ACKHEDIS - Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents

ACK- HEDIS

MY:                     2014

Subject:           Weight Assessment & Counseling for Nutrition & Physical Activity for Children/Adolescents (WCC)

Members age 3–17 years 

Provider Type:  PCP / OBGYN

Specialty:

Required Documentation:  

Documentation of an outpatient visit with evidence of the following during the measurement year:

• BMI percentile

• BMI percentile plotted on age-growth chart 

For members who are younger than 16 years of age on the date of service, only evidence of the

BMI percentile or BMI percentile plotted on an age-growth chart meets criteria. A BMI value is

not acceptable for this age range.

For adolescents 16–17 years on the date of service, documentation of: 

• BMI value expressed as kg/m2 is acceptable

• Counseling for nutrition

• Counseling for physical activity

  

Coding Guidelines

 

BMI Percentile: ICD-9: V85.50–V85.53 

·         Counseling for Nutrition: CPT: 97802–97804; ICD-9: V65.3; HCPCS: G0270, G0271, G0447, S9449, S9452, S9470

·         Outpatient Visits: CPT: 99381–99385, 99391–99395, 99461;

·         UB Revenue Codes: 051x, 0520–0523, 0526–0529, 0982, 0983

·         Exclusions: Members with diagnosis of pregnancy during the measurement year or year prior. 

 Pregnancy: ICD-9: 630–679, V22, V23, V28

 

 

For more information call AccuChecker 305-227-2383.

 

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ACKHEDIS - Adolescent Well Care

ACK- HEDIS

MY:                     2014

Subject:          Adolescent Well Care Visit

Members age 12–21 years

 

Provider Type:  Primary Care Physician (PCP): A physician or non-physician (e.g. nurse

  practitioner) who offers primary care medical services.

 

Specialty:

• General or family practice physician

• General internal medicine physician

• General pediatrician

• Obstetrician/gynecologist (OB/GYN)

• Certified nurse midwife, nurse practitioner, and physician assistant under the direction

  of an OB/GYN certified provider 

Required Documentation:    One Well Child Visit with a PCP or OB/GYN during the measurement year.

 

All three components of an Adolescent Well Care Visit must be included: 

• Health and Development History (physical and mental)

• Physical Examination

• Health Education/Anticipatory Guidance

 

Coding Guidelines

 

• CPT: 99381–99385, 99391–99395, 99461

• HCPCS: G0438, G0439

• ICD-9: V20.2, V20.3, V20.31, V20.32, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9 

The codes do not have to be primary codes. The codes are deemed meeting the measure’s assessment components.

Well visits can be done in conjunction with sick visits as long as they are billed with the appropriate modifier and can be performed anytime in the measurement/calendar year.

Priority Partners does not have frequency or date limit restrictions on well visits. 

For more information call AccuChecker 305-227-2383. 

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