Total Health Quality Indicators For Providers 2015 Child Preventive

Transcription

1 Total Health Quality Indicators For Providers 2015 Child Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Well Child 0-15 months Well Vist 0-15 months 1-6 visits Well Child 3-6 yrs Well Vist 3-6 yrs Yearly Adolescent Well Child Well Vist yrs Yearly 99381, 99382, 99391, 99392, 99461, G0438, G , 99383, 99392, 99393, G0439, G , 99385, 99394, V70.3, V70.5, V70.6, V70.8, V70.9 V70.3, V70.5, V70.6, V70.8, Z under 8 days Z days Z (exam w/o abnormal findings, 29 days or >) or Z (with abnormal findings) V70.9 Z00.129, Z V70.3, V70.5, Z00.129, Z00.121, V70.6, V70.8, Z00.00 or Z00.01 (18 yo V70.9 >) Childhood Immunization Adolescent Immunizations Immunizations- Combo 3 Immunizations Meningococcal and Dtap/Td by 2 yrs old yrs Meningococcal yrs for Dtap/Td Tetanus child who, by 2 birthday, has rec'd 4 Dtap; 3 IPV; one MMR; 3 HiB; 3 HepB, one VZV; and 4 PCV One dose of meningococcal vaccine, one Tetanus and one Tdap or Td by 13th birthday Code for specific vaccine V20.2 *Z , , 90714, , V20.2 *Z23 first, along with the immunization code - if first, along with the immunization code - if Immunization HPV 9-13 yrs Female Females who have had three doses of HPV vaccine by 13th birthday 90649, V20.2 *Z23 first, along with the immunization code - if 1

2 Influenza Vaccine age 6 mo and > Immunization 6 mo > Yearly 90655, 90657, 90661, 90662, 90673, 90685, G F V04.81 *Z23 Report the appropriate code listed and appropriate code(s) for other services rendered, if any. first, along with the immunization code - if patient is in for both service Blood Lead Capillary or Venous Lead Blood Test Before 2nd Birthday Yearly V20.2 V15.86 One test at age 1, another no later than before 2 birthday 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 Height, Weight and BMI must be from same data source BMI percentile plotted on age-growth chart Weight Assessment and Counseling for Nutrition and Physical Activity BMI Percentile 3-17 yrs Yearly See Comment 3008F V85.5 Z Report the V code, and Z code with the appropriate diagnosis code(s) and CPT code(s) that represent the office visit rendered 2

3 Nutrition Counseling 3-17 yrs Yearly , , G0270, G0271 S9449, S9452, S9470 V65.3 Z71.3 Physical Activity Counseling 3-17 yrs Yearly S F V65.41 Z71.89 Documentation must include a note indicating the date and at least one of the following: Discussion of current nutritional behaviors Checklist indicating nutrition was addressed Counseling or referral for nutritional education Member received educational material on nutrition during a face-to-face visit Anticipatory guidance for nutrition Weight or obesity counseling Use the Z code if appropriate and use additional code for BMI if known. Discussion of current physicial activity; provision of educational materials Use the Z code if appropriate Substance Abuse Screening Tobacco 13 yrs > Yearly G9275, G F (tobacco use assessed); 1034F (current tobacco smoker); 1035F (smokeless tobacco user); 1036F (non tobacco user); 4004F (smoker/cessation intervention provided) 305.1x * Z72.0* Report the appropriate CPTII code with other appropriate diagnosis codes(s) and CPT code(s) that reflect the office visit rendered * tobacco use disorder, use this if they are tobacco users. See F17 codes if nicotine dependent 3

4 Alcohol 13 yrs > Yearly G0396, G0397, G0442, G0443, 99408, F 305.0X 303.9X F10.10 F10.20 F10.21 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 Substance Abuse 13 yrs > Yearly G0396, G0397, 99408, XX, Multiple codes depending on the substance (F section) Diagnosis codes listed reflect a positive drug dependence-only report these if the screening is positive Tobacco Cessation Counseling ages 13 to 100 Tobacco 13 yrs > Yearly G9458, 99406, F (cessationcounseling); 4001F (cessation-pharm); 4004F (either one or both) Z72.0 Report the appropriate CPT II with other appropriate diagnosis code(s) and CPT code(s) that reflect the office visit rendered 4

5 Child with Illness , Appropriate Treatment Dispensed antibiotic 87081, 87430, for Children with and received a Group , 034.0, 460, 462, Pharyngitis A strep test 2-18 yrs Per Occurrence F 463, B95.0, J00, J02.0, J02.9, J03.00, J03.01, J03.90, J06.0, J06.9 Appropriate Treatment for Children with URI Asthma Meds ADHD Follow up vist after mental health admit Absence of antibiotic Rx on day of dx or up to 3 days after the episode 3 mo to 18 yrs Per Occurrence , , , Use of appropriate medication 5-18 yrs Yearly 4015F Office Visit (OV) within 30 days of dx OV- 2 additional in last 9 mos Office Visit (OV) within 7 days of discharge 6-12 yrs with Rx for ADHD and received follow up office visit within 30 days or start of medication 6-12 yrs with Rx for ADHD and received 2 additional follow up visits within days 6 > on date of discharge Start of Medication Per Occurrence , , 99078, , , , , , 460, 465.0, 465.8, J00, J06.0, J XX 493.1X 493.8X 493.9X J45.XXX , , , , Appropriate Office Visit Many Many F90.0, F90.1, F90.2, F90.8, F90.9 F90.0, F90.1, F90.2, F90.8, F90.9 Indicator is measured on prescription(s) written and dispensed based on the listed diagnoses 5