WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY FOR CHILDREN AND ADOLESCENTS (WCC)

Transcription

1 WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY FOR CHILDREN AND ADOLESCENTS (WCC) APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? HEDIS (Hybrid) Healthy Kentuckians (Hybrid) NCQA Accreditation EPSDT* To identify child and adolescent members whose BMI percentile was documented and who received counseling for nutrition and physical activity at an outpatient visit Child and adolescent members age 3-17 by December 31st of the measurement year Note: Members in Hospice are excluded from the eligible population. Height and weight should be assessed at each visit. BMI percentile should be assessed at least annually. Assessment and/or counseling for nutrition and physical activity should also be addressed at least annually. Members with a diagnosis of pregnancy during the measurement year are excluded from the measure. Please see code table. Height, weight, and BMI percentile or BMI percentile plotted on age-growth chart during the measurement year. (Please note that the BMI value does not meet criteria for any age group for this measure.) Nutrition documentation must include a note indicating the date and at least one of the following: Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors). Documentation of member s appetite does not meet this criterion. Checklist indicating nutrition was addressed.

2 REFERENCES Counseling or referral for nutrition education. Member received educational materials on nutrition during a face-to-face visit. Anticipatory guidance for nutrition. Weight or obesity counseling. Physical activity documentation must include a note indicating the date and at least one of the following: Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation). Checklist indicating physical activity was addressed. Counseling or referral for physical activity. Member received educational materials on physical activity during a face-to-face visit. Anticipatory guidance for physical activity. Weight or obesity counseling. Services may be rendered during a visit other than a well-child visit. These services count if the specified documentation is present, regardless of the primary intent of the visit; however, services specific to the assessment and treatment of an acute or chronic condition do not count toward the counseling for nutrition and counseling for physical activity indicators. For more information, please refer to Passport Health Plan s Childhood Clinical Practice Guideline and the AAP Bright Futures Toolkit. Passport also has the SCORE (Shrinking Childhood Obesity with Real Expectations!) Program to provide additional support, education, and care coordination.** The criteria above are based on standards established under NCQA s HEDIS 2018 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

3 *The Early and Periodic Screening Diagnosis and Treatment (EPSDT) program is designed to provide a comprehensive preventive health care package to members from birth to age 21. For billing and or other questions/concerns please contact Care Connectors your Provider Network Account Manager or Provider Services at (800) **If you have any questions about the SCORE Program, please call TDD/TTY users may call

4 WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY FOR CHILDREN/ADOLESCENTS Meet Screening Criteria BMI Percentile: ICD10CM Z68.51 [Z68.51] Body mass index (BMI) pediatric, less than 5th ICD10CM Z68.52 [Z68.52] Body mass index (BMI) pediatric, 5th percentile to less than 85th ICD10CM Z68.53 [Z68.53] Body mass index (BMI) pediatric, 85th percentile to less than 95th ICD10CM Z68.54 [Z68.54] Body mass index (BMI) pediatric, greater than or equal to 95th ICD9CM V85.51 BMI,pediatric <5% ICD9CM V85.52 BMI,pediatric 5% - <85% ICD9CM V85.53 BMI,pediatric 85% - <95% ICD9CM V85.54 BMI,pediatric >= 95% Counseling for Nutrition: CPT CPT CPT HCPCS G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face w HCPCS G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individu HCPCS G0447 Face-to-face behavioral counseling for obesity, 15 minutes (G0447) HCPCS S9449 Weight management classes, non-physician provider, per session (S9449) HCPCS S9452 Nutrition classes, non-physician provider, per session (S9452) HCPCS S9470 Nutritional counseling, dietitian visit (S9470) ICD10CM Z71.3 [Z71.3] Dietary counseling and surveillance Counseling for Physical Activity: HCPCS G0447 Face-to-face behavioral counseling for obesity, 15 minutes (G0447) HCPCS S9451 Exercise classes, non-physician provider, per session (S9451) ICD10CM Z02.5 [Z02.5] Encounter for examination for participation in sport ICD10CM Z71.82 [Z71.82] Exercise counseling Exclusions Pregnancy

5