HEDIS: 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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