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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