2019 Provider Reference Guide for Healthcare Effectiveness ...

2019 Provider Reference Guide for Healthcare Effectiveness Data and Information Set

HEDIS? measures

Children and Adolescents

HEDIS measure definition

Required service/ documentation

Coding tips

W15

Documentation from the medical Well-Child

Well-Child 15 months

Members who turned 15 months old during the measurement year and who had a minimum of 6 comprehensive Well-Child visits.

record MUST include a note indicating a visit with a PCP, the date when the Well-Child visit occurred and evidence of all of the following:

? A health history

CPT Codes ? 99381, 99382?99385, 99391?99395, 99461

Annual Wellness Visit ICD-10 Codes Z00.110 ? Health examination for

*The ages for Well-Child visits as recommended by the American

? A physical developmental history

newborn under 8 days old

Z00.111 ? Health examination for newborn 8-28 days old

Academy of Pediatrics' Bright Futures ? A mental developmental history

Periodicity Schedule are 1 month, 2 months, 4 months, 6 months, 9

? A physical exam

Z00.121 ? Encounter for routine child health check with abnormal findings

months, 12 months, and 15 months. ? Health education/anticipatory Z00.129 ? Encounter for routine child

guidance.

health check without abnormal findings

Z00.8 ? Encounter for other general examination

Quality Toolkit

Aetna Better Health? of Pennsylvania | Aetna Better Health? Kids

pa

compliance code

Children and Adolescents

HEDIS measure definition

Required service/ documentation

Coding tips

W34

Well-Child 3-6 years Members 3?6 years of age who had one or more Well-Child visits with a PCP during the measurement year.

*One Well-Child visit every year.

Documentation must include a

Well-Child

note indicating a visit to a PCP, the date when the Well-Child visit occurred and evidence of all of the following:

CPT Codes ? 99381, 99382?99385, 99391?99395, 99461

Annual Wellness Visit

? A health history

ICD-10 Codes

? A physical developmental history

Z00.121 ? Encounter for routine child health check with abnormal findings

Z00.129 ? Encounter for routine child ? A mental developmental history health check without abnormal findings

? A physical exam

Z00.8 ? Encounter for other general

? Health education/anticipatory examination

guidance.

AWC

Adolescent Well-Child visits

Members 12?21 years of age who had at least one comprehensive Well-Child visit with a PCP or an Ob/Gyn practitioner during the measurement year.

*One Well-Child visit every year.

Documentation must include a

Well-Child

note indicating a visit to a PCP or CPT Codes ? 99381, 99382?99385,

Ob/Gyn, the date when the

99391?99395, 99461

Well-Child visit occurred and evidence of all of the following:

Annual Wellness Visit

? A health history

ICD-10 Codes

? A physical developmental history

Z00.121 ? Encounter for routine child health check with abnormal findings

Z00.129 ? Encounter for routine child ? A mental developmental history health check without abnormal findings

? A physical exam

Z00.8 ? Encounter for other general

? Health education/anticipatory examination

guidance.

WCC

Weight assessment and counseling for nutrition and physical activity for children/ adolescents Members 3?17 years of age who had an outpatient visit with a PCP or Ob/ Gyn and who had evidence of the following during the measurement year:

? BMI Percentile documentation

? Counseling for nutrition

? Counseling for physical activity.

At least once during the measurement year, there must be documentation of:

1. Height and weight in the measurement year and Body Mass Index (BMI) Percentile rating

2. Counseling for nutrition

3. Counseling for physical activity.

BMI Percentile ICD-10 Codes Z68.51 BMI ................
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