HEDIS 2010 Summary Table of Measures, Product Lines and Changes Applicable to:
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1 HEDIS 2010 Summary Table of Measures, Product Lines and Changes Adult BMI Assessment Added CPT codes , to Table ABA-A. Added ICD-9-CM Diagnosis codes 678, 679 to Table ABA-C. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents Deleted ICD-9-CM Procedure codes 93.11, 93.13, 93.19, from Table WCC-B. Deleted HCPCS H2032 from Table WCC-B. Added ICD-9-CM Diagnosis codes 678, 679 to Table WCC-C. Childhood Immunization Status Added hepatitis A, rotavirus and influenza vaccines. Added Combinations Clarified that pneumococcal conjugate vaccinations administered prior to 42 days after birth should not be counted as a numerator hit. Immunizations for Adolescents First-year measure. Lead Screening in Children Clarified requirements when reducing the sample size. Breast Cancer Screening No changes to this measure. Cervical Cancer Screening Removed the Hybrid Method of data collection for the commercial product line. Clarified documentation of no endocervical cells. Colorectal Cancer Screening Lowered upper age limit from 80 to 75 years of age. Removed double contrast barium enema (DCBE) from numerator criteria. Clarified requirements for medical record documentation for the FOBT. Deleted HCPCS code G0107 from Table COL-A. Deleted LOINC code from to Table COL-A FOBT description.
2 Chlamydia Screening in Women Clarified the lower age range in the description to reflect the look-back period. Added CPT code to Table CHL-B. Added ICD-9-CM Diagnosis codes 678, 679, to Table CHL-B. Added ICD-9-CM Procedure code to Table CHL-B. Added LOINC codes , , , , , to Table CHL-B. Deleted LOINC codes , from CHL-B. Added LOINC codes , to Table CHL-C. Added Table CHL-E: Medications to Identify Exclusions. Glaucoma Screening in Older Adults No changes to this measure. Care for Older Adults Added HCPCS G8427, G8428 to Table COA-C. Clarified that a complete physical functional status assessment is required. Clarified that a comprehensive pain assessment is required. Appropriate Testing for Children With Pharyngitis Added the Episode Date as the Anchor Date. Appropriate Treatment for Children With Upper Respiratory Infection Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Use of Spirometry Testing in the Assessment and Diagnosis of COPD Pharmacotherapy of COPD Exacerbation Added competing diagnosis criteria for acne. Added ICD-9-CM Diagnosis code 209 to Table AAB-C Malignancy neoplasms description. No changes to this measure. Clarified in step 2 that for ED visits resulting in an inpatient stay only the inpatient stay should be included. Clarified that an ED visit for any diagnosis on or seven days after the Episode Date should be excluded in step 4.
3 Persistence of Beta-Blocker Treatment After a Heart Attack Comprehensive Diabetes Care No changes to this measure. Clarified that HbA1c control (<7.0%) is only reported for the commercial and Medicaid product lines. Deleted CPT codes , , , , from Table CDC-C. Deleted CPT Category II code 3047F from Tables CDC-D, CDC-E, CDC-F and CDC-Q. Clarified that a calculated or direct LDL may be used for LDL-C screening and control. Deleted LOINC code from Table CDC-H. Deleted LOINC code , from Table CDC-J. Added CPT codes , 90965, 90966, 90969, to Table CDC-K Evidence of treatment for nephropathy description. Added LOINC code to Table CDC-K. Deleted LOINC codes , , , from Table CDC-K. Deleted CPT code from Tables CDC-K, CDC-P. Deleted CPT Category II code 3076F from Table CDC-N. Clarified that member-reported BP readings are not acceptable. Added ICD-9-CM Diagnosis code 249 to Table CDC-O Steroid induced description. Added CPT codes , 90965, 90966, 90969, to Table CDC-P ESRD description.
4 Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis Osteoporosis Management in Women Who Had a Fracture Use of Imaging Studies for Low Back Pain Antidepressant Medication Management Follow-Up Care for Children Prescribed ADHD Medication Follow-Up After Hospitalization for Mental Illness Annual Monitoring for Patients on Persistent Medications Medication Reconciliation Post- Discharge Potentially Harmful Drug-Disease Interactions in the Elderly Deleted CPT codes , , , from Table ART-B. Added J codes J2910 Anti-rheumatics description and J9310 Immunomodulators description. Added ICD-9-CM Diagnosis codes 678, 679 to Table ART-D Pregnancy description. Added ICD-9-CM Diagnosis codes to Table OMW-A. Deleted HCPCS S2362 from Table OMW-A. Added ICD-9-CM Diagnosis code 209 to Table LBP-C Cancer description. Clarified Negative Diagnosis History for inpatient claims/encounters and transfers. Deleted CPT codes 90871, from Table AMM-B. Clarified that different medications should be identified using the Drug ID field in the NDC list. Deleted CPT codes from Table ADD-C. Deleted CPT codes 90871, from Table FUH-C. Clarified numerator criteria for Rates 1 3. Clarified codes that identified a lab panel in Table MPM-A. Deleted LOINC codes , , , , , , , , , , , from Table MPM-A. Deleted LOINC codes , from Table MPM-E. Added definition of medication reconciliation. Clarified medical record documentation for evidence of medication reconciliation. Added CPT codes , 90966, to Table DDE-H Chronic renal failure description. Deleted CPT code from Table DDE-H.
5 Use of High-Risk Medications in the Elderly No changes to this measure. Fall Risk Management This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2010, Volume 6: Specifications for the Medicare Health Outcomes Survey. Management of Urinary Incontinence in Older Adults This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2010, Volume 6: Specifications for the Medicare Health Outcomes Survey. Osteoporosis Testing in Older Women This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2010, Volume 6: Specifications for the Medicare Health Outcomes Survey. Physical Activity in Older Adults This measure is collected using survey methodology. Detailed specifications and summary of changes are contained in HEDIS 2010, Volume 6: Specifications for the Medicare Health Outcomes Survey. Aspirin Use and Discussion First-year measure. Flu Shots for Adults Ages This measure is collected using survey methodology. Detailed specifications and Flu Shots for Older Adults This measure is collected using survey methodology. Detailed specifications and Medical Assistance With Smoking and Tobacco Use Cessation Pneumonia Vaccination Status for Older Adults This measure is collected using survey methodology. Detailed specifications and This measure is collected using survey methodology. Detailed specifications and
6 Access/Availability of Care Adults Access to Preventive/ Ambulatory Health Services Children s and Adolescents Access to Primary Care Practitioners No changes to this measure. No changes to this measure. Annual Dental Visit No changes to this measure. Initiation and Engagement of Alcohol and Other Drug Dependence Deleted CPT codes from Table IET-C. Treatment Prenatal and Postpartum Care Added ICD-9-CM Diagnosis codes 678.x1, 679.x1, 679.x2 to Table PPC-B (Step A). Deleted LOINC codes , , , from Table PPC-C (Decision Rules 2 and 3). Added ICD-9-CM Diagnosis codes 649.x3, 678.x3, 679.x3 to Table PPC-C (Decision Rules 2 and 3) and Table PPC-D. Added ICD-9-CM Procedure code to Table PPC-C (Decision Rules 2 and 3) and Table PPC-D. Deleted CPT codes from Table PPC-C and PPC-D. Clarified that a notation of breastfeeding is acceptable for the evaluation of breasts component of the Postpartum Care numerator. Call Abandonment No changes to this measure. Call Answer Timeliness No changes to this measure. Satisfaction With the Experience of Care CAHPS Health Plan Survey 4.0H, Adult Version CAHPS Health Plan Survey 4.0H, Child Version This measure is collected using survey methodology. Detailed specifications and This measure is collected using survey methodology. Detailed specifications and Children With Chronic Conditions This measure is collected using survey methodology. Detailed specifications and summary of changes for the measure are contained in HEDIS 2010, Volume 3: Specifications for Survey
7 Use of Services Guidelines for Use of Services Measures No changes to this measure. Frequency of Ongoing Prenatal Care Added CPT code to Table W15-A. Well-Child Visits in the First 15 Months of Life Removed the Hybrid Method of data collection for commercial only. Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Removed the Hybrid Method of data collection for commercial only. Adolescent Well-Care Visits Removed the Hybrid Method of data collection for commercial only. Frequency of Selected Procedures Added CPT codes 22856, 22861, 22864, to Table FSP-A. Added ICD-9-CM Procedure codes 80.53, to table FSP-A ( back surgery description). Deleted CPT codes 63035, 63043, 63044, 63048, 63057, 63066, 63076, 63078, 63082, 63086, 63088, 63091, from Table FSP-A. Removed CMS-DRGs from Table FSP-A. Ambulatory Care Added CPT code to Table AMB-A. Inpatient Utilization General Hospital/ Acute Care Removed CMS-DRGs from Tables IPU-A and IPU-B. Added ICD-9-CM Diagnosis codes to Table IPU-B Maternity description. Inpatient Utilization Nonacute Care No changes to this measure. Identification of Alcohol and Other Drug Services Removed CMS-DRGs from Table IAD-B. Deleted CPT codes 90871, from Table IAD-C. Added CPT codes 96102, 96103, 96105, 96119, 96120, to Table IAD-D. Deleted CPT code from Table IAD-D. Mental Health Utilization Removed CMS-DRGs from Table MPT-B. Deleted CPT codes 90871, from Table MPT-C. Added CPT codes 96102, 96103, 96105, 96119, 96120, to Table MPT-D. Deleted CPT code from Table MPT-D.
8 Use of Services Antibiotic Utilization No changes to this measure. Outpatient Drug Utilization No changes to this measure. Cost of Care Guidelines for Cost of Care Measures Updated specifications to allow separate collection and reporting of inpatient and Clarified that the treatment period for Acute Low Back Pain should include the IESD. SPTs will be posted to NCQA s Web site ( by November 16, Diabetes Asthma Acute Low Back Pain Cardiovascular Conditions Updated specifications to allow separate collection and reporting of inpatient and Added ICD-9-CM Diagnosis code 209 to Table RDI-A. Deleted CPT code from Table RDI-A. Added CPT codes , 90965, 90966, 90969, to Table RDI-B ESRD description. Deleted CPT code from Table RDI-B. Deleted CPT codes , , , , from Table RDI-E. Removed Table RDI-H: Codes to Identify Inpatient Facility Discharges. Updated specifications to allow separate collection and reporting of inpatient and Revised definitions based on changes to the ASM measure. Defined treatment period. Updated specifications to allow separate collection and reporting of inpatient and Added UB type of bill code 28x to Table RLB-B. Updated specifications to allow separate collection and reporting of inpatient and
9 Cost of Care Uncomplicated Hypertension COPD Health Plan Descriptive Information Updated specifications to allow separate collection and reporting of inpatient and Updated specifications to allow separate collection and reporting of inpatient and Board Certification Clarified that physicians listed in an organization s directory should be included. Enrollment by Product Line No changes to this measure. Enrollment by State No changes to this measure. Language Diversity of Membership No changes to this measure. Race/Ethnicity Diversity of Membership No changes to this measure. Weeks of Pregnancy at Time of Enrollment No changes to this measure. Health Plan Stability Total Membership Retired the Years in Business portion of the measure. Renamed the measure. Clarified Total Membership count. Informed Health Care Choices There are currently no measures in this domain.
SUMMARY TABLE OF MEASURE CHANGES
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Summary Table of Measures, Product Lines and Changes 1 SUMMARY TABLE OF MEASURES, PRODUCT LINES AND CHANGES General Guidelines for Data Collection and Reporting Guidelines for Calculations and Sampling
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