Total Health Quality Indicators For Providers 2015

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1 Total Health Quality Indicators For Providers 2015 Adult- Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 BMI Assessment BMI Recording yrs Yearly G8417, G8418, G F V85.0, V85.1, V85.2X, V85.3X, V85.4X ICD-10 Use 10/1/15 and after Z68.1, Z , Z , Z Comments Report the V and Z code with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Substance Abuse Screening Tobacco Use Screening 13 yrs > Yearly G9275, G F (tobacco use assessed), 1031F (Smoking status and exposure to secondhand smoke assessed) 1032F(current tobacco smoker or currently exposed to secondhand smoke) 1033F(current tobacco non smoker and not exposed to secondhand smoke) 1034F (current tobacco smoker), 1035F (smokeless tobacco user), 1036F (non tobacco user), 4004F (smoker/cessation intervention provided) 305.1X * Z72.0* F17.2XX* Report the appropriate CPTII code with other appropriate diagnoses codes(s) and CPT code(s) that reflect the office visit rendered * tobacco use disorder, use this if they are tobacco users Alcohol Screening 13 yrs > Yearly Substance Abuse Screening 13 yrs > Yearly G0396, G0397, G0442, G0443, 99408, F G0396, G0397, 99408, Tobacco Cessation Counseling ages 13 to 100 Tobacco 13 yrs > Yearly G9458, 99406, X 303.9X 304.XX, F (cessation-counseling), 4001F (cessation-pharm), 4004F (either one or both) Z F10.10 F10.20 F10.21 Multiple codes depending on the substance (F section) Report the CPT II with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Only report 305.0X if positive for alcohol abuse. Diagnosis codes listed reflect a positive drug dependence-only report these if the screening is positive Report the appropriate CPT II with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered

2 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Colorectal Cancer Screening Fecal Occult Blood Test (FOBT) yrs Yearly G0328, 82270, F Flexible Sigmoidoscopy yrs Every 5 yrs Colonoscopy yrs Every 10 yrs ICD-10 Use 10/1/15 and after , , G F , , 45391, 45392, G0105, G F V76.51 Z12.11 Comments Use V76.51 for screening and use other diagnostic codes related to findings (i.e. polyp.) Blood Pressure (B/P) -No Previous dx of HTN B/P Reading Documented 2 yrs and > Glucose Screening Laboratory Test 19 yrs > Yearly LDL-C Screening Laboratory Test 19 yrs > Yearly Influenza vaccine Immunization yrs Yearly B/P < 120/80 (screen q2 years), 140/90 (rescreen G8476, G8477, G8752- in one month), G8755, G8783, G8950, 139/80-90 (q 1 yr) G9273, G F 80047, 80048, 80050, 80053, 80069, 82947, 82948, 82950, 82951, 82952, 83036, F 80061, 83700, 83701, 83704, F, 3048F, 3049F, 3050F , 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90672,90673, 90685, 90686, 90687, 90688, G F Depression Screen yrs Yearly G F, 1220F V79.0 Z13.89 V70.0 V70.3 G0438, G0439, G0463, V70.5 G0402, 99385, 99395, V , 99396, 99387, V70.8 Well Adult Well Visit 20 yrs > Yearly V70.9 Z00.00 Report the appropriate code listed in addition to other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Report the appropriate code listed in addition to other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Report the appropriate code listed in addition to other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Report the appropriate codes listed and appropriate codes for other services rendered, if any. Report the CPT II with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered 2

3 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Women Preventive G0202, G0204, G0206, Breast Cancer Screening Mammogram yrs Yearly F Pap: , 88147, 88148, , , , G0123, G0124, G0141, G0143- G0145, G0147, G0148, Pap Test 21- P3000, 93001, Q0091 V yrs Pap plus HPV: above V70.0, Pap Test or Pap and HPV 3 yrs codes plus 87623, V72.31 Cervical Cancer Screening Pap Test and HPV yrs 5 yrs 87624, F V73.81 ICD-10 Use 10/1/15 and after V76.12 V76.11 Z12.31 Z00.00, Z01.419, Z01.411, Z12.4 Z85.41 Comments Report the V and Z code with other appropriate diagnosis code(s) and CPT code(s) that reflects the office visit rendered Chlamydia Screening Laboratory Test yrs, must be sexually active Yearly 87110, 87270, 87320, 87490, 87491,87492, F V72.31 V73.88 V73.89 Z A74.9 Report the V and Z code with other appropriate diagnosis code(s) and CPT code(s) that reflects the office visit rendered Prenatal Post Partum Prenatal Visits Post Partum Visit Prenatal visit in the first trimester or within 42 days of enrollment if 1-3 visits, if 1-3 visits, for 4-6 visits, or > 0500F, 0501F, 0502F V22.0, V22.1, V23.XX Z , Z , Z Per Occurrence Do not bill globally visit between 21 and 56 days after delivery Per Occurrence F V24.2 Z39.2 Do not bill globally 3

4 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Adult with Illness Asthma Meds Antibiotic Avoidance with Acute Bronchitis Beta-Blocker Treatment after Heart Attack Use of appropriate medication yrs Yearly 4015F Absence of antibiotic Rx on day of dx or up to 3 days after the episode yrs Per Occurrence Appropriate Office Visit Code 4124F 18 ys old or older who were discharged with dx of AMI who remained on beta blocker treatment for 6 months 18 yrs > Per Occurence G F Comprehensive Diabetes Care Retinal Eye Exam yrs Yearly , , , 92002, 92004, 92012, 92014, 92018, 92019, 92134, , , , , S0620, S0621, S0625, S F, 2024F, 2026F, 3072F 493.XX 493.1X 493.8X 493.9X V , , , , , , , , , X X, XX, , 648.0X ICD-10 Use 10/1/15 and after J45.2X, J45.3X, J45.4X J45.5X, J45.901, J45.902, J45.909, J45.990, J45.991, J J20.9 Z91.12X Z91.13X Z91.14 I21.09, I21.19, I21.11, I21.29, I21.4, I21.3 E10.XX- E11.XXX Comments Indicator is measured on prescription(s) written and dispensed based on the listed diagnoses; members must remain on an asthma controller for at least 75% of their treatment period 4

5 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 COPD Exacerbation- Pharmacotherapy Management HbA1c yrs Yearly 83036, F (<7), 3045F (7-9), 3046F (>9) HTN Control B/P < 140/ yrs Yearly Nephropathy Screening yrs Yearly 82042, 82043, 82044, F, 3061F Dispensed systemic corticosteroid within 14 days of event* Dispensed a bronchodilator within 30 days of event* 40 yrs > Per Occurrence 4025F, 4135F 3074F, 3075F, 3077F, 3078F, 3079F, 3080F 250.0X X, XX, , 648.0X 250.0X X, XX, , 648.0X 250.0X X, XX, , 648.0X , , , 496, 491.8, 491.9, 492.0, ICD-10 Use 10/1/15 and after E10.XX- E11.XXX E10.XX- E11.XXX E10.XX- E11.XXX Comments J44.0, J44.1, J44.9, J41.8, J42, J43.9 *event = acute inpatient discharges and ED visits 5

6 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 COPD- Spirometry Evaluation HTN Control Spirometry Performed and Results Documented 40 yrs > Yearly B/P Recording yrs with dx of HTN, whose B/P is < 140/90 Yearly 94010, 94014, 94015, 94016, 94060, 94070, 94375, F, 3025F , , G8752 (Systolic <140), G8753(systolic > 140), G8754 (Diastoic <90), G8755 (Diastolic >90) 3074F, 3075F, 3078F, 3079F 491.0, 491.1, , , , 491.8, 491.9, 492.0, 492.8, , , , I10 ICD-10 Use 10/1/15 and after J41.0, J41.1, J41.8, J42, J43.9, J44.0, J44.1, J44.9 Comments Report the G code and CPT II code with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered 6

7 Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Imaging Studies for Low Back Pain Imaging Studies yrs with dx of LBP who did not receive an imaging study within 28 days of diagnosis Per Occurrence 72010, 72020, 72052, 72100, 72110, 72114, 72120, 72131, 72132, 72133, 72141, 72142, , 72158, 72200, 72202, F 721.3, , , , , , , 724.2, 724.3, 724.5, 724.6, , , , 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, ICD-10 Use 10/1/15 and after M47.814, M48.04, M48.06, M , M , M , M46.47, M , M54.5, M54.30, M54.89, M54.9, M43.8X9, M53.9, M53.3, M53.2X8, M53.3, M , M99.03, M99.04, S33.8XXA, S33.6XXA, S33.9XXA, S33.5XXA Comments Major Depression- Antidepressant Medication Medication for at least 84 days 18 yrs and > Per Occurrence 4064F , , 298.0, 311 F32.0-F32.9, F33.0-F33.3, F33.8, F33.9, F34.1 Report the appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered Medication for at least 180 days 18 yrs and > Per Occurrence 4064F , , 298.0, 311 F32.0-F32.9, F33.0-F33.3, F33.8, F33.9, F34.1 Report the appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered 7

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