Pediatric Quality Measure Information Sheet 2017

Transcription

1 Prevention and Screening Adolescent Preventive Care Measures (APC) The percentage of adolescents years of age who had at least one outpatient visit with a PCP or OB/ GYN practitioner during the measurement year and received the following four components of care during the measurement year: Assessment or counseling or education on risk behaviors and preventive actions associated with sexual activity Assessment or counseling or education for depression Assessment or counseling or education about the risks of tobacco usage and Assessment or counseling or education about the risks of substance use (including alcohol and excluding tobacco) It is recommended an adolescent receive the above preventive care measures at least once per year during the ages of ***Measure Compliance will be determined using the Hybrid Data Collection method (Chart Review) *** Performance will be determined through a sample chart audit. Five points may be deducted if less than the 75 th percentile is achieved. Counseling related to Sexual Activity Z Z30.019, Z30.2, Z30.9, Z71.7, Z71.89 Depression screening Z13.89 Tobacco Cessation Counseling; 99406, Alcohol and Substance Use Counseling Z13.89, Z71.41, Z71.42, Z71.51, Z71.52, Z71.6 ** Ensure all diagnosis codes are included in the medical record Weight Assessment and Counseling for Nutrition and Physical Activity for Children/ Adolescents (WCC) The percentage of members 3-17 years of age who had an outpatient visit with a PCP or OB/ GYN practitioner and who had evidence of the following during the measurement year: BMI percentile documentation Counseling for nutrition Counseling for physical activity It is recommended a child receive weight assessment and counseling for nutrition and physical activity at least once per year during each of their 3 rd 17 th years of life ***Measure Compliance will be determined using the Hybrid Data Collection method (Chart Review) BMI percentile Z68.51, Z68.52, Z68.53, Z68.54 ** Ensure all diagnosis codes are included in the medical record QI Pediatric (Rev 6/17) Page 1

2 Childhood Immunizations Status (vaccination combo 3) (CIS) The percentage of children 2 years of age who have had the following immunizations on or before their second birthday: 4 diphtheria, tetanus, and acellular pertussis (DTaP) 3 polio (IPV) 1 MMR (Measles, Mumps and Rubella) 3 H influenza type B (HiB) 3 hepatitis B (HepB) 1 chicken pox (VZV) 4 pneumococcal conjugate (PCV) The initial vaccination of the following immunizations should be administered no earlier than 42 days after birth: DTaP; IPV; HiB; PCV The claim for each vaccine administered must include the vaccination supply code in addition to the administration code Vaccine codes: Refer to NYS VFC Provider Manual Appendix D Immunizations for Adolescents (IMA) Adolescents 13 years of age who have had the following immunizations by their 13th birthday: 1 dose of meningococcal conjugate vaccine and 1 tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine At least one meningococcal conjugate vaccine between the 11 th and 13 th birthday At least one Tdap vaccine between the 10 th and 13 th birthday Exclusion: Anaphylactic reaction to the vaccine or its components any time on or before the member's 13 th birthday The claim for each vaccine administered must include the vaccination supply code in addition to the administration code Vaccine codes: Refer to NYS VFC Provider Manual Appendix D QI Pediatric (Rev 6/17) Page 2

3 Human Papillomavirus Vaccine for Adolescents (HPV) The percentage of adolescents 13 years of age who had three doses of the human papillomavirus (HPV) vaccine by their 13 th birthday. At least three HPV vaccinations with different dates of service on or between the 9 th and 13 th birthday Exclusion: Anaphylactic reaction to the vaccine or its components any time on or before the member's 13 th birthday *** Please note that we are awaiting notification of a change in the HEDIS requirements for HPV which recognizes the option of a 2 dose series for children under 15 yrs. of age per ACIP The claim for each vaccine administered must include the vaccination supply code in addition to the administration code Vaccine codes: Refer to NYS VFC Provider Manual Appendix D Lead Screening in Children (LSC) The percentage of children 2 years of age who had one or more capillary or venous lead blood tests for lead poisoning on or before their second birthday The result or finding and the date the test was performed must be documented in the medical record Chlamydia Screening in Women (CHL) The percentage of women years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year Urine chlamydia tests are non-invasive and widely acceptable for this screening Chlamydia is most prevalent among adolescent (15-19) and young adult (20-24) women 87110, 87270, 87320, 87490, 87491, 87492, Screening is essential because the majority of females who have the condition do not experience symptoms QI Pediatric (Rev 6/17) Page 3

4 Respiratory Conditions Appropriate Testing for Children with Pharyngitis (CWP) The percentage of children 3 18 years of age who were diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode Pediatric clinical practice guidelines recommend that only children diagnosed with group A streptococcus (strep) pharyngitis, based on appropriate lab tests, be treated with antibiotics Perform a strep test each time antibiotics are prescribed for the diagnosis of pharyngitis J02.0, J02.8, J02.9, J03.00, J0301, J03.80, J03.81, J03.90, J , 87081, 87430, , ** An additional diagnosis code reported with the pharyngitis diagnosis code will exclude the encounter from the measure Appropriate Treatment for Children with Upper Respiratory Infection (URI) The percentage of children 3 months to 18 years who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription The common cold (or URI) is a frequent reason for pediatric office visits. Clinical guidelines DO NOT support the use of antibiotics for the common cold Pediatric clinical practice guidelines DO NOT recommend antibiotics for a majority of upper respiratory infections because of the viral etiology of these infections, including the common cold Include all diagnosis codes related to a visit for URI ** An additional diagnosis code reported with the URI diagnosis code will exclude the encounter from the measure QI Pediatric (Rev 6/17) Page 4

5 Medication Management for People With Asthma (MMA) The percentage of members 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on during the treatment period. The percentage of members who remained on an asthma controller medication for at least 75% of their treatment period According to New York State quality guidelines, persistent asthma is defined as: At least one ED visit, with a principal diagnosis of asthma, OR At least one acute inpatient encounter, with a principal diagnosis of asthma, OR At least four outpatient visits or observation visits on different dates of service, with any diagnosis of asthma and at least two asthma medication dispensing events, OR At least four asthma medication dispensing events Individuals with emphysema, COPD, or other respiratory conditions should NOT get diagnosed or coded as having asthma Behavioral Health Follow Up Care for Children Prescribed ADHD Medication (ADD) Initiation Phase - The percentage of children 6-12 years of age with newly prescribed attention deficit hyperactivity disorder (ADHD) medication who had one follow-up visit with a practitioner with prescribing authority during the 30-day Initiation Phase Facilitate scheduling of ADHD follow-up appointments to occur within 30 days of newly prescribed medication Educate parents/caregivers regarding the importance of follow-up care for children taking ADHD medications F90.0, F90.1, F90.2, F90.8, F90.9 *** Five points may be deducted if less than the 75 th percentile is achieved. QI Pediatric (Rev 6/17) Page 5

6 Utilization Well Child Visits in the First 15 Months of Life (W15) The percentage of children who turned 15 months old during the measurement year and who had six or more well child visits with a PCP during the measurement year It is recommended a child receive, at minimum, 6 preventive visits within the first 15 months of life YourCare will reimburse for preventive visits appropriately performed, documented, and billed by a PCP type specialty Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z00.70, Z00.71, Z00.8 Z02.0, Z02.2-Z02.6, Z02.8-Z02.9, Z76.1, Z , 99382, 99391, 99392, Well Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) The percentage of children 3-6 years of age who had one or more well child visits with a PCP during the measurement year It is recommended a child receive, at minimum, one preventive visit during each of their 3 rd, 4 th, 5 th and 6 th years of life YourCare will reimburse for preventive visits appropriately performed, documented, and billed by a PCP type specialty Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z00.70, Z00.71, Z00.8, Z00.00, Z00.01, Z02.0-Z02.6, Z02.8-Z , 99383, 99392, Adolescent Well-Care Visits (AWC) The percentage of adolescents years of age who had at least one comprehensive well-care visit with a PCP or OB/ GYN practitioner during the measurement year It is recommended that an adolescent receive, at minimum, one preventive visit during each of their 12 th 21 st years of life YourCare will reimburse for preventive visits appropriately performed, documented, and billed by a PCP or OB/GYN type specialty Z00.00, Z00.01, Z02.0-Z02.6, Z02.8-Z , 99385, 99394, QI Pediatric (Rev 6/17) Page 6