Total Health Quality Indicators For Providers 2017

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1 Well Adult Well Visit 20 yrs > Yearly , , G0402, G0438, G0439, G0463 Total Health Quality Indicators For Providers 2017 Adult- Preventive Z00.00 Report ALL components of an annual visit using CPT and Dx code BMI Assessment BMI Recording yrs Yearly G8417, G8418, G F Z Z68.45, Z , T1015 Report the Dx w/an E/M on one line OR Report CPT II and Dx on the same line Substance Abuse/Screening Tobacco Use Screening 13 yrs > Yearly G9275, G F (tobacco use assessed) 1031F (Smoking status and exposure to secondhand smoke assessed in home) 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) F17.2XX, T65.211A, T65.212A, T65.213A, T65.214!, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A Z Report E/M w/appropriate Z code and other Dx code(s) on the same line OR Report CPT II code w/ Z Dx code on a separate line * tobacco use disorder, use this if they are tobacco users Alcohol Screening 13 yrs > Yearly G0396, G0397, G0442, G0443, 99408, F F10.10 F10.20 F10.21 Report E/M w/appropriate Dx or OR Report on a separate line, use CPT II with other appropriate Dx code(s) and CPT code(s) that reflect the office visit rendered Substance Abuse Screening 13 yrs > Yearly G0396, G0397, 99408, Multiple codes depending on the substance (refer to 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 99406, 99407, S9075, S9453, G0436, F F (cessation-counseling), 4001F (cessation-pharm), 4004F (either one or both) F17.2XX, T65.211A, T65.212A, T65.213A, T65.214!, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A Z Report the Dx w/an E/M on one line OR appropriate CPT II and Dx on the same line 1

2 Colorectal Cancer Screening FIT DNA,Cologuard yrs Yearly 81528, 82274, G F Z12.11 PCP - Order test (s) if not done. If already done, report CPT II and screening Dx if results discussed w/pt Blood Pressure (B/P) -No Previous dx of HTN Flexible Sigmoidoscopy yrs Every 5 yrs , , 45345, G0104, Colonoscopy yrs Every 10 yrs , 44397, 45355, , 45391, 45392, G0105, G0121, , , 45393, B/P Reading Documented 2 yrs and > B/P < 120/80 (screen q2 years), 140/90 (rescreen in one month), 139/80-90 (q 1 yr) G8476, G8477, G8752- G8755, G8783, G8950, G9273, G F Z F Z F B/P Measured Z00.00 *report the CPT II BP reading on claim as noted (see under frequency) Glucose Screening Laboratory Test 19 yrs > Yearly 80047, 80048, 80050, 80053, 80069, 82947, 82948, 82950, 82951, 82952, 83036, LDL-C Screening Laboratory Test 19 yrs > Yearly 80061, 83700, 83701, 83704, F 3011F Lipid results documented/reviewed 3048F LDL C<100 mg/dl 3049F LDL C mg/dl 3050F LDL C >130 mg/dl Influenza vaccine Immunization yrs Yearly 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, , 90685, 90686, 90687, 90688, G0008, Q Q F Depression Screen yrs Yearly G0444, G8431, G F Report the appropriate E/M code and report other appropriate CPT II and diagnosis code(s); administer PHQ2/PHQ9 as appropriate 2

3 Breast Cancer Screening Mammogram yrs Yearly G0202, G0204, G0206, Cervical Cancer Screening Pap Test or Pap Test and HPV Pap Test yrs Pap and HPV yrs 3 yrs 5 yrs Pap: , 88147, 88148, , , , , G0123, G0124, G0141, G0143- G0145, G0147, G0148, P3000, 93001, Q0091 Women Preventive 3014F Z12.31 PCP - Order/schedule test for pt. If already done, report CPT II and screening Dx on claim 3015F Z00.00, Z01.419, Z01.411, Z12.4 Z85.41 Chlamydia Screening Laboratory Test yrs, must be sexually active Pap plus HPV: above codes plus 87623, 87624, Yearly 87110, 87270, 87320, 87490, 87491,87492, F Z11.8 Z A74.9 Prenatal Prenatal Visits Prenatal visit in the first trimester or within 42 days of enrollment Per Occurrence if 1-3 visits, if 1-3 visits, for 4-6 visits, or > 0500F, 0501F, 0502F Z , Z , Z Do not bill globally Post Partum Post Partum Visit visit between 21 and 56 days after delivery Per Occurrence 59430, 57170, F Z39.2 Do not bill globally Adult with Illness Antibiotic Avoidance with Acute Bronchitis Absence of antibiotic Rx on day of dx or up to 3 days after the episode yrs Per Occurrence Appropriate Office Visit Code 4124F J20.9X Z91.12X Z91.13X Z91.14 Beta-Blocker Treatment after Heart Attack (AMI) 18 ys old or older who were hospitalized/discharg ed with dx of AMI who remained on beta blocker treatment for 6 months 18 yrs > Per Occurence G F I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4 Comprehensive Diabetes Care (CDC) Retinal Eye Exam yrs Yearly Optometrist/ophthlmologist: 67015, 67028, , 67036, , 37101, 67105, , 67110, 67113, 67121, 67141, 67145, 37208, 67210, 67218, , , 92002, 92004, 92012, 92014, , 92133, 92134, , 92230, 92235, 92240, 92250, 92260, , , F, 2024F, 2026F 3072F - no evidence of retinopathy E10.10-E10.9, E11.00-E11.9, E13-E13.9, O O24.33, O O24.83 Any provider type may report CPT II 3

4 CDC HbA1c yrs Yearly 83036, F (<7), 3046F (>9) E08.XX - E13.35XX, For Diabetic Dx, please annually report HbA1c result as a CPT II codes ONLY if range is <7 or >9 CDC Diabetes Care B/P Control < 140/ yrs Yearly 3074F, 3075F, 3077F, 3078F (systolic) 3079F, 3080F (dyastolic) E10.10-E10.9, E11.00-E11.9, E13-E13.9, O O24.33, O O24.83 CDC Diabetic Care Monitoring for Nephropathy yrs Yearly 36147, 36800, 38810, 36815, , , 90935, 90937, , 90947, , 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, F, 3061F, 3062F N000 - N08, N140 - N144, N170 - N172, N178 - N189; N19, N250, N251, N2581, N2589, N259, N261, N262, N269 Q600 - Q606, Q612 - Q615, Q618, Q619 R800 - R803, R808, R809 Z992, Z9115 Medical attention for nephropathy include: nephropathy test, evidence of nephropathy, uring macro albumin tests or at least one ACE inhibitor or ARB dispensing event COPD Exacerbation- Pharmacotherapy Management Dispensed systemic corticosteroid within 14 days of event* Dispensed a bronchodilator within 30 days of event* 40 yrs> Per Occurrence 4025F, 4135F *COPD: J44.0-J44.9 *Chronic Bronchitis: J41.--J42 *Emphysema: J43-J43.9 *any Acute inpatient or ED visits COPD- Spirometry Evaluation Spirometry testing Performed and Results Documented 40 yrs> Yearly 94010, 94014, 94015, 94016, 94060, 94070, 94375, F, 3025F *COPD: J44.0-J44.9 *Chronic Bronchitis: J41.--J42 *Emphysema: J43-J43.9 *at least one encounter/claim for spirometry during 2 yrs prior to the event/dx of COPD - 6 mo afterward HTN Control B/P Recording yrs with dx of HTN, whose B/P is < 140/90 Yearly , F, 3075F, 3077F, 3078F (systolic) , , F, 3080F (dyastolic) 387, , , , , G8752 (Systolic <140), G8753 (systolic > 140), G8754 (Diastoic <90), G8755 (Diastolic >90) *I10 MUST Report the G code and CPT II code with other appropriate Dx code(s) and CPT code(s) that reflect the office visit rendered *members are identified by claims indicating at least 1 outpatient visit w/htn Dx during the first 6 mo of the year 4

5 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 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 Major Depression- Antidepressant Medication Medication for at least 84 days 18 yrs and > Per Occurrence 4064F F32.0-F32.9, F33.0-F33.3, F33.8, F33.9, F34.1 Report the appropriate and CPT code(s) that reflect the office visit rendered Medication for at least 180 days 18 yrs and > Per Occurrence 4064F F32.0-F32.9, F33.0-F33.3, F33.8, F33.9, F34.1 Report the appropriate and CPT code(s) that reflect the office visit rendered 5