, to help ensure that patients' charts include accurate, legible and complete medical record documentation.
For additional HEDIS information, contact Horizon Healthy Journey at 1-844-754-2451.
- Best Practices Overall For Coding
- Adherence to Antipsychotic Medications for Individuals With Schizophrenia (SAA)
- Adult Immunization Status (AIS-E)
- Adults' Access to Preventive/Ambulatory Health Services (AAP)
- Advanced Care Planning (ACP)
- Antibiotic Utilization for Respiratory Conditions (AXR)
- Antidepressant Medication Management (AMM)
- Appropriate Testing for Children with Pharyngitis (CWP)
- Appropriate Treatment for Upper Respiratory Infection (URI)
- Asthma Medication Ratio (AMR)
- Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
- Blood Pressure Control for Patients With Diabetes (BPD)
- Breast Cancer Screening (BCS-E)
- Cardiovascular Monitoring for People With Cardiovascular Disease and Schizophrenia (SMC)
- Care for Older Adults (COA)
- Cervical Cancer Screening (CCS) (CCS-E)
- Child and Adolescent Well-Care Visits (WCV)
- Childhood Immunization Status (CIS) (CIS-E)
- Chlamydia Screening in Women (CHL)
- Colorectal Cancer Screening (COL) (COL-E)
- Controlling High Blood Pressure (CBP)
- Deprescribing of Benzodiazepines in Older Adults (DBO)
- Depression Remission or Response for Adolescents and Adults (DRR-E)
- Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
- Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD)
- Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)
- Eye Exam for Patients With Diabetes (EED)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)
- Follow-Up After High-Intensity Care for Substance Use Disorder (FUI)
- Follow-Up After Hospitalization for Mental Illness (FUH)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD) (ADD-E)
- Hemoglobin A1c Control for Patients With Diabetes (HBD)
- Immunizations for Adolescents (IMA) (IMA-E)
- Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
- Kidney Health Evaluation for Patients with Diabetes (KED)
- Lead Screening in Children (LSC) - EPSDT
- Lead Screening in Children (LSC) - NCQA
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) (APM-E)
- Osteoporosis Management in Women Who Had a Fracture (OMW)
- Osteoporosis Screening in Older Women (OSW)
- Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
- Pharmacotherapy Management of COPD Exacerbation (PCE)
- Postpartum Depression Screening and Follow-Up (PDS-E)
- Prenatal and Postpartum Care (PPC)
- Prenatal Depression Screening and Follow-Up (PND-E)
- Prenatal Immunization Status (PRS-E)
- Risk of Continued Opioid Use (COU)
- Statin Therapy for Patients with Cardiovascular Disease (SPC)
- Statin Therapy for Patients with Diabetes (SPD)
- Topical Fluoride for Children (TFC)
- Transitions of Care (TRC)
- Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
- Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
- Use of Imaging Studies for Low Back Pain (LBP)
- Use of Opioids at High Dosage (HDO)
- Use of Opioids From Multiple Providers (UOP)
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)
- Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
- Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
- Well-Child Visits in the First 30 Months of Life (W30)