Total Health Quality Indicators For Providers 2015

Total Health Quality Indicators For Providers 2015 Adult- Preventive Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 BMI Assessment BMI Recording 18-74 yrs Yearly G8417, G8418, G8420 3008F V85.0, V85.1, V85.2X, V85.3X, V85.4X ICD-10 Use 10/1/15 and after Z68.1, Z68.20-29, Z68.30-39, Z68.41-45 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, G9276 1000F (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, 99409 3016F G0396, G0397, 99408, 99409 Tobacco Cessation Counseling ages 13 to 100 Tobacco 13 yrs > Yearly G9458, 99406, 99407 305.0X 303.9X 304.XX, 305.2-.9 4000F (cessation-counseling), 4001F (cessation-pharm), 4004F (either one or both) 305.1 Z72.0 1 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

Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Colorectal Cancer Screening Fecal Occult Blood Test (FOBT) 50-75 yrs Yearly G0328, 82270, 82274 3017F Flexible Sigmoidoscopy 50-75 yrs Every 5 yrs Colonoscopy 50-75 yrs Every 10 yrs ICD-10 Use 10/1/15 and after 45330-38, 45340-42, G0104 3017F 45.24 44388-44394, 45378-45386, 45391, 45392, G0105, G0121 3017F 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 18-64 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, G9274 2000F 80047, 80048, 80050, 80053, 80069, 82947, 82948, 82950, 82951, 82952, 83036, 83037 3754F 80061, 83700, 83701, 83704, 83721 3011F, 3048F, 3049F, 3050F 90644-90648, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90672,90673, 90685, 90686, 90687, 90688, G0008 4037F Depression Screen 12-75 yrs Yearly G0444 3725F, 1220F V79.0 Z13.89 V70.0 V70.3 G0438, G0439, G0463, V70.5 G0402, 99385, 99395, V70.6 99386, 99396, 99387, V70.8 Well Adult Well Visit 20 yrs > Yearly 99397 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

Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Women Preventive G0202, G0204, G0206, Breast Cancer Screening Mammogram 50-74 yrs Yearly 77055-77057 3014F Pap: 88141-43, 88147, 88148, 88150-54, 88164-67, 88174-75, G0123, G0124, G0141, G0143- G0145, G0147, G0148, Pap Test 21- P3000, 93001, Q0091 V10.41 64 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 30-64 yrs 5 yrs 87624, 87625 3015F 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 16-24 yrs, must be sexually active Yearly 87110, 87270, 87320, 87490, 87491,87492, 87810 3511F V72.31 V73.88 V73.89 Z01.411 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 99201-99215 if 1-3 visits, 99241-99245 if 1-3 visits, 59425 for 4-6 visits, 59426-7 or > 0500F, 0501F, 0502F V22.0, V22.1, V23.XX Z34.00-03, Z34.80-83, Z34.90-93 Per Occurrence Do not bill globally visit between 21 and 56 days after delivery Per Occurrence 59430 0503F V24.2 Z39.2 Do not bill globally 3

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 19-64 yrs Yearly 4015F Absence of antibiotic Rx on day of dx or up to 3 days after the episode 18-64 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 G8450 4008F Comprehensive Diabetes Care Retinal Eye Exam 18-75 yrs Yearly 67028-67113, 67121-67221, 67227-67228, 92002, 92004, 92012, 92014, 92018, 92019, 92134, 92225-92260, 99203-99205, 99213-99215, 99242-99245, S0620, S0621, S0625, S3000 2022F, 2024F, 2026F, 3072F 493.XX 493.1X 493.8X 493.9X 466.0 V15.81 410.01, 410.11, 410.21, 410.31, 419.41, 410.51, 410.61, 410.71, 410.81, 410.91 250.0X - 250.9X, 357.2. 362.XX, 366.41, 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, J45.998 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

Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 COPD Exacerbation- Pharmacotherapy Management HbA1c 18-75 yrs Yearly 83036, 83037 3044F (<7), 3045F (7-9), 3046F (>9) HTN Control B/P < 140/90 18-75 yrs Yearly Nephropathy Screening 18-75 yrs Yearly 82042, 82043, 82044, 84156 3060F, 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 - 250.9X, 357.2. 362.XX, 366.41, 648.0X 250.0X - 250.9X, 357.2. 362.XX, 366.41, 648.0X 250.0X - 250.9X, 357.2. 362.XX, 366.41, 648.0X 491.21 491.22 493.20, 493.21, 493.22, 496, 491.8, 491.9, 492.0, 492.8 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

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 18-85 yrs with dx of HTN, whose B/P is < 140/90 Yearly 94010, 94014, 94015, 94016, 94060, 94070, 94375, 94620 3023F, 3025F 99201-99205, 99211-99215, G8752 (Systolic <140), G8753(systolic > 140), G8754 (Diastoic <90), G8755 (Diastolic >90) 3074F, 3075F, 3078F, 3079F 491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8, 493.20, 493.21, 493.22, 496 401.0 401.1 401.9 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

Measure Test/Procedure Parameters Frequency CPT/HCPCS CPT II ICD-9 Imaging Studies for Low Back Pain Imaging Studies 18-50 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, 72146-72149, 72158, 72200, 72202, 72220 1134F 721.3, 722.10, 722.32, 722.52, 722.93, 724.02, 724.03, 724.2, 724.3, 724.5, 724.6, 724.70, 724.71, 724.79, 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, 847.2 ICD-10 Use 10/1/15 and after M47.814, M48.04, M48.06, M51.26-27, M51.46-47, M51.36-37, M46.47, M51.86-87, M54.5, M54.30, M54.89, M54.9, M43.8X9, M53.9, M53.3, M53.2X8, M53.3, M99.83-84, 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 296.20-296.26, 296.30-296.36, 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 296.20-296.26, 296.30-296.36, 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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