HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid...

2017 HEDISreg

Provider Guideand Toolkit

Prepared By Quality Improvement Department Molina Healthcare of Washington

MolinaHealthcarecom

HEDISreg 2017

TABLE OF CONTENTS Welcome to 2017 HEDIS TIPS3 Molina Provider Contacts 4 Adults with Acute Bronchitis (AAB) 6 Adults Access to PreventiveAmbulatory Health Services (AAP)7 Adult BMI Assessment (ABA)8 Follow Up Care for Children Prescribed ADHD Medication (ADD) 9 Annual Dental Visits (ADV)10 Antidepressant Medication Management (AMM) 11 Asthma Medication Ratio (AMR) 13 Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC)15 Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) 16 First Line Psychosocial Care for Child Adolescents on Antipsychotics (APP)18 Disease Modifying Anti-Rheumatic Drug Therapy (DMARD) for Rheumatoid Arthritis (ART) 20 Adolescent Well-Care Visit (AWC)21 Breast Cancer Screening (BCS) 22 Children and Adolescents Access to Primary Care Practitioners (CAP) 23 Controlling High Blood Pressure (CBP)24 Cervical Cancer Screening (CCS)25 Comprehensive Diabetes Care (CDC) 26 Chlamydia Screening (CHL) 28 Childhood Immunization Status (CIS) 29 Care for Older Adults (COA) 31 Colorectal Cancer Screening (COL) 33 Appropriate Testing for Children with Pharyngitis (CWP) 35 Frequency of Ongoing Prenatal Care (FPC)36 Follow Up After Hospitalization for Mental Health (FUH) 38 Initiation amp Engagement of Alcohol amp Other Drug Dependence Treatment (IET) 39 Immunizations for Adolescents (IMA) 41 Low Back Pain (LBP) 42 Lead Screening in Children (LSC) 43 Medication Management for People with Asthma (MMA) 44 Annual Monitoring for Patients on Persistent Medications (MPM) 46 Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS) 47 Osteoporosis Management for Fractures (OMW)48 Persistence of Beta-Blocker Treatment after a Heart Attack (PBH) 50 Pharmacotherapy Management of COPD Exacerbation (PCE) 52 Postpartum Care (PPC)54

Prenatal Care ndash Timeliness (PPC)56 Non-Recommended PSA-Based Screening in Older Men (PSA)58 Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA) 60 Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia (SMC)62 Diabetes Monitoring for People with Diabetes and Schizophrenia (SMD) 63 Spirometry Testing in COPD Assessment (SPR) 65 Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who are Using Antipsychotic Medications (SSD)67 Appropriate Treatment for Children with URI (URI)69 Well-Child Visits First 15 Months of Life (W15) 71 Well-Child Visits 3-6 Years (W34)72 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)73

Welcome to 2017 HEDISreg Tips Welcome to Molinarsquos Healthcare Effectiveness Data and Information Set (HEDISreg) Provider Guide and Toolkit Developed by the National Committee for Quality Assurance (NCQA) HEDISreg is a widely used set of performance measures in the managed care industry part of NCQA accreditation and an essential tool in ensuring that our members are getting the best health care possible Thus it is vitally important that our providers understand the HEDISreg specifications and guidelines

Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs and we want to do everything we can do to make this process as easy as possible This guide is intended to be an easy-to-follow reference that covers all of the 2017 HEDISreg measures applicable to Medicaid (Apple Health) Medicare and Marketplace This guide includes ICD-10 codes with ICD-9 included only as a reference

We understand that HEDISreg specifications can be complex so we have designed this guide to clearly define Molinarsquos criteria for meeting the guidelines of 46 HEDISreg measures

We welcome your feedback and look forward to supporting all your efforts to provide quality healthcare to our members

The information provided in this document is current for 2017 HEDISreg at the time it was created and can be subject to change in order to comply with NCQA and HEDISreg requirements

About Molina Molina Healthcare of Washington is active in 38 of the 39 Washington counties with over 736500 members (as of January 2017) NCQA has awarded Molinarsquos Medicaid plan with the rating of Commendable as an organization with well-established programs for service and clinical quality that meets rigorous requirements for consumer protection and quality improvement for our members Our Marketplace plan is currently rated as Accredited and our Medicare plan received 35 Stars

For HEDISreg related inquiries contact us at (800) 869-7175 Ext 141486 or MHW_QI_DEPARTMENT MolinaHealthcarecom

Quality is improving access removing barriers providing a positive customer service experience and delivering preventative and diagnostic care

HEDISreg is a registered trademark of the National Committee for Quality Assurance (NCQA)

3

Molina Healthcare of Washington Provider Contacts PROVIDER INFORMATION FOR MEDICAIDMEDICARE

Prior Authorizations MedicalBehavioral Health Phone (855) 322-4082 Fax (800) 767-7188

24 Hour Nurse Advice Line English (888) 275-8750 (TTY 1-866735-2929) Spanish (866) 648-3537 (TTY 1-866833-4703)

Radiology NICU Transplant Authorizations Phone (855) 714-2415 Fax (877) 731-7218

Vision Care Phone (888) 493-4070 Fax (866) 772-0285

Pharmacy Authorizations Phone (800) 869-7185 Fax (800) 869-7791

Transportation Covered by Apple Health A list of brokers can be found at httpwwwhcawagovmedicaidtransportation pagesphoneaspx Click on ldquoRegional Brokerrdquo

Provider Customer Service Phone (888) 858-5414 Fax (877) 814-0342

Dental Covered by Apple Health A list of dental providers and more information on dental benefits is available at httpwwwhcawagovmedicaid dentalprovidersDocumentsAdultDentalCoveragepdf or you can call HCA for more information at (800) 562-3022

PROVIDER INFORMATION FOR MARKETPLACE Prior Authorizations MedicalBehavioral Health Phone (855) 322-4082 Fax (800) 767-7188

Dental Phone (855) 322-4082 Fax (866) 772-0285

Transplant Authorizations Phone (855) 322-4082 Fax (866) 767-7188

Providers may utilize Molina Healthcarersquos ePortal at MolinaHealthcarecom Available features include

Electronic authorization submission and status through Clear Coverage application with potential for automatic approval at the time of submission httpseportalmolinahealthcarecomProviderLogin

bull Claims submission and status bull Member Eligibility bull Provider Directory

bull Download Frequently used Forms bull Nurse Advice Line Report

4

MEMBER INFORMATION FOR MEDICAID Member Customer Service BenefitsEligibility Phone (800) 869-7165 TTYTDD 711 Fax (800) 816-3778

Transportation Phone (800) 869-7185 Fax (800) 767-7188

24 Hour Nurse Advice Line English (888) 275-8750 (TTY 711)

Spanish (888) 648-3537 (TTY 711)

MEMBER INFORMATION FOR MEDICARE Member Customer Service BenefitsEligibility Phone (800) 665-1029

Non-Molina Medicare members can get information Phone (866) 403-8293

24 Hour Nurse Advice Line English (888) 275-8750 Spanish (866) 648-3537

Transportation Reservations (866) 475-5423 Ride Assist (866) 474-5331

MEMBER INFORMATION FOR MARKETPLACE Member Customer Service BenefitsEligibility Phone (888) 858-3492 Fax (310) 507-6186

24 Hour Nurse Advice Line English (888) 275-8750 Spanish (866) 648-3537 My Molina allows members to manage their health care online at MyMolinacom

Benefits of registering for My Molina bull Check your doctor bull Check your eligibility bull View service history

bull Request and print your ID Card bull Update your contact information bull Get health reminders on services you need

MOLINA HEALTHCARE VIRTUAL CARE Free 247 Virtual Care to Molina Apple Health (Medicaid) member Visit today at wavirtualcaremolinahealthcarecom All you need is bull a telephone smartphone computer or tablet bull Molina ID member bull an email address

5

HEDISreg is a registered trademark of NCQA

Description ICD-9 Code ICD-10 Code Acute 4660 J200ndash202

bronchitis J202 J203-J209

HEDISreg TIPS ADULTS WITH ACUTE BRONCHITIS (AAB)

MEASURE DESCRIPTION Adults 18-64 years of age diagnosed with acute bronchitis should not be dispensed an antibiotic within 3 days of the visit

Note Prescribing antibiotics for acute bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right)

Only about 10 of cases of acute bronchitis are due to a bacterial infection so in most cases antibiotics will not help

HOW TO IMPROVE HEDISreg SCORES

bull Discuss realistic expectations for recovery time (eg cough can last for 4 weeks without being ldquoabnormalrdquo)

bull For patients requesting an antibiotic Give a brief explanation Write a prescription for symptom relief

instead of an antibiotic Encourage follow-up in 3 days if

symptoms do not get better bull Submit comorbid diagnosis codes if present

on claimencounter (see codes above) bull Submit competing diagnosis codes for

bacterial infection if present on claimencounter (see codes above)

bull Ensure progress note is closed out with a provider signature

USING CORRECT BILLING CODES Codes to Identify Acute Bronchitis

Codes to Identify Most Common Comorbid Conditions Description ICD-9 Code ICD-10 Code Chronic 4918 4919 J410 J411 bronchitis J418 J42 Emphysema 4920 4928 J430 J431

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Codes to Identify Most Common Comorbid Conditions Description ICD-9 Code ICD-10 Code Acute sinusitis 4618 4619 J0180 J0190

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

Pharyngitis streptococcal tonsillitis or acute tonsillitis

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

ICD-10-CM codes are to be used on or after 1012015 Please refer to your ICD-10-CM Manual for further code specificity

6

HEDISreg TIPS ADULTSrsquo ACCESS TO PREVENTIVEAMBULATORY HEALTH SERVICES (AAP)

MEASURE DESCRIPTION Patients 20 years and older who had an ambulatory or preventive care visit during the measurement year

USING CORRECT BILLING CODES Codes to Identify PreventiveAmbulatory Health Services Description Codes Ambulatory Visits CPTreg 99201-99205 99211-99215 99241-99245 99341-99345 99347-99350

99381-99387 99391-99397 99401-99404 99411 99412 99420 99429 HCPCS G0402 G0438 G0439 G0463 T1015 ICD-9 V202 V700 V703 V705 V706 V708 V709 UB Rev 0510-0517 0519-0523 0526-0529 0982-0983 ICD-10-CM Z0000 Z0001 Z00121 Z00129 Z005 Z008 Z020-Z026 Z0271 Z0279 Z0281 Z0282 Z0283 Z0289 Z029

Other Ambulatory Visits

CPTreg 92002 92004 92012 92014 99304-99310 99315 99316 99318 99324shy99328 99334-99337 HCPCS S0620 S0621 UB Rev 0524 0525

ICD-10-CM and ICD-10-PCS codes are to be used on or after 1012015 Please refer to your ICD-10-CM and ICD-10-PCS Manuals for further code specificity

HOW TO IMPROVE HEDISreg SCORES bull Document all elements of a preventative exam including health history developmental history

physical exam and educationanticipatory guidance bull Code to the highest specificity using the appropriate billing codes as described above bull Educate patients on the importance of having at least one ambulatory or preventive care visit during

each calendar year bull Contact patients on the needed services list who have not had a preventive or ambulatory health visit bull Make reminder calls to patients who have appointments to decrease no-show rates bull Ensure progress note is closed out with a provider signature

7

HEDISreg TIPS ADULT BMI ASSESSMENT (ABA)

MEASURE DESCRIPTION Adults 18ndash74 years of age who had an outpatient visit and whose body mass index (BMI) or BMI percentile (for patients younger than 20 years) was documented during the measurement year or the year prior to the measurement year

For patients 20 years of age or older on the date of service documentation in the medical record must indicate the weight and BMI value dated during the measurement year or year prior to the measurement year

For patients younger than 20 years on the date of service documentation in the medical record must indicate the height weight and BMI percentile dated during the measurement year or year prior to the measurement year The following meets criteria for BMI percentile bull BMI percentile documented as a value (eg

85th percentile) bull BMI percentile plotted on an

age-growth chart

USING CORRECT BILLING CODES Codes to Identify BMI Description ICD-9

Code ICD-10 Code

BMI lt19 adult V850 Z681

BMI 19 or less adult V850 Z681

BMI between 19-24 adult V851

BMI between 20-24 adult Z6820-Z6824

BMI between 25-29 adult V8521- Z6825-V8525 Z6829

BMI 40 and over adult V8541- Z6841-V8545 Z6845

BMI pediatric lt5th percentile for age

V8551 Z6851

BMI pediatric 5th percentile to lt85th percentile for age

V8552 Z6852

V8553 Z6853

BMI pediatric ge 95th percentile for age

V8554 Z6854

ICD-10-CM and ICD-10-PCS codes are to be used on or after 1012015 Please refer to your ICD-10-CM and ICDshy10-PCS Manuals for further code specificity

HOW TO IMPROVE HEDISreg SCORES bull Make BMI assessment part of the vital sign assessment at each visit bull Use correct billing codes to report BMI (Z681-Z6854) Accurate billing and coding will decrease

need for additional records requests bull Ensure proper documentation for BMI in the medical record with all components (eg date weight

height and BMI value and percentage) Provider signature must be on the same page bull Update the EMR templates to automatically calculate a BMI if on an EMR bull Place BMI charts near scales (ask Molina for copies) Be sure graphscharts are labeled for BMI bull Calculate the BMI here if not on an EMR httpwwwcdcgovhealthyweightassessingbmi

8

Description Codes

Follow-up Visits

CPTreg 96150-96154 98960-98962 99078 99201-99205 99211-99215 99217-99220 99241-99245 99341-99345 99347-99350 99381-99384 99391-99394 99401-99404 99411 99412 99510 HCPCS G0155 G0176 G0177 G0409-G0411 G0463 H0002 H0004 H0031 H0034-H0037 H0039 H0040 H2000 H2001 H2010-H2020 M0064 S0201 S9480 S9484 S9485 T1015 UB Revenue 0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0905 0907 0911-0917 0919 0982 0983

Telephone Visits CPTreg 98966-98968 99441-99443 (can use for one Continuation and Maintenance Phase visit)

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

HEDISreg TIPS FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION (ADD)

MEASURE DESCRIPTION Patients 6-12 years old with a new prescription for an attention-deficithyperactivity disorder (ADHD) medication who had bull At least one follow-up visit with practitioner with prescribing authority during the first 30 days of when the

ADHD medication was dispensed (Initiation Phase) bull At least two follow-up visits within 270 days (9 months) after the end of the initiation phase One of these visits

may be a telephone call (Continuation and Maintenance Phase)

USING CORRECT BILLING CODES Codes to Identify Follow-up Visits

HOW TO IMPROVE HEDISreg SCORES bull When prescribing a new medication schedule a follow-up visit within 30 days to assess your patientrsquos response

to the medication bull Schedule two more visits in the 9 months after the first 30 days to continue to monitor your patientrsquos progress bull You may use a phone visit for one of the visits after the first 30 days This may help you and your patients

if getting to an office visit is difficult (codes 98966-98968 99441-99443) Only one phone visit is allowed during the Continuation and Maintenance Phase If a phone visit is done at least one face-to-face visit should also be completed

bull Do not continue these controlled substances without at least 2 visits per year to evaluate a childrsquos progress bull Refer to the Clinical Practice Guideline (CPG) for the Diagnosis Evaluation and Treatment of ADHD at

httpwwwmolinahealthcarecomproviderswamedicaidresourcePDFCPG-ADHDpdf bull Ensure progress note is closed out with a provider signature to last order bull Code appropriately using the above codes as guidelines

9

HEDISreg TIPS ANNUAL DENTAL VISIT (ADV)

MEASURE DESCRIPTION Patients 2ndash20 years of age who had at least one dental visit with a dental practitioner during the measurement year

USING CORRECT BILLING CODES Codes to Identify Annual Dental Visit Description Codes Dental Visits CPTreg 70300 70310 70320 70350 70355

HOW TO IMPROVE HEDISreg SCORES bull Use appropriate billing codes as described above bull Document all elements of a dental exam including physical exam oral cleaning and x-rays bull Remind patients of their dental benefits bull Help patients schedule an appointment to see a dentist bull Provide appointment reminder calls or postcards to help ensure that patients do not miss

appointments bull Provide preventive services such as fluoride varnish application where appropriate bull Ensure progress note is closed out with a provider signature

10

HEDISreg TIPS ANTIDEPRESSANT MEDICATION MANAGEMENT (AMM)

MEASURE DESCRIPTION The percentage of adults 18 years of age and older who were treated with antidepressant medication had a diagnosis of major depression and who remain on an antidepressant medication treatment Two rates are reported

ANTIDEPRESSANT MEDICATIONS Codes to Identify BMI

Effective Acute Phase Treatment The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks) (Continuous treatment allows gaps in treatment up to a total of 30 days during the Acute Phase)

Effective Continuation Phase Treatment The percentage of members who remained on an antidepressant medication for at least 180 days (6 months) (Continuous treatment allows gaps in treatment up to a total of 51 days during the Acute and Continuation Phases combined)

USING CORRECT BILLING CODES Codes to Identify Major Depression Description ICD-9 Code ICD-10

Code Major Depression 29620shy

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

ICD-10-CM and ICD-10-PCS codes are to be used on or after 1012015 Please refer to your ICDshy10-CM and ICD-10-PCS Manuals for further code specificity

Description Generic Name Brand Name Miscellaneous Bupropion Wellbutrinreg antidepressants Vilazodone

Vortioxetine ZybanregViibrydregTrintellix (Brintellixwas changedto Trintellix in June 2016 by the FDA)

Phenylpiperazine antidepressants

Nefazodone Trazodone

Serzonereg Desyrelreg

Psycho-therapeutic Amitriptyline- Limbitrolreg combinations chlordiazepoxide

AmitriptylineshyperphenazineFluoxetineshyolanzapine

Triavilreg Etrafonreg Symbaxreg

SNRI Desvenlafaxine Pristiqregantidepressants Levomilnacipran

Duloxetine Venlafaxine Desvenlafaxine MilnacipranLevomilnacipranVenlafaxine

CymbaltaAcircregEffexorAcircreg PristiqAcircregSavellaAcircreg FetzimaAcircreg CymbaltaregEffexorreg

SSRI Citalopram Celexareg antidepressants Escitalopram Lexaproreg

Fluoxetine Prozacreg Fluvoxamine Luvoxreg Paroxetine Paxilreg Sertraline Zoloftreg

Tetracyclic antidepressants

MaprotilineMirtazapine

Ludiomilreg Remeronreg

Tricyclic Amitriptyline Elavilreg antidepressants Amoxapine

ClomipramineDesipramineDoxepin (gt6mg)ImipramineNortriptylineProtriptylineTrimipramine

Asendinreg Anafranilreg NorpraminregSinequanregTofranilreg Pamelorreg Vivactilreg Surmontilreg

Monoamine oxidase Isocarboxazid Marplanreginhibitors Phenelzine Nardilreg

Selegiline Aniprylreg Tranylcypromine Emsamreg

Parnatereg

11

12 HEDISreg is a registered trademark of NCQA

bull Document reason for prescribed medication (eg depression sleep) bull Code to the highest specificity bull Review missing services list for pharmacy refills to ensure member is getting timely refills If the patient is started on medication for anxiety disorder or other stress reaction disorder proper

coding will exclude the patient from the measure bull Place reminder calls to remind patients of their appointment bull Educate patients on the following The importance of staying on the antidepressant for a minimum of 6 months Strategies for remembering to take the antidepressant on a daily basis Common side effects how long the side effects may last and how to manage them

bull Refer to Molina Healthcare of Washington Drug Formulary for coverage updates at httpwwwmolinahealthcarecomproviderswamedicaiddrugPagesformularyaspx or contact Molina Provider Pharmacy at (800) 869-7175 Ext 751406

bull Ensure progress notes are closed out with a provider signature

HEDISreg TIPS ASTHMA MEDICATION RATIO (AMR)

MEASURE DESCRIPTION The percentage of patients 5ndash64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 050 or greater during the measurement year Patients are in the measure if they met at least one of the following during both the measurement year and the year prior bull At least one ED visit with asthma as the principal diagnosis bull At least one acute inpatient claimencounter with asthma as the principal diagnosis bull At least 4 outpatient asthma visits with asthma as one of the diagnoses and at least 2 asthma medication dispensing events bull At least 4 asthma medication dispensing events If leukotriene modifiers were the sole asthma medication dispensed

there must also be at least one diagnosis of asthma in any setting in the same year as the leukotriene modifier (ie measurement year or the year prior)

USING CORRECT BILLING CODES Codes to Identify Asthma Description ICD-9 Code ICD-10 Code Asthma 49300-49302 49310-49312 49381 49382

49390-49392 Mild Intermittent Asthma J4520 J4521 J4522 Mild Persistent Asthma J4530 J4531 J4532 Moderate Persistent Asthma J4540 J4541 J4542 Severe Persistent Asthma J4550 J4551 J4552 Other and Unspecified Asthma J45901 J45902 J45909 J45990 J45991

J45998

Asthma Controller Medications Description Prescriptions Antiasthmatic combinations Dyphylline-guaifenesin Guaifenesin-theophylline Antibody inhibitor Omalizumab Inhaled steroid combinations Budesonide-formoterol Fluticasone-salmeterol

Mometasone-formoterol Inhaled corticosteroids Beclomethasone Budesonide Ciclesonide Flunisolide

Fluticasone CFC free Mometasone Leukotriene modifiers Montelukast Zafirlukast Zileuton Mast cell stabilizers Cromolyn Methylxanthines Aminophylline Dyphylline Theophylline

Please refer to the Molina Healthcare Drug Formulary at httpwwwmolinahealthcarecomproviderswamedicaiddrugPages formularyaspxfor asthma controller medications that may require prior authorization or step therapy

13

HOW TO IMPROVE HEDISreg SCORES bull Ensure proper documentation and coding to avoid coding asthma if the diagnosis is for an asthma-

like symptom (eg wheezing during viral URI and acute bronchitis is not ldquoasthmardquo) bull Use the needed services list and contact patients who have not filled a controller medication bull Inform patients mail-order delivery is available to them bull Ensure progress note is closed out with a provider signature bull Patients with chronic conditions such as asthma may qualify for case management and should be

referred to the Molina Healthcare Case Management Program for evaluation at (800) 869-7165 Ext 751411

HEDISreg TIPS USE OF MULTIPLE CONCURRENT ANTIPSYCHOTICS IN CHILDREN AND ADOLESCENTS (APC)

MEASURE DESCRIPTION The percentage of children and adolescents 1 to 17 years of age who were on two or more different antipsychotic medications concurrently for at least 90 consecutive days during the measurement year A lower rate indicates better performance

ANTIPSYCHOTIC MEDICATIONS Description Generic Name Brand Name First Generation Chlorpromazine HCL Fluphenazine HCL Thorazine HCL Prolixin HCL Prolixin Antipsychotic Fluphenazine decanoate Haloperidol decanoate Haldol Haldol intramuscular Medications Haloperidol decanoate Haloperidol

lactate Loxapine HCL Loxapine succinate Molindone HCL Perphenazine Pimozide Thioridazine HCL Thiothixene Trifluoperazine HCL

Haldol intravenous Loxitane HCL Loxitane succinate Moban HCL Trilaphon Orap Mellaril HCL Navane Stelazine HCL

Second Generation Aripiprazole Asenapine Brexpiprazole Abilify Saphris Rexulti Vraylar Clozaril Antipsychotic Cariprazine Clozapine Iloperidone Fanapt Latuda Zyprexa Zyprexa Relprevv Medications Lurasidone Olanzapine Olanzapine

pamoate Paliperidone Paliperidone palmitate Quetiapine fumarate Risperidone Risperidone microspheres Ziprasidone HCL Ziprasidone mesylate

Invega Invega Sustenna Seroquel Risperdal Risperdal Consta Geodon Geodon for injection

HOW TO IMPROVE HEDISreg SCORES bull Avoid the simultaneous use of multiple antipsychotic medications for children and adolescents per The

American Academy of Child and Adolescent Psychiatry bull Consider monotherapy as the preferred treatment option as it poses a reduced health risk burden for patients

associated with multiple concurrent antipsychotics bull Monitor children and adolescents prescribed antipsychotics closely as they are more at risk for serious health

concerns including weight gain extrapyramidal side effects hyperprolactinemia and some metabolic effects bull Monitor members treated with certain antipsychotics closely as they may also be at increased risk for

gynecological problems bull Inform parentsguardians of the increased side effect burden of multiple concurrent antipsychotics on

childrenrsquos health has implications for future physical health concerns including obesity and diabetes bull Ensure progress note is closed out with a provider signature

15

Codes to Identify Diabetes Screening --AND--Complete at least ONE Cholesterol Screening test during the measurement year

Description Generic Name Codes to IdentifyLDL-C Tests

CPTreg 80061 83700 83701 83704 83721 CPTreg II 3048F (if less than 100 mgdL) 3049F (if 100-129 mgdL) 3050F (if greater than or equal to 103 mgdL)

Codes to Identify Cholesterol Tests (other than LDL)

CPTreg 82465 83718 84478

HEDISreg TIPS METABOLIC MONITORING FOR CHILDREN AND ADOLESCENTS ON ANTIPSYCHOTICS (APM)

MEASURE DESCRIPTION The percentage of children and adolescents 1 to 17 years of age who had at least two antipsychotic prescriptions of the same or different medications on different dates of service during the measurement year and had metabolic testing (one diabetes screening test and one cholesterol screening test)

Combinations Olanzapine-fluoxetine HCL Perphenazineshyamitriptyline HCL

Symbyax Etrafon Triavil

USE CORRECT BILLING CODES Codes to Identify Diabetes Screening Complete at least ONE Diabetes Screening test during the measurement year

Description Generic Name Codes to Identify Glucose Tests

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

Codes to IdentifyHbA1c Tests

CPTreg 83036 83037 CPTreg II 3044F (if HbA1clt7) 3045F (if HbA1c7-9) 3046F (if HbA1cgt9)

16

bull Document patients response to medication including the order for glucose and cholesterol levels bull Document lab results and any action that may be required bull Use supplemental lab data to update medical records when applicable bull Monitor the glucose and cholesterol levels of children and adolescents on antipsychotic medications

Metabolic monitoring is recommended by The American Academy of Child and Adolescent Psychiatry

bull Monitor children on antipsychotic medications to help to avoid metabolic health complications such as weight gain and diabetes

bull Establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side-effects of antipsychotic medication therapy

bull Code appropriately using the above codes as guidelines bull Ensure progress note is closed out with a provider signature

HEDISreg TIPS USE OF FIRST-LINE PSYCHOSOCIAL CARE FOR CHILDREN AND ADOLESCENTS ON ANTIPSYCHOTICS (APP)

MEASURE DESCRIPTION The percentage of children and adolescents 1 to 17 years of age who had a new prescription for an antipsychotic medication and had documentation of psychosocial care as first-line treatment

ANTIPSYCHOTIC MEDICATIONS Description Generic Name Brand Name First Generation Chlorpromazine HCL Fluphenazine Thorazine HCL Prolixin HCL Antipsychotic HCL Fluphenazine decanoate Prolixin decanoate Haldol Haldol Medications Haloperidol Haloperidol decanoate

Haloperidol lactate Loxapine HCL Loxapine succinate Molindone HCL Perphenazine Pimozide Thioridazine HCL Thiothixene Trifluoperazine HCL

intramuscular Haldol intravenous Loxitane HCL Loxitane succinate Moban HCL Trilaphon Orap Mellaril HCL Navane Stelazine HCL

Second Generation Aripiprazole Asenapine Abilify Saphris Rexulti Vraylar Antipsychotic Brexpiprazole Cariprazine Clozapine Clozaril Fanapt Latuda Zyprexa Medications Iloperidone Lurasidone Olanzapine

Olanzapine pamoate Paliperidone Paliperidone palmitate Quetiapine fumarate Risperidone Risperidone microspheres Ziprasidone HCL Ziprasidone mesylate

Zyprexa Relprevv Invega Invega Sustenna Seroquel Risperdal Risperdal Consta Geodon Geodon for injection

Combinations Olanzapine-fluoxetine HCL Perphenazine-amitriptyline HCL

USE CORRECT BILLING CODES Description Generic Name Psychosocial Care CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 99291

99292 90791 90792 90832-90834 90836-90840 90845-90847 90849 90853 90867-90870 90875 90876 90880 98960-98962 99078 99201shy99205 99211-99215 99217-99220 99241-99245 99341-99345 99347shy99350 99384-99387 99394-99397 99401-99404 99411 99412 99510 HCPCS G0155 G0176 G0177 G0409-G0411 G0463 H0002 H0004 H0031 H0035-H0040 H2000 H2001 H2010-H2020 M0064 S0201 S9480 S9484 S9485 T1015

18

bull Psychosocial care which includes behavioral interventions psychological therapies and skills training among other is the recommended first-line treatment option for children and adolescents diagnosed with nonpsychotic conditions such as attention-deficit disorder and disruptive behaviors

bull When prescribed antipsychotic medications should be part of a comprehensive multi-modal plan for coordinated treatment that includes psychosocial care

bull Periodically review the ongoing need for continued therapy with antipsychotic medications bull Patients can be referred for Case Management at (800) 869-7165 Ext 751411 bull Code appropriately using the above codes as guidelines bull Ensure progress note is closed with a provider signature

HEDISreg TIPS DISEASE MODIFYING ANTI-RHEUMATIC DRUG THERAPY (DMARD) FOR RHEUMATOID ARTHRITIS (ART)

MEASURE DESCRIPTION Patients 18 years of age and older who were diagnosed with rheumatoid arthritis (RA) and who were dispensed at least one DMARD prescription during the measurement year

DMARDs Description Prescription 5-Aminosalicyclates Sulfasalazine Alkylating agents Cyclophosphamide Aminoquinolines Hydroxychloroquine Anti-rheumatics Auranofin Gold sodium

thiomalate Leflunomide Methotrexate Penicillamine

Immunomodulators Abatacept Adalimumab Anakinra Certolizumab Certolizumab pegol Etanercept Golimumab Infliximab Rituximab Tocilizumab

Immunosuppressive agents

Azathioprine Cyclosporine Mycophenolate

Janus kinase (JAK) inhibitor

Tofacitinib

Tetracyclines Minocycline

USING CORRECT BILLING CODES Codes to Identify Rheumatoid Arthritis Description Codes Rheumatoid Arthritis ICD-9 7140 7141

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

Codes to Identify DMARD Description Codes DMARD HCPCS J0129 J0135

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

HOW TO IMPROVE HEDISreg SCORES bull Confirm RA versus osteoarthritis (OA) or joint pain bull Document diagnosis of RA along with prescription of DMARD bull Code appropriately using the above codes as guidelines bull Refer to current American College of Rheumatology standardsguidelines bull Refer patients to network rheumatologists as appropriate for consultation andor co-management bull Audit a sample of charts of members identified as having rheumatoid arthritis to assess accuracy of coding Usual ratio of OARA = 91 Aggressive risk adjustment can overstate RA vs OA

bull Refer to the current American College of Rheumatology practice guidelines at httpwwwrheumatologyorg Practice-QualityClinical-SupportClinical-Practice-GuidelinesRheumatoid-Arthritis

20

HEDISreg TIPS ADOLESCENT WELL-CARE VISIT (AWC)

MEASURE DESCRIPTION Patients 12-21 years of age who had one comprehensive well-care visit with a PCP or OBGYN during the measurement year

Well-care visit consists of bull A health history bull A physical exam bull A physical developmental history bull Health educationanticipatory guidance bull A mental developmental history

USING CORRECT BILLING CODES

Description Codes Well-Care Visits CPTreg 99384 99385 99394 99395

HCPCS G0438 G0439 ICD-9 V202 V700 V703 V705 V706 V708 V709 ICD-10Z00121 Z00129 Z005 Z008 Z020-Z026 Z0271 Z0279 Z0281-Z0283 Z0289 Z029

ICD-10-CM and ICD-10-PCS codes are to be used on or after 1012015 Please refer to your ICD-10- CM and ICD-10-PCS Manuals for further code specificity

HOW TO IMPROVE HEDISreg SCORES bull Avoid missed opportunities by taking advantage of every office visit (including sick visits) to provide well care

when possible (immunizations and BMI valuepercentile calculations) bull Make sportsday care physicals into well-care visits by performing the required services and submitting

appropriate codes bull Document all elements of a well-care visit including health history developmental history physical exam and

health educationanticipatory guidance bull Use standardized templates in charts and in EMRs that allow checkboxes for standard counseling activities bull Refer to the Clinical Practice Guideline (CPG) for Preventative Health of Children and Adolescents at

httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Children-Adolescentspdf bull Code appropriately using the above codes as guidelines bull Molina Healthcare offers a member health incentive program for Adolescent Well Care Medicaid member

earns reward points redeemable for health related items For more information please call WA QI Health Education Line at (800) 869-7175 Ext 141428

21

HEDISreg TIPS BREAST CANCER SCREENING (BCS)

MEASURE DESCRIPTION Patients 50-74 years of age who had one or more mammograms any time on or between October 1 two years prior to the measurement year and December 31 of the measurement year

Exclusions Bilateral mastectomy

Note This measure evaluates primary screening Do not count biopsies breast ultrasounds MRIs or tomosynthesis (3D mammography) because they are not appropriate methods for primary breast cancer screening

USING CORRECT BILLING CODES Codes to Identify Breast Cancer Screening Description Breast Cancer

Codes CPT 77055-77057

Screening HCPCS G0202 ICD-9 8736 8737 ICD-10 BH00ZZZshyBH02ZZZ BH00ZZZshyBH06ZZZ UB Revenue 0403

Measure Exclusion Codes

Bilateral Mastectomy ICD-9 8542 8544 8546 8548 ICD-10 0HTV0ZZ

Unilateral Mastectomy with a Bilateral Modifier or Two Unilateral Mastectomy Codes 14 days or more apart

Unilateral Mastectomy CPT19180 19200 19220 19240 19303-19307 ICD-9 Codes 8541 8543 8545 8547 ICD-10 0HTT0ZZ OHTTU0ZZ Bilateral Modifier CPT 50 09950

History of Bilateral Mastectomy

ICD-9 V4571 ICD-10 Z9013

HOW TO IMPROVE HEDISreg SCORES bull Educate patients about the importance of early detection and encourage testing bull Review missing services list to identify patients in need of mammograms bull Document diagnosis and code to the highest specificity bull Increase patient compliance by Scheduling a mammogram for patient or sendgive patient a referralscript (if needed) Have a list of mammogram facilities available to share with the patient (helpful to print on colored paper for easy

reference) Discuss possible fears the patient may have about mammograms and inform the patient that currently available

testing methods are less uncomfortable and require less radiation bull Document in the medical record if the patient has had bilateral mastectomy and fax the chart to Molina Healthcare

(800) 338-7976 bull Molina Healthcare offers a member Health Incentive program for Breast Cancer Screening Medicaid members earn

reward points redeemable for health related items For more information please call (800) 869-7175 Ext 141428 bull Ensure progress notes is closed out with a provider signature

22

HEDISreg TIPS CHILDREN AND ADOLESCENTSrsquo ACCESS TO PRIMARY CARE PRACTITIONERS (CAP)

MEASURE DESCRIPTION The percentage of patients 12 months to 19 years of age who had a visit with a Primary Care Provider (PCP) Four separate percentages are reported for each product line bull Children 12 to 24 months and 25 months to 6 years who had a visit with a PCP during the

measurement year bull Children 7 to 11 years and adolescents 12 to 19 years who had a visit with a PCP during the

measurement year or the year prior to the measurement year

USING CORRECT BILLING CODES Codes to Identify Ambulatory or Preventive Care Visits Description Codes Ambulatory Visits ICD-9 V202 V700 V703 V705 V706 V708V709

ICD-10 Z00121 Z00129 Z005 Z008 Z020-Z026 Z0271 Z0279 Z0281-Z0283 Z0289 Z029 CPTreg 99201-99205 99211-99215 99241-99245 99341-99345 99347-99350 99381-99387 99391-99397 99401-99404 99411 99412 99420 99429 HCPCS G0402 G0438 G0439 G0463 T1015 UBREV 0510-0517 0519-0523 0526-0529 0982 0983

HOW TO IMPROVE HEDISreg SCORES bull Avoid missed opportunities by taking advantage of every office visit (including sick visits) to provide well

care components when applicable bull Make sportsday care physicals into ambulatory or preventive care visits by performing the required

services and submitting appropriate codes bull Review missing services list to identify patients that need an appointment bull Document all elements of a preventative exam including health history developmental history physical

exam and educationanticipatory guidance bull Use standardized templates in charts and in EMRs that allow checkboxes for standard counseling activities bull Code appropriately using the above codes as guidelines bull Molina Healthcare offers a member Health Incentive program for Well Child Exams Medicaid members

earn reward points redeemable for health related items For more information please call (800) 869-7175Ext 141428

23

HEDISreg TIPS CONTROLLING HIGH BLOOD PRESSURE (CBP)

MEASURE DESCRIPTION bull Patients 18 ndash 59 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately

controlled (lt14090) during the measurement year bull Patients 60-85 years of age who had a diagnosis of hypertension (HTN) and diabetes and whose BP was

adequately controlled (lt14090) during the measurement year bull Patients 60-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled

(lt15090) during the measurement year Note Patients are included in the measure if there was a claimencounter with a diagnosis of hypertension on or before June 30 of the measurement year

bull The most recent BP during the measurement year is used

USING CORRECT BILLING CODES Codes to Identify Hypertension Description ICD-9 Code ICD-10 Code Ambulatory Visits 4010 4011 4019 I10

HOW TO IMPROVE HEDISreg SCORES bull Document diagnosis of hypertension prior to June 30th of the measurement year bull Take two BP readings One at the start of the exam and one at the end of the exam (HEDISreg allows us to use

the lowest systolic and lowest diastolic readings in the same day) bull Code appropriately using the above codes as guidelines bull Close the encounter by dating and signing the chart note bull Document the exact value of the BP readings do not round up or down bull Review and document hypertensive medication history and patient compliance bull Refer to the Clinical Practice Guideline (CPG) for Hypertension at httpwwwmolinahealthcarecom

providerswamedicaidresourcePDFCPG-Hypertensionpdf bull Molina also offers a Heart Healthy Living Cardiovascular Program that assists members with their

understanding and management of cardiovascular disease including hypertension Please contact Molina for further information at (800) 869-7175 Ext 751411

bull If your patient has other conditions complicating hypertension be sure to document and code as specifically as possible to ensure accurate Risk Adjustment reporting For example if the patient has Stage 5 Chronic Kidney Disease or End Stage Renal Disease (CKDESRD) in addition to hypertension Improper and Non-Specific Documentation and Coding I10 (Essential primary hypertension) Correct Complete and Specific Documentation and Coding I120 (Stage 5 CKDESRD) An additional

code to identify the stage of CKD would also be reported) bull Please refer to the Molina HCC Pearl on Chronic Kidney Disease at

httpwwwmolinahealthcarecomproviderswamedicaidcommPDFchronic-kidney-diseasepdf

24

HEDISreg TIPS CERVICAL CANCER SCREENING (CCS)

MEASURE DESCRIPTION Patients 21-64 years of age who were screened for cervical cancer using either of the following criteria bull Patients age 21-64 who had cervical cytology

during the measurement year or the two years prior to the measurement year

bull Patients age 30-64 who had cervical cytology and human papillomavirus (HPV) co-testing performed during the measurement year or the four years prior to the measurement year

Exclusions Patients who had a hysterectomy with no residual cervix cervical agenesis or acquired absence of cervix

Molina Healthcare has adopted guidelines recommending cervical cancer screening to begin at age 21 years

USING CORRECT BILLING CODES Codes to Identify Cervical Cancer Screening Description Codes Cervical Cytology

CPTreg 88141-88143 88147 88148 88150 88152-88154 88164-88167 88174 88175HCPCS G0123 G0124 G0141 G0143-G0145 G0147 G0148 P3000 P3001 Q0091UB Revenue 0923

HPV Tests CPTreg 87620-87622 87624 87625 Measure Exclusion Codes

Absence of Cervix

CPTreg 51925 56308 57540 57545 57550 57555 57556 58150 58152 58200 58210 58240 58260 58262 58263 58267 58270 58275 58280 58285 58290-58294 58548 58550 58552-58554 58570 58571-58573 58951 58953 58954 58956 59135ICD-10 Q515 Z90710 Z90712ICD-10 PCS 0UTC0ZZ 0UTC4ZZ 0UTC7ZZ 0UTC8ZZ 0UT94ZZ 0UT9FZZ 0UT97ZZICD-9 6185 75243 V8801 V8803 6841 6849 6851 6859 6861 6869 6871 6879 688

HOW TO IMPROVE HEDISreg SCORES bull Review missing services list to identify patients who are due for a Pap andor an HPV test bull Document date of PapHPV testing along with results of the testing HEDISreg requires they both be collected

on the same date in order to meet compliance bull Ensure results of Pap tests are sent to you if done outside your facilitypractice bull Document in the medical record if the patient has had a hysterectomy with no residual cervix and fax us the

chart Remember synonyms ndash ldquototalrdquo ldquocompleterdquo and ldquoradicalrdquo bull Donrsquot miss opportunities Complete a Pap tests during regularly-scheduled well woman visits sick visits urine

pregnancy tests UTI and ChlamydiaSTI screenings when appropriate bull Utilize ICD-10-CM diagnosis codes to report exclusions to the HEDISreg measure such as absence of the cervix

(see codes in the above table) Correctly coding these conditions may prevent medical record requests bull Refer to the Clinical Practice Guideline (CPG) for Cervical Cancer Screening (within Adult Preventative

Services) at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Adultspdf bull Molina offers a member health incentive program for Cervical Cancer Screening Medicaid members earn

reward points redeemable for health related items For more information please call (800) 869-7175 Ext 141428 bull Ensure progress note is closed out with a provider signature

25

HEDISreg TIPS COMPREHESIVE DIABETES CARE (CDC)

USING CORRECT BILLING CODES MEASURE DESCRIPTION Codes to Identify Comprehensive Diabetes Care Adults 18-75 years of age with diabetes

(type1 and type 2) who had each of the following bull Hemoglobin A1c (HbA1c) testing bull HbA1c poor control (gt90)

a lower rate is better bull HbA1c control lt80 bull Eye exam (retinal or dilated) performed bull BP control (lt14090 mmHg) bull Nephropathy monitoring Nephropathy screening or

monitoring test Treatment for nephropathy or ACEARB

therapy Stage 4 CKD ESRD Kidney transplant Visit with a nephrologist ACEARB dispensed

Description Codes to

Codes ICD-9 25000-25093 3572

Identify 36201-36207 36641 64800shyDiabetes 64804

ICD-10 E10 E11 E13 O24 (base codes)

Codes to CPTreg 83036 83037 Identify CPTreg II 3044F (if HbA1cHbA1c Tests lt7) 3045F (if HbA1c 7 -

9) 3046F (if HbA1c gt9) Codes to Identify Nephropathy Screening Test (Urine Protein Tests)

CPTreg 81000-81003 81005 82042 82043 82044 84156 CPTreg II 3060F 3061F 3062F

Codes to Identify Eye Exam (must be performed by optometrist or ophthalmoloshygist)

CPTreg 67028 67030 67031 67036 67039-67043 67101 67105 67107 67108 67110 67112 67113 67121 67141 67145 67208 67210 67218 67220 67221 67227 67228 92002 92004 92012 92014 92018 92019 92134 92225shy92228 92230 92235 92240 92250 92260 99203-99205 99213-99215 99242-99245 HCPCS S0620 S0621 S3000

Codes to Identify Diabetic Retinal Screening With Eye Care Professional billed by any provider

CPTreg II 2022F 2024F 2026F 3072F

ICD-10-CM codes are to be used on or after 1012015 Please refer to your ICD-10-CM Manual for further code specifity

26

bull Ensure all lab results (nephropathy and A1c) are documented and dated including point of care Document should include the assessment of the patientsrsquo condition vital signs (BP) evidence of monitoring for good control of diabetes

bull A digital eye exam remote imaging and fundus photography MUST be read by an eye care professional (optometrist or ophthalmologist)

bull If memberrsquos eye exam was negative or showed low risk for retinopathy in the prior year use the appropriate code from the above table

bull Refer to the Clinical Practice Guideline (CPG) for Diabetes at httpwwwmolinahealthcarecom providerswamedicaidresourcePDFCPG-Diabetespdf

bull Please also refer to the Molina HCC Pearl for Diabetes at httpwwwmolinahealthcarecom providerswamedicaidcommPDFDiabetespdf

bull Members with chronic conditions such as diabetes may qualify for case management and should be referred to the Molina Healthcare Case Management Program for evaluation at (800) 869-7165 Ext 751411

bull Molina offers a health incentive program for Medicaid members called Staying Healthy with Diabetes Members who reduce their Hemoglobin A1c and get their annual eye exams receive reward points For more information call the Molina Health Education Line at (800) 869-7175 Ext 141428

bull Ensure progress note is closed out with a provider signature and dated

HEDISreg TIPS CHLAMYDIA SCREENING (CHL)

MEASURE DESCRIPTION Patients 16-24 years of age who were identified as sexually active and who had at least one Chlamydia test during the measurement year

Exclusion Patients who were included in the measure based on pregnancy test alone and the member had a prescription for isotretinoin or an x-ray on the date of the pregnancy test or the 6 days after the pregnancy test

USING CORRECT BILLING CODES Codes to Identify Chlamydia Screening Description CPT Code Chlamydia Screening

87110 87270 87320 87490shy87492 87810

bull Perform annual Chlamydia screening on every 16-24 year old patient identified as sexually active (use any visit opportunity)

bull Review missing services list to identify patients that meet the criteria and need a screening bull Add Chlamydia screening as a standard lab for patients 16-24 years old Use adolescent well care and

adult wellness exams for this purpose bull Remember that Chlamydia screening can be performed through a urine test Offer this as an option

for your patients bull Document progress notes with a provider signature and code appropriately bull Refer to the Clinical Practice Guideline (CPG) for Chlamydia Screening at

httpwwwmolinahealthcarecomproviderswamedicaidresourcePDFChlamydia_Clinical_ Practice_Guideline_2013pdf

28

HEDISreg TIPS CHILDHOOD IMMUNIZATION STATUS (CIS)

USING CORRECT BILLING CODESMEASURE DESCRIPTION Children 2 years of age who had the following vaccines on or before their second birthday bull Four DTaP (diphtheria tetanus and

acellular pertussis) bull Three IPV (polio) bull One MMR (measles mumps rubella) bull Three HiB (H influenza type B) bull Three HepB (hepatitis B) bull One VZV (chicken pox) bull Four PCV (pneumococcal conjugate) bull One HepA (hepatitis A) bull Two or Three RV (rotavirus) bull Two Influenza

Codes to Identify Childhood Immunizations Description DTaP

CPTregHCPCSICDCVX Codes CPTreg 90698 90700 90721 90723 CVX 20 50 106 110 120

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

Measles CPTreg 90705 CVX 05

Mumps CPTreg 90704 CVX 07

Rubella CPTreg 90706 CVX 06

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Hepatitis B CPTreg 90723 90740 90744 90747 90748 HCPCS G0010 CVX 08 44 51 110

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

Pneumococcal conjugate

CPTreg 90669 90670 CVX 100 133 HCPCS G0009

Hepatitis A CPTreg 90633 CVX 83

Rotavirus (two-doseschedule)

CPTreg 90681 CVX 119

Rotavirus (three-doseschedule)

Influenza CPTreg 90655 90657 90661 90662 90673 90685 90687 CVX 135 140 141 153 155 161 166 HCPCS G0008

29

bull Use the state immunization registry to keep up to date with state immunization bull If possible use a tickler system to remind providers that immunizations are due bull Recommend immunizations to parents Parents are more likely to agree with vaccinations when

supported by the provider Address common misconceptions about vaccinations eg MMR causes autism (now completely disproven)

bull If the parents refuse immunizations document clearly in chart note bull Complete a blood lead level screening before the age of 2 Document date and results bull Some vaccines may have been given before patients were Molina members Include these on the

membersrsquo vaccination record even if your office did not provide the vaccine bull Code appropriately using the above codes as guidelines bull Refer to the Clinical Practice Guideline (CPG) for Immunizations (within Preventative Services for

Children and Adolescents) at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Children-Adolescentspdf

bull Molina Healthcare offers a member health incentive program for Childhood Immunizations Medicaid members earn reward points redeemable for health related items For more information please call the Molina Health Education Line at (800) 869-7175 Ext 141428

HEDISreg TIPS CARE FOR OLDER ADULTS (COA)

USING CORRECT BILLING CODES MEASURE DESCRIPTION The percentage of adults 66 years and older who had each of the following during the measurement year bull Advance care planning (eg living will health

care power of attorney health care proxy) bull Medication review by a prescribing

practitioner or clinical pharmacist and presence of a medication list (a medication list signed and dated during the measurement year by a prescribing practitioner or clinical pharmacist will also count) or Transitional Care Management Services during the measurement year Transitional care management is a 30-day period that begins on the date of discharge and continues for the next 29 days The date of service on the claim is the date of the face-to-face visit Medication management must be furnished no later than the date of the face-to-face visit

bull Functional status assessment (eg ADLs or IADLs)

bull Pain assessment (eg pain inventory numeric scale faces pain scale) Notation of screening or documentation for chest pain alone does not count

Codes to Identify Chlamydia Screening Description Codes Advance Care Planning

CPTreg 99497 CPTreg II 1157F 1158F HCPCS S0257

Medication Review

CPTreg 90863 99605 99606 CPTreg II 1160F

Medication List

CPTreg II 1159F HCPCS G8427

Functional Status Assessment

CPTreg II 1170F

Pain Assessment

CPTreg II 1125F 1126F

TCM14 Day CPTreg 99495

TCM7 day CPTreg 99496

31

bull Use the Annual Comprehensive Exam (ACE) form from Molina Healthcare to capture these assessments if patient is eligible

bull Use the Medicare Stars checklist tool for reference and to place on top of chart as a reminder to complete

bull Remember that the medication review measure requires that the medications are listed in the chart plus the review

bull The pain screening cannot be for an acute pain event Instead the screening must be comprehensive involving not only any current acute pain syndrome but also other systems not involved in the current pain event (Overall global evaluation of pain)

bull If on EMR incorporate a standardized template to capture these measures for members 66 years and older The Molina HEP Annual Comprehensive Exam (ACE) form may be utilized as a guide

bull Refer to your Molina Healthcare of Washington Provider Manual for additional information concerning Advanced Directives httpwwwmolinahealthcarecomproviderswamedicaidmanual Pagesprovmanaspx (Section 3 Page 3)

bull Patients with chronic conditions such as asthma diabetes and End Stage Renal Disease may qualify for case management and should be referred to the Molina Case Management Program for evaluation at (800) 869-7165 Ext 751411

HEDISreg TIPS COLORECTAL CANCER SCREENING (COL)

MEASURE DESCRIPTION Patients 50-75 years of age who had one of the following screenings for colorectal cancer screening bull gFOBT or iFOBT (or FIT) with required number of samples for each test during the measurement year or bull Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year or bull Colonoscopy during the measurement year or the nine years prior to the measurement year bull CT colonography during the measurement year or the four years prior to the measurement year bull FIT-DNA test during the measurement year or the two years prior to the measurement year

Note FOBT tests performed in an office or performed on a sample collected via a digital rectal exam (DRE)do not meet criteria

USING CORRECT BILLING CODES Codes to Identify Colorectal Cancer Screening Description Codes FOBT CPTreg 82270 82274

HCPCS G0328 Flexible Sigmoidoscopy

CPTreg 45330-45335 45337-45342 45345-45347 45349 45350 HCPCS G0104 ICD-9 4524 ICD-10 PCS 0DJD8ZZ

Colonoscopy CPTreg 44388-44394 44397 44401-44408 45355 45378-45393 45398 HCPCS G0105 G0121 ICD-9 4522 4523 4525 4542 4543 ICD-10 0DJD8ZZ Base Codes 0D9 0DB 0D5

Codes to Identify Exclusions Description Codes Colorectal Cancer HCPCS G0213-G0215 G0231

ICD-9-CM 1530-1539 1540 1541 1548 1975 V1005 V1006 ICD-10 C180-C189 C19 C20 C212 C218 C785 Z85038 Z85048

Total Colectomy CPTreg 44150-44153 44155-44158 44210-44212 ICD-9 4581 4582 4583 ICD-10 PCS 0DTE0ZZ 0DTE4ZZ 0DTE7ZZ 0DTE8ZZ

33

bull Review and document patient history annually regarding colorectal cancer screening (test done and a date)

bull Encourage patients who are resistant to having a colonoscopy to have a stool test that they can complete at home (either gFOBT or iFOBT)The iFOBTFIT has fewer dietary restrictions and samples

bull Use standing orders and empower office staff to distribute FOBT or FIT kits to patients who need colorectal cancer screening or prepare referral for colonoscopy Document these were given to patient so that compliance can be determined

bull Clearly document patients with ileostomies which imply colon removal (exclusion) and patients with a history of colon cancer

bull Document and code which test was completed date and results bull Refer to the Clinical Practice Guideline (CPG) for Colorectal Cancer Screening at

httpwwwmolinahealthcarecomproviderswamedicaidresourcePDFColorectal_Cancer_ Screening_Practice_Guideline_2013pdf

HEDISreg TIPS APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS (CWP)

MEASURE DESCRIPTION Children 3-18 years of age diagnosed with pharyngitis and dispensed an antibiotic should have received a Group A strep test within 3 days prior to the diagnosis date through the 3 days after the diagnosis date

USING CORRECT BILLING CODES Codes to Identify Pharyngitis Description ICD-9 Code ICD-10 Code Acute pharyngitis 462 J028 J029 Acute tonsillitis 463 0340 J0300 J0301 J0380 J0381 J0390

J0391 Streptococcal sore throat J020

Codes to Identify Strep Test Description CPT Codes Strep Test 87070 87071 87081 87430 87650-87652 87880

bull Document that a rapid strep test or throat culture was done to confirm diagnosis before prescribing antibiotics Submit this test to Molina Healthcare for payment if the State permits or as a record that you performed the test Use the codes above

bull Never treat ldquored throatsrdquo empirically as they are viral even in children with a long history of strep Clinical findings alone do not adequately distinguish Strep vs no Strep pharyngitis The patientrsquos strep may have become resistant and needs a culture

bull Submit any co-morbid diagnosis codes that apply on claimencounter bull Educate parentscaregivers that an antibiotic is not necessary for viral infections if rapid strep test

andor throat culture is negative bull Code appropriately using the above codes as guidelines bull Additional resources for clinicians and parentscaregivers about pharyngitis can be found here

httpwwwcdcgovgetsmartindexhtml

35

HEDISreg TIPS FREQUENCY OF ONGOING PRENATAL CARE (FPC)

MEASURE DESCRIPTION The percentage of deliveries that had 81 percent or more of expected visits The percentage is adjusted by the month of pregnancy at the time of enrollment and gestational age A full 42 week gestational pregnancy is expected to have 16 prenatal care visits

Please note that global billing or bundling codes do not provide specific date information to count towards this measure Please consider not using global billing or bundling codes

Codes to Identify Prenatal Care Visits Description Codes Prenatal Care Visits CPTreg 99201-99205 99211-99215 99241-99245 99500

CPTreg II 0500F 0501F 0502F HCPCS H1000-H1004 T1015 G0463 UB Rev 0514

Obstetric Panel CPTreg 80055 80081 Prenatal Ultrasound CPTreg 76801 76805 76811 76813 76815-76821 76825-76828

ICD-9 Procedure 8878 ICD-10 PCS BY49ZZZ BY4BZZZ BY4CZZZ BY4DZZZ BY4FZZZ BY4GZZZ

ABO and Rh CPTreg (ABO) 86900 CPTreg (Rh) 86901

TORCH CPTreg (Toxoplasma) 86777 86778 CPTreg (Rubella) 86762 CPTreg (Cytomegalovirus) 86644 CPTreg (Herpes Simplex) 86694 86695 86696

Pregnancy Diagnosis (for PCP use these codes and one of the codes above)

ICD-9 Diagnosis 640x3 641x3 642x3 643x3 644x3 645x3 646x3 647x3 648x3 649x3 651x3 652x3 653x3 654x3 655x3 656x3 657x3 658x3 659x3 678x3 679x3 V22-V23 V28 (base codes) ICD-10 O09-O16 O20-O26 O28-O36 O40-O48 (base codes) O6000-06003 O71 O88 O91 O92 O98 O99 O9A (base codes) Z0371-Z0379 Z33 Z34 Z36 (base codes)

ICD10-CM codes are to be used on or after 1012015 Please refer to your ICD-10-CM Manual for further code specificity

36

bull Document all prenatal exams including fetal heart tones fundal height prenatal labs ultrasounds and any pelvic exam that has OB observations

bull Document LMP and EDD dates bull If using an AGOG sheet provider should sign off on all prenatal visits bull Schedule prenatal care visits starting in the first trimester or within 42 days of enrollment bull Have a direct referral process to OBGYN in place bull Emphasize to patients the importance of continued monitoring throughout pregnancy to minimize

pregnancy problems Visit schedule should be every 4 weeks for the first 28 weeks of pregnancy every 2-3 weeks for the next 7 weeks and weekly thereafter until delivery

bull Code appropriately using the above codes as guidelines bull Refer Molina patients to our Motherhood Mattersreg program at (866) 472-9483 bull Molina Healthcare offers a member Health Incentive program for Prenatal Care Medicaid

members earn reward points redeemable for health related items For more information please call (800) 869-7175 Ext 141428

Description Codes CPTreg 98960-98962 99078 99201-99205 99211-99215 99217-99220 99241-99245 99341shy99345 99347-99350 99383-99387 99393-99397 99401-99404 99411 99412 99510

Follow-up Visits

Transitional Care Management Visits 99496 (only for 7-day indicator) 99495 (only for 30-day follow-up indicator) HCPCS G0155 G0176 G0177 G0409-G0411 G0463 H0002 H0004 H0031 H0034-H0037 H0039 H0040 H2000 H2001 H2010-H2020 M0064 S0201 S9480 S9484 S9485 T1015 UB Rev (visit in a behavioral health setting) 0513 0900-0905 0907 0911-0917 0919 UB Rev (visit in a non-behavioral health setting) 0510 0515-0517 0519-0523 0526shy0529 0982 0983

Description Codes CPTreg 90791 90792 90832-90834 POS 03 05 07 09 11 12 13 90836-90840 90845 90847 90849 WITH 14 15 16 17 18 19 20 22 24

Follow-up Visits 90853 90867-90870 90875 90876 33 49 50 52 53 71 72 CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

HEDISreg TIPS FOLLOW-UP AFTER HOSPITALIZATION FOR MENTAL ILLNESS (FUH)

MEASURE DESCRIPTION Patients 6 years of age and older who were hospitalized for treatment of selected mental health diagnoses and who had an outpatient visit an intensive outpatient encounter or partial hospitalization with a mental health practitioner within 7 days and 30 days of discharge

USING CORRECT BILLING CODES Codes to Identify Follow-up Visits (must be with mental health practitioner)

HOW TO IMPROVE HEDISreg SCORES bull To assist with compliance schedule the follow-up appointment prior to the patient leaving the hospital bull Schedule follow up appointment within 7 days of discharge Same-day outpatient visits count

Document that the appointment was scheduled If applicable document that appointment was kept bull If possible assist the patient with navigation of barriers such as using their transportation benefit to get

to their follow-up appointment bull Review medications with patients to ensure they understand the purpose and appropriate frequency

and method of administration Document review was completed bull Ensure accurate hospital discharge dates bull Follow up visits must be with a mental health practitioner bull Code the follow-up visits appropriately using the codes above as a guideline bull Contact Molina Case Management if assistance is needed to obtain follow-up appointment at

(800) 869-7175 Ext 751411 bull Ensure progress not are closed out with a provider signature

38

HEDISreg TIPS INITIATION amp ENGAGEMENT OF ALCOHOL amp OTHER DRUG DEPENDENCE TREATMENT (IET)

MEASURE DESCRIPTION The percentage of adolescent and adult patients 13 years of age and older with a new diagnosis of alcohol or other drug (AOD) dependence with the followingbull Initiation of AOD Treatment Initiate treatment through inpatient AOD admission outpatient visit

intensive outpatient encounter or partial hospitalization within 14 days of diagnosis bull Engagement of AOD Treatment Initiated treatment and had two or more additional services with a

diagnosis of AOD within 30 days of the initiation visit

USING CORRECT BILLING CODES Codes to Identify AOD Dependence ICD-9-CM Diagnosis 2910-2915 29181 29182 29189 2919 30300-30302 30390-30392 30400-30402 30410-30412 30420-30422 30430-30432 30440-30442 30450-30452 30460-30462 30470-30472 30480-30482 30490-30492 30500-30502 30520-30522 30530-30532 30540-30542 30550-30552 30560-30562 30570-30572 30580-30582 30590-30592 53530 53531 5711 ICD-10-CM Diagnosis F1010 ndash F1020 F1022 ndash F1029 F1110 ndash F1120 F1122 ndash F1129 F1210 ndash F1220 F1222 ndash F1229 F1310 ndash F1320 F1322 ndash F1329 F1410 ndash F1420 F1422 ndash F1429 F1510 ndash F1520 F1522 ndash F1529 F1610 ndash F1620 F1622 ndash F1629 F1810 ndash F1820 F1822 ndash F1829 F1910 ndash F1920 F1922 ndash F1929 K2920 K2921 K7010 K7011

Codes to Identify Outpatient Intensive Outpatient and Partial Hospitalization Visits (use these visit codesalong with the one of the diagnosis codes above to capture initiation and engagement of AOD treatment) CPTreg HCPCS UB Revenue 98960-98962 99078 99201-99205 99211-99215 99217-99220 99241-99245 99341-99345 99347-99350 99384-99387 99394-99397 99401-99404 99408 99409 99411 99412 99510

G0155 G0176 G0177 G0396 G0397 G0409-G0411 G0443 G0463 H0001 H0002 H0004 H0005 H0007 H0015 H0016 H0020 H0022 H0031 H0034-H0037 H0039 H0040 H2000 H2001 H2010-H2020 H2035 H2036 M0064S0201 S9480 S9484 S9485 T1006 T1012 T1015

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

HOW TO IMPROVE HEDISreg SCORES bull Consider using screening tools to identify substance abuse issues in patients bull Document identified substance abuse in the patient chart and submit a claim with the appropriate

codes using the codes above as a guideline bull Avoid inappropriate use of diagnosis codes that are the result of alcohol or drug dependency (eg

Cirrhosis) as these also qualify patients for the measures bull Schedule a follow-up visit within 14 days of an AOD diagnosis bull Schedule at least two additional visits within 30 days after initiation of treatment bull Refer to a behavioral health provider where applicable bull Involve family members or others who the patient desires for support and invite their help in

intervening with the patient diagnosed with AOD dependence bull Provide patient educational materials and resources that include information on the treatment process

and options bull Work collaboratively with the Molina Care Manager if they contact you about a recent encounter with a

patient for substance dependency to motivate the patient to initiate treatment bull Continue ongoing discussions with patients about treatment to help increase their willingness to

commit to the process as the timeframe for initiating treatment is brief (14 days) bull Ensure progress note are closed out with a provider signature

HEDISreg TIPS IMMUNIZATIONS FOR ADOLESCENTS INCLUDING HPV (IMA)

MEASURE DESCRIPTION Adolescents 13 years of age who received the following vaccines on or before their 13th

birthday bull One meningococcal conjugate vaccine

(must be completed on or between the 11th

and 13th birthdays) bull One Tdap or one tetanus diphtheria toxoids

and acellular pertussis (Tdap) (must be completed on or between the 10th and 13th

birthdays) bull Three Human Papillomavirus vaccines with

different dates of service on or between the 9th and 13th birthdays

USING CORRECT BILLING CODES Codes to Identify Adolescent Immunizations Description CPTregCVX Codes Meningococcal CPTreg 90644 90734

CVX 136 148 Tdap CPTreg 90715

CVX 115 Td CPTreg 90714

Human Papillomavirus (HPV)

CPTreg 9064990650 90651 CVX 62118165

bull Make every office visit count- take advantage of sick visits for catching up on needed vaccines bull Institute a system for patient reminders if able bull Document any vaccines that were given prior to being seen at your officepractice bull Document and code antigen given date given and signature of person administering the

immunization list to identify patients that need immunizations bull HPV is now recommended for both male and females bull Use the State Immunization registry to keep medical records updated bull Refer to the Clinical Practice Guideline (CPG) for Immunizations (within Preventative Services for

Children and Adolescents) at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHGshyChildren-Adolescentspdf

bull Code appropriately using the above codes as guidelines bull Molina Healthcare offers a member health incentive program for Adolescent Well Care Medicaid

member earns reward points redeemable for health related items For more information please call the Molina Health Education Line at (800) 869-7175 Ext 141428

41

HEDISreg TIPS LOW BACK PAIN (LBP)

MEASURE DESCRIPTION Patients 18-50 years of age with a new primary diagnosis of low back pain in an outpatient or ED visit who did not have an x-ray CT or MRI within 28 days of the primary diagnosis A higher score indicates appropriate treatment of low back pain (ie the proportion for whom imaging studies did not occur)

Exclusions bull Patients with a diagnosis of low back pain during the 180 days prior to the Index Episode Start Date

(IESD = earliest date of service with a principal diagnosis of low back pain) bull Cancer any time during the memberrsquos history through 28 days after the IESD bull Trauma any time during the 12 months prior to the IESD bull IV drug abuse any time during the 12 months prior to the IESD through 28 days after the IESD bull Neurologic impairment any time during the 12 months prior to the IESD through 28 days after the IESD

USING CORRECT BILLING CODES Codes to Identify Low Back Pain Description ICD-9 Codes Uncomplicated Low Back Pain

7213 72190 72210 72252 7226 72402 7242 7243 7245 7246 72470 72471 72479 7385 7393 7394 8460-8463 8468 8469 8472 ICD-10 Codes M4726-M4728 M47816-M47818 M47896-M47898 M4720 M47819 M47899 M479 M4806-M4808 M5116 M5117 M5126 M5127 M5136 M5137 M5186 M5187 M532X6 M532X7 M532X8 M533 M5386-M5388 M5416-M5418 M5430-M5432 M5440-M5442 M545 M5489 M549 M9903 M9904 M9923 M9933 M9943 M9953 M9963 M9973 M9983 M9984 S33100A S33100D S33100S S33110A S33110D S33110S S33120A S33120D S33120S S33130A S33130D S33130S S33140A S33140D S33140S S335XXA S336XXA S338XXA S339XXA S39002A S39002D S39002S S39012A S39012D S39012S S39092A S39092D S39092S S3982XA S3982XD S3982XS S3992XA S3992XD S3992XS

HOW TO IMPROVE HEDISreg SCORES bull Avoid ordering diagnostic studies within 30 days of a diagnosis of new-onset back pain in the absence of red flags

(eg cancer recent trauma neurologic impairment or IV drug abuse) bull Code appropriately using the above codes as guidelines (including exclusion codes if applicable (eg cancer) bull Document full exam bull Look for other reasons for visits for low back pain (eg depression anxiety narcotic dependency psychosocial

stressors etc) bull Ensure progress note is closed out with a provider signature

42

HEDISreg TIPS LEAD SCREENING IN CHILDREN (LSC)

MEASURE DESCRIPTION Children 2 years of age who had at least one capillary or venous lead blood test for lead poisoning on or before their second birthday

USING CORRECT BILLING CODES Codes to Identify Lead Tests Description CPTreg Code Lead Tests 83655

bull Avoid missed opportunities by taking advantage of every office visit (including sick visits) to perform lead testing

bull The requirement for this measure is for a blood lead test not a lead screening questionnaire bull Consider a standing order for in‐office lead testing bull Document lead screening results and code appropriately using the above codes as a guideline bull Provide in-office testing (capillary) bull Bill in-office testing where permitted by the State fee schedule and Molina policy bull Ensure progress note is closed out with a provider signature

43

HEDISreg TIPS MEDICATION MANAGEMENT FOR PEOPLE WITH ASTHMA (MMA)

MEASURE DESCRIPTION The percentage of patients 5ndash85 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 Two rates are reported 1 The percentage of patients who remained on an asthma controller medication for at least 50 of their

treatment period 2 The percentage of patients who remained on an asthma controller medication for at least 75 of their

treatment period

Patients are in the measure if they met at least one of the following during both the measurement year and the year prior bull At least one ED visit with asthma as the principal diagnosis bull At least one acute inpatient claimencounter with asthma as the principal diagnosis bull At least 4 outpatientobservation visits on different dates of service with asthma as one of the diagnoses

and at least 2 asthma medication dispensing events Visit type need not be the same for the 4 visits bull At least 4 asthma medication dispensing events bull If leukotriene modifiers or antibody inhibitors were the sole asthma medication dispensed there must

also be at least one diagnosis of asthma in any setting in the same year as the leukotriene modifier or antibody inhibitor (ie measurement year or the year prior)

USING CORRECT BILLING CODES Codes to Identify Asthma Description ICD-9 Code ICD-10 Code Asthma 49300-49302 49310-49312

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

Mild Intermittent Asthma 49300 49302 49301 J4520 J4521 J4522 Mild Persistent Asthma 49300 49302 49391 J4530 J4531 J4532 Moderate Persistent Asthma

49300 49302 49301 J4540 J4541 J4542

Severe Persistent Asthma 49300 49302 49301 J4550 J4551 J4552 Other and Unspecified Asthma

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

Asthma Controller Medications Description Prescriptions Antiasthmatic combinations

Dyphylline-guaifenesin Guaifenesin-theophylline

Antibody inhibitor Omalizumab Inhaled steroid combinations

Budesonide-formoterol Fluticasone-salmeterol Mometasone-formoterol

Inhaled corticosteroids Beclomethasone Budesonide Ciclesonide Flunisolide Fluticasone CFC free Mometasone

Leukotriene modifiers Montelukast Zafirlukast Zileuton Mast cell stabilizers Cromolyn Methylxanthines Aminophylline Dyphylline Theophylline

Please refer to the Molina Healthcare Drug Formulary for asthma controller medications that may require prior authorization or step therapy

like symptom (eg wheezing during viral URI and acute bronchitis is not ldquoasthmardquo) bull Use the missing service list and contact patients who have not filled a controller medication bull Patients with chronic conditions such as asthma may qualify for case management and should be

bull Prescribe a long-term controller medication and provide reminders to your patients to fill controller medications

bull Prescription mail-order delivery is available for Molina Medicare and Marketplace members only bull Visit Drug Formulary for coverage updates at httpwwwmolinahealthcarecomproviderswa

medicaiddrugPagesformularyaspx or contact Molina Provider Pharmacy at (800) 869-7175 Ext 751406

45

HEDISreg TIPS ANNUAL MONITORING FOR PATIENTS ON PERSISTENT MEDICATIONS (MPM)

USING CORRECT BILLING CODES MEASURE DESCRIPTION Adults 18 years of age and older who received at least 180 treatment days of ambulatory medication therapy for a select therapeutic agent during the measurement year and at least one therapeutic monitoring event for the therapeutic agent in the measurement year

bull Annual monitoring for members on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) Need either a lab panel test or a serum potassium test and a serum creatinine test

bull Annual monitoring for patients on digoxin Need either a lab panel test and a serum digoxin text or a serum potassium test and a serum creatinine test and a serum digoxin test

bull Annual monitoring for patients on diuretics Need a lab panel test or a serum potassium test and a serum creatinine test

Codes to Identify Therapeutic Monitoring Description CPTreg Codes Lab Panel 80047 80048 80050 80053

80069 Serum Potassium

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

bull Schedule a follow-up visit for no more than 30 days out prior to patient leaving the office when prescribing a new medication

bull Schedule two more visits in the 5 months after the first 30 days to continue to monitor your patientrsquos progress

bull Document all elements of this visit including new medications patientrsquos response to medication and lab test results

bull Review missing services list to identify patients bull Code appropriately using the above codes as guidelines bull Ensure progress note is closed out with a provider signature

46

HEDISreg TIPS NON-RECOMMENDED CERVICAL CANCER SCREENING IN ADOLESCENTS (NCS)

MEASURE DESCRIPTION Adolescents 16-20 years of age should not be screened unnecessarily for cervical cancer

Exceptions Patient has prior history of cervical cancer HIV or immunodeficiency disorders

USING CORRECT BILLING CODES Codes to Identify Cervical Cancer Screening (adolescents 16-20 years should not be screened for cervical cancer) Description ICD-9 Codes Cervical Cytology CPTreg 88141 88142 88143 88147 88148 88150 88152 88153 88154 88164

88165 88166 88167 88174 88175 HCPCS G0123 G0124 G0141 G0143 G0144 G0145 G0147 G0148 P3000 P3001 Q0091 UB Rev 0923

HPV Tests CPTreg 87620 87621 876228762487625 HCPCS G0476

HOW TO IMPROVE HEDISreg SCORES bull Consider not screening patients 16-20 years of age regardless of age at sexual initiation and other

behavior-related risk factors bull Consider not performing the screening on healthy asymptomatic women An ldquoexternal onlyrdquo genital examination is acceptable

bull Discuss the decision whether or not to perform a complete pelvic examination with the patient as this should be a shared decision between the patient and their health care provider

bull Ensure progress note is closed out with a provider signature bull Code appropriately using the above codes as guidelines

47

HEDISreg TIPS OSTEOPOROSIS MANAGEMENT FOR FRACTURES (OMW)

MEASURE DESCRIPTION The percentage of patients 67-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat or prevent osteoporosis in the six months after the fracture

USING CORRECT BILLING CODES Codes to Identify Bone Mineral Density Test and Osteoporosis Medications Description Codes Bone Mineral Density Test

CPTreg 76977 77078 77080-77082 77085 77086 HCPCS G0130 ICD-9 8898 ICD-10 BP48ZZ1 BP49ZZ1 BP4GZZ1 BP4HZZ1 BP4LZZ1 BP4MZZ1 BP4NZZ1 BP4PZZ1 BQ00ZZ1 BQ01ZZ1 BQ03ZZ1 BQ04ZZ1 BR00ZZ1 BR07ZZ1 BR09ZZ1 BR0GZZ1

Osteoporosis Medications HCPCS J0630 J0897 J1740 J3110 J3487 J3488 J3489 Q2051 Long-Acting Osteoporosis Medications (for inpatient stays only)

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

ICD-10-PCS codes are to be used on or after 1012015 Please refer to your ICD-10-PCS Manual for further code specificity

Osteoporosis Therapies Description Prescription Bisphosphonates bull Alendronate bull Ibandronate

bull Alendronate-cholecalciferol bull Risedronate bull Zoledronic acid

Other agents bull Calcitonin bull Raloxifene bull Denosumab bull Teriparatide

48

HOW TO IMPROVE HEDISreg SCORES bull Document actions taken to screen andor prescribe medication on all patients with a diagnosis of a

fracture within 6 months OR prescribe medication (eg biphosphonates) to prevent osteoporosis (eg bisphosphonates)

bull Code using the guidelines above for diagnosis testing and medication prescribed bull Aggressive risk adjustment can overstate osteoporosis by confusing lower Z scores osteopenia with

osteoporosis bull Refer to the Clinical Practice Guideline (CPG) for Osteoporosis Screening (within Adult Preventive

Services) at httpwwwmolinahealthcarecom providerswamedicaidPDFPHG- Adultspdf bull Please also refer to the Molina Healthcare HCC Pearl on Fractures at

httpwww molinahealthcarecomproviderswamedicaidcommPDFfracturespdf bull Ensure progress note is closed out with a provider signature

HEDISreg TIPS PERSISTENCE OF BETA-BLOCKER TREATMENT AFTER A HEART ATTACK (PBH)

MEASURE DESCRIPTION Patients 18 years and older who were hospitalized and discharged with a diagnosis of Acute Myocardial Infarction (AMI) and received persistent beta-blocker treatment for six months after discharge Persistence of treatment for this measure is defined as at least 75 of the days supply filled Exclusion Intolerance or allergy to beta-blocker therapy

USING CORRECT BILLING CODES Codes to Identify AMI Description ICD-9 Code ICD-10 Code Acute myocardial infarction (AMI)

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

Beta-Blocker Medications Description Prescription Noncardioselective beta-blockers

Carvedilol Penbutolol Timolol Labetalol Pindolol Sotalol Nadolol Propranolol

Cardioselective beta-blockers

Acebutolol Betaxolol Metoprolol Atenolol Bisoprolol Nebivolol

Antihypertensive combinations

Atenolol-chlorthalidone Hydrochlorothiazide-metoprolol Bendroflumethiazide-nadolol Hydrochlorothiazide-propranolol Bisoprolol-hydrochlorothiazide

50

HOW TO IMPROVE HEDISreg SCORES bull Document all elements of the exam including the medication patientrsquos response vital signs and

patient compliance bull Utilize pharmacy resources to assist in compliance with patients bull Utilize missing services report for pharmacy to make sure patient is refilling medications bull Continue to stress the value of prescribed medications for managing heart disease bull Utilize flow sheets to promote better adherence to guidelines when it comes to beta-blocker

assessment and treatment after a heart attack bull Provide smoking cessation and other interventions to eliminate or control risk factors bull Code appropriately using above codes as guidelines bull Ensure progress note is closed out with a provider signature

Systemic Corticosteroids Description Prescription Glucocorticoids Betamethasone

Dexamethasone Hydrocortisone

Methylprednisolone Prednisolone Prednisone

Triamcinolone

HEDISreg TIPS PHARMACOTHERAPY MANAGEMENT OF COPD EXACERBATION (PCE)

MEASURE DESCRIPTION The percentage of COPD exacerbations for patients 40 years and older who had an acute inpatient discharge or ED visit with a primary diagnosis of COPD emphysema or chronic bronchitis on or between January 1 ndash November 30 of the measurement year and were dispensed appropriate medications bull A systemic corticosteroid (or there was evidence of an active prescription) within 14 days of the event bull A bronchodilator (or there was evidence of an active prescription) within 30 days of the event

USING CORRECT BILLING CODES Codes to Identify COPD Emphysema or Chronic Bronchitis Description COPD

Prescription ICD9 49320 49321 49322 496 ICD-10 J440 J441 J449

Emphysema ICD9 4920 4928 ICD-10 J430 J431 J432 J438 J439

Chronic Bronchitis ICD9 4910 4911 49120 49121 49122 4918 4919 ICD-10 J410 J411 J418 J42 J449 J441 J440

Bronchodilators Description Anticholinergic agents

Prescription Albuterol-ipratropium Ipratropium Aclidinium-bromide Tiotropium

Umeclidinium

Beta 2-agonists Albuterol Formoterol Arformoterol Indacaterol Budesonide-formoterol Levalbuterol Fluticasone-salmeterol Mometasone-formoterol Fluticasone-vilanterol Metaproterenol

Olodaterol hydrochloride Olodaterol-tiotropium Pirbuterol Salmeterol Umeclidinium-vilanterol

Methylxanthines Aminophylline Dyphylline Guaifenesin-theophylline Theophylline

Dyphylline-guaifenesin

52

HOW TO IMPROVE HEDISreg SCORES bull Schedule a follow-up appointment within 7-14 days of discharge from a hospital stay or an ER visit bull Document all elements of visit including patientrsquos response since incident of COPD prescribed

medications and response to medications bull Code appropriately according to the above guidelines bull Contact your patient once they have been discharged to schedule a follow-up appointment as soon

as possible bull Remind patients to fill their corticosteroid and bronchodilator prescriptions bull Refer to Molinarsquos adopted Clinical Practice Guidelines on COPD via the Molina website at

httpwwwmolinahealthcarecomproviderswamedicaidresourcePDFCPG-COPDpdf bull Ensure progress note is closed out with a provider signature

HEDISreg TIPS POSTPARTUM CARE (PPC)

MEASURE DESCRIPTION Postpartum visit for a pelvic exam or postpartum care with an OBGYN practitioner or midwife family practitioner or other PCP on or between 21 and 56 days after delivery A Pap test within 21-56 days after delivery also counts

Documentation in the medical record must include a note with the date when the postpartum visit occurred and one of the following bull Pelvic exam or bull Evaluation of weight BP breast and abdomen or bull Notation of ldquopostpartum carerdquo PP check PP care 6-week check or pre-printed ldquoPostpartum Carerdquo

form in which information was documented during the visit

USING CORRECT BILLING CODES Please note that global billing or bundling codes do not provide specific date information to count towards this measure

Codes to Identify Postpartum Visits Description Codes Postpartum Visit CPTreg 57170 58300 59430 99501

CPTreg II 0503F HCPCS G0101 ICD-9-CM Diagnosis V241 V242 V2511 V2512 V2513 V7231 V7231 V762 ICD-9-CM Procedure 8926 ICD-10-CM Diagnosis Z01411 Z01419Z0142 Z30430 Z391 Z392 Z30432 Z30433 Z124 ICD-10 Procedure 8E04XY7

Systemic Corticosteroids Description Codes Cervical Cytology CPTreg 88141-88143 88147 88148 88150 88152-88154 88164-88167 88174

88175 HCPCS G0123 G0124 G0141 G0143-G0145 G0147 G0148 P3000 P3001 Q0091 UB Rev 0923

54

HOW TO IMPROVE HEDISreg SCORES bull Schedule your patient for a postpartum visit within 21 to 56 days from delivery (please note that

staple removal following a cesarean section does not count as a postpartum visit for HEDISreg) bull Document that the patient is there for a post-partum visit along with the elements of the visit

including the pelvic exam pap smear (if done) physical exam of the breast abdomen and also include vital signs

bull Code appropriately using the above codes as guidelines bull Use the postpartum calendar tool from Molina to ensure the visit is within the correct time frames

The calendar tool is available online at httpwwwmolinahealthcarecomproviderswamedicaid forms PDFPrenatal-and-Postpartum-CalendarsPDF

bull Please refer to the Clinical Practice Guideline (CPG) on Prenatal Care (which also addresses Postpartum Care) at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Prenatal-Care-Routinepdf

bull Molina offers a member health incentive program for Postpartum Care Medicaid members earn reward points redeemable for health related items For more information please call the Molina Health Education Line at (800) 869-7175 Ext 141428

HEDISreg TIPS PRENATAL CARE ndash TIMELINESS (PPC)

MEASURE DESCRIPTION Prenatal care visit in the first trimester or within 42 days of enrollment Prenatal care visit where the practitioner type is an OBGYN or other prenatal care practitioner or PCP with one of thesebull Basic physical obstetrical exam that includes auscultation for fetal heart tone or pelvic exam with

obstetric observations or measurement of fundus height (a standardized prenatal flow sheet may be used) bull Obstetric panel bull Ultrasound of pregnant uterus bull Pregnancy-related diagnosis code (For visits to a PCP a diagnosis of pregnancy must be present) bull TORCH antibody panel (Toxoplasma Rubella Cytomegalovirus and Herpes simplex testing) bull Rubella antibody testtiter with an Rh incompatibility (ABORh) blood typing (eg a prenatal visit with

rubella and ABO a prenatal visit with rubella and Rh or a prenatal visit with rubella and ABORh) bull Documented LMP or EDD with either a completed obstetric history or prenatal risk assessment and

counselingeducation For visits to a PCP a diagnosis of pregnancy must be present along with any of the above

USING CORRECT BILLING CODES Please note that global billing or bundling codes do not provide specific date information to count towards this measure Description Codes Prenatal Care Visits CPTreg 99201-99205 99211-99215 99241-99245 99500

ABO and Rh CPTreg (ABO) 86900 CPTreg (Rh) 86901 TORCH CPTreg (Toxoplasma) 86777 86778 CPTreg (Rubella) 86762

CPTreg (Cytomegalovirus) 86644 CPTreg (Herpes Simplex) 86694 86695 86696 Pregnancy Diagnosis (for PCP use these codes and one of the codes above)

ICD-9 Diagnosis 640x3 641x3 642x3 643x3 644x3 645x3 646x3 647x3 648x3 649x3 651x3 652x3 653x3 654x3 655x3 656x3 657x3 658x3 659 x3 678x3 679x3 V22-V23 V28 (base codes) ICD-10 O09-O16 O20-O26 O28-O36 O40-O48 (base codes)O6000-O6003 O71 O88 O91 O92 O98 O99 O9A (base codes)Z0371-Z0379 Z33 Z34 Z36 (base codes)

56

HOW TO IMPROVE HEDISreg SCORES bull Schedule prenatal care visits starting in the first trimester or within 42 days of enrollment bull Document all prenatal exams including fetal heart tones fundal height prenatal labs ultrasounds

and any pelvic exam that has OB observations bull Document LMP and EDD dates bull If using an AGOG sheet provider should sign off on all prenatal visits bull Have a direct referral process to OBGYN in place bull Emphasize to patients the importance of continued monitoring throughout pregnancy to minimize

pregnancy problems bull Visit schedule should be every 4 weeks for the first 28 weeks of pregnancy every 2-3 weeks for the

next 7 weeks and weekly thereafter until delivery bull Code appropriately using the above codes as guidelines bull Refer Molina patients to our Motherhood Mattersreg program at (866) 472-9483 bull Use the Prenatal Calendar Tool from Molina to ensure the visit is within the correct time frame The

calendar tool is available on-line at httpwwwmolinahealthcarecomproviderswamedicaidforms PDFPrenatal-and-Postpartum-CalendarsPDF

bull Please refer to the Clinical Practice Guideline (CPG) on Prenatal Care at httpwwwmolinahealthcare comproviderswamedicaidPDFPHG-Prenatal-Care-Routinepdf

bull Patients diagnosed with a high-risk pregnancy including patients with a history of previous preterm delivery may qualify for case management and should be referred to the Molina Case Management Program for evaluation at (800) 869-7165 Ext 751411

bull Molina offers a member health incentive program for Prenatal Care Medicaid members earn reward points redeemable for health related items For more information please call the Molina Health Education Line at (800) 869-7165 Ext 141428

HEDISreg TIPS NON-RECOMMENDED PSA-BASED SCREENING IN OLDER PATIENTS (PSA)

MEASURE DESCRIPTION Patients 70 years and older should not be screened unnecessarily for prostate cancer using prostate-specific antigen (PSA)-based screening A lower rate indicates better performance

Exclusions Patients who had a diagnosis for which PSA-based testing is clinically appropriate Any of the following meet criteria bull Prostate cancer diagnosis at any time in their history bull Dysplasia of the prostate during the measurement year or the year prior to the measurement year bull An elevated PSA test result (gt40 nanogrammilliliter [ngmL]) during the year prior to the

measurement year bull Dispensed prescription for 5-alpha reductase inhibitor (5-ARI) during the measurement year

USING CORRECT BILLING CODES Description Codes PSA Tests CPTreg 84152 84153 84154

HCPCS G0103 PSA Test Exclusions CPTreg 84153

HCPCS G0103 (with result gt40 ngmL) Prostate Cancer ICD-9-CM 185 2334 2365 V1046 V8403

ICD-10-CM C61 D075 D400 Z1503 Z8546 Prostate Dysplasia ICD-9-CM 6023

ICD-10-CM N4230 5-alpha reductase inhibitors

bull Finasteride bull Dutasteride

ICD-10-CMcodes are to be used on or after 1012015 Please refer to your ICD-10-CM Manual for further code specificity

58

HOW TO IMPROVE HEDISreg SCORES bull Educate patients on the adverse effects and benefits of the testing bull Avoid testing for low-risk patientrsquos if there is no prior family history of prostate cancer there is no prior history of elevated PSA test value (gt40 nanogrammilliliter [ngmL]

bull Code appropriately using the above codes as guidelines bull Refer to the Clinical Practice Guideline (CPG) for Preventative Health Guideline for Adults at

httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Adultspdf bull Ensure progress note is closed out with a provider signature

Description Codes Schizophrenia ICD-9 29500-29505 29510-29515 29520-29525 29530-29535 29540-29545

29550-29555 29560-29565 29570-29575 29580-29585 29590-29595 ICD-10-CM F200 F201 F202 F203 F205 F2081 F2089 F209 F250 F251 F258 F259

Description Generic Name Brand Name Miscellaneous antipsychotic agents

Aripiprazole Asenapine Cariprazine Clozapine Haloperidol Iloperidone Loxapine Lurisadone Molindone Olanzapine Paliperidone Pimozide Quetiapine Quetiapine fumarate Risperidone Ziprasidone

Abilify Saphris Vraylar Clozaril Haldol Fanapt LoxipacLoxitane Latuda Moban Zyprexa Invega Orap Seroquel Seroquel XR Risperdal Geodon

Phenothiazine antipsychotics

Chlorpromazine Fluphenazine Perphenazine Perphenazineshyamitriptyline Prochlorperazine Thioridazine Trifluperazine

Thorazine Prolixin Trilafon Etrafon Compazine Mellaril Stelazine

Psychotherapeutic combinations

Fluoxetine-olanzapine Symbyax

Thio xanthenes Thiothixene Navane 28 days supply Aripiprazole Fluphenazine decanoate Haloperidol decanoate Olanzapine Paliperidone palmitate14 days supply Risperidone

Abilify Maintena Prolixin Haldol Decanoate INJ Zyprexa Relprew Invega Sustenna Risperdal Consta

HEDISreg TIPS ADHERENCE TO ANTIPSYCHOTIC MEDICATIONS FOR INDIVIDUALS WITH SCHIZOPHRENIA (SAA)

USING CORRECT BILLING CODES Codes to Identify Schizophrenia

Codes to Identify Long-Acting Injections Description Codes Long-Acting Injections

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

ANTIPSYCHOTIC MEDICATIONS

The percentage of patients 19 to 64 years of age during the measurement year with schizophrenia who were dispensed and remained on an antipsychotic medication for at least 80 of their treatment period

MEASURE DESCRIPTION

60

HOW TO IMPROVE HEDISreg SCORES bull Schedule appropriate follow-up with the patients to evaluate if medication is taken as prescribed bull Document reason for prescribed medication and patients response bull Code to the highest specificity using the above codes as guidelines bull Review missing services list for pharmacy refills to ensure patients are getting timely refills bull Place reminder calls to remind patients of their appointment bull Educate patients on the following The importance of staying on the medication Strategies for remembering to take the antidepressant on a daily basis Common side effects how long the side effects may last and how to manage them

bull Refer patients for Health Management interventions and coaching by contacting Health Care Services at your affiliated Molina State plan

HEDISreg TIPS CARDIOVASCULAR MONITORING FOR PEOPLE WITH CARDIOVASCULAR DISEASE AND SCHIZOPHRENIA (SMC)

MEASURE DESCRIPTION Adults 18-64 years of age with schizophrenia and cardiovascular disease who had an LDL-C test during the measurement year

Patients who have cardiovascular disease are defined as having any of the following bull Discharged from an inpatient setting with an Acute Myocardial Infarction (AMI) or any setting with a

Coronary Artery Bypass Graft (CABG) during the year prior to the measurement year bull Patients who had a Percutaneous Coronary Intervention (PCI) during the year prior to the

measurement year or bull Patients diagnosed with Ischemic Vascular Disease (IVD) during both the measurement year and the year

prior to measurement year

USING CORRECT BILLING CODES Description Codes Codes to Identify LDLndashC Tests

CPTreg 80061 83700 83701 83704 83721 CPTreg II 3048F 3049F 3050F

HOW TO IMPROVE HEDISreg SCORES bull Order labs prior to patient appointments bull Order lab tests through a Behavioral Health (BH) provider for patients who do not have regular

contact with their PCP but who regularly see the BH provider The BH provider can then coordinate medical management with the PCP

bull Review cardiovascular services needed at each office visit and ensure lipid levels blood pressure and glucose are monitored at every appointment

bull Educate patient (and caregiver) about the risks associated with antipsychotic medications and cardiovascular disease and the importance of a healthy lifestyle This includes nutrition exercise and smoking cessation

bull For LDLs if patient is not fasting order direct LDL to avoid a missed opportunity bull Adjust therapy to improve HbA1c LDL and BP levels follow-up with patients to monitor changes bull Code appropriately using the above codes as guidelines bull Patients with chronic conditions and behavioral health conditions should be referred to the Molina

Healthcare Case Management Program for evaluation at (800) 869-7165 Ext 751411 bull Ensure progress note is closed out with a provider signature

62

HEDISreg TIPS DIABETES MONITORING FOR PEOPLE WITH DIABETES AND SCHIZOPHRENIA (SMD)

MEASURE DESCRIPTION Adults 18-64 years of age with schizophrenia and diabetes who had both an LDL-C test and an HbA1c test during the measurement year

USING CORRECT BILLING CODES Description Codes Codes to Identify HbA1c Tests

CPTreg 83036 83037 CPTreg II 3044F (if HbA1clt7) 3045F (if HbA1c 7-9 3046F (if HbA1cgt9)

Codes to Identify LDL-C Tests

Codes to Identify Schizophrenia

ICD-9 29500-29505 29510-29515 29520-29525 29530-29535 29540-29545 29550-29555 29560-29565 29570-29575 29580-29585 29590-29595 ICD-10-CM F200-F203 F205 F2081 F2089 F209 F250 F251 F258 F259

Codes to Identify ICD-9 25000-25003 25010-25013 25020-25023 25030-25033 25040shyDiabetes 25043 25050-25053 25060-25063 25070-25073 25080-25083 25090shy

25093 3572 36201-36207 36641 64800-64804 ICD-10-CM E1010 E1011 E1021 E1022 E1029 E10311 E10319 E10321 E10329 E10331 E10339 E10341 E10349 E10351 E10359 E1036 E1039-E1044 E1049 E1051 E1052 E1059 E10610 E10618 E10620-E10622 E10628 E10630 E10638 E10641 E10649 E1065 E1069 E108 E109 E1100 E1101 E1121 E1122 E1129 E11311 E11319 E11321 E11329 E11331 E11339 E11341 E11349 E11351 E11359 E1136 E1139 E1140-E1144 E1149 E1151 E1152 E1159 E11610 E11618 E11620-E11622 E11628 E11630 E11638 E11641 E11649 E1165 E1169 E118 E119 E1300 E1301 E1310 E1311 E1321 E1322 E1329 E13311 E13319 E13321 E13329 E13331 E13339 E13341 E13349 E13351 E13359 E1336 E1339 E1340-E1344 E1349 E1351 E1352 E1359 E13610 E13618 E13620-E13622 E13628 E13630 E13638 E13641 E13649 E1365 E1369 E138 E139 O24011-O24013 O24019 O2402 O2403 O24111-O24113 O24119 O2412 O2413 O24311-O24313 O24319 O2432 O2433 O24811-O24813 O24819 O2482 O2483

63

HOW TO IMPROVE HEDISreg SCORES bull Document all elements of the exam including response to medication and test results bull Code appropriately using the above codes as guidelines bull Order a direct LDL if patient is not fasting to avoid a missed opportunity Some lab order forms have

conditional orders ndash if fasting LDL-C if not fasting direct LDL bull Order diabetic lab tests through the Behavioral Health (BH) provider for patients who do not have

regular contact with their PCP but who regularly see the BH provider The BH provider can then coordinate medical management with the PCP

bull Adjust therapy to improve HbA1c LDL and BP levels follow-up with patients to monitor changes bull Give any patient caregiver instructions on the course of treatment labs or future appointment dates bull Monitor body mass index plasma glucose level lipid profiles and signs of prolactin elevation at each

appointment bull Educate patients about appropriate health screenings with some medication therapies Refer patients for Health Management interventions and coaching by contacting Health Care

Services at your affiliated Molina Healthcare State plan Remember Care Coordination with the patientrsquos behavioral health provider is a key component in

the development of a comprehensive treatment plan bull Ensure progress note is closed out with a provider signature

HEDISreg TIPS SPIROMETRY TESTING IN COPD ASSESSMENT (SPR)

MEASURE DESCRIPTION Patients 40 years of age and older with a new diagnosis of COPD or newly active COPD who received a spirometry testing to confirm the diagnosis in the 2 years prior to the diagnosis or within 6 months of the diagnosis

USING CORRECT BILLING CODES Codes to Identify COPD Description ICD-9-CM

Diagnosis ICD-10-CM Diagnosis

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

ICD-10-CM codes are based on or after 1012015 Please refer to your ICD-10-CM Manual for further code specificit

Codes to Identify Spirometry Testing Description CPT Codes Spirometry 94010 94014-94016

94060 94070 94375 94620

65

bull Follow the standard of care and use spirometry testing for diagnosing COPD bull Perform spirometry test on patients newly diagnosed with COPD within 180 days to confirm

diagnosis of COPD evaluate severity and assess current therapy Note If the patient had a spirometry performed in the previous 2 years to confirm the ldquonewrdquo diagnosis of COPD in the first place they do not need a repeat

bull Ensure appropriate documentation of spirometry testing using the above codes as guidelines bull Perform spirometry in office if equipment available If equipment is not available in your office

arrange for patient to get the test completed at a location with spirometry equipment for example a pulmonology unit

bull Differentiate acute from chronic bronchitis and use correct code so that patient is not inadvertently put into the measure

bull Review problem lists and encounter forms and remove COPD chronic bronchitis when the diagnosis was made in error

bull Refer to the Clinical Practice Guideline (CPG) for COPD at httpwwwmolinahealthcarecom providerswamedicaidresourcePDFCPG-COPDpdf

bull For patients diagnosed with chronic bronchitis document and code to the highest specificity of the patientrsquos condition for more accurate Risk Adjustment reporting for example Non-specific documentation and coding J40 (Bronchitis not specified as acute or chronic) Correct complete and specific documentation coding J411 (Mucopurulent chronic bronchitis)

bull Molina Healthcare has a COPD Health Management Program aimed at assisting patients with their understanding of management of COPD Please contact the Molina Case Management Program for further information at (800) 869-7165 Ext 751411

HEDISreg TIPS DIABETES SCREENING FOR PEOPLE WITH SCHIZOPHRENIA OR BIPOLAR DISORDER WHO ARE USING ANTIPSYCHOTIC MEDICATIONS (SSD)

USING CORRECT BILLING CODES Codes to Identify Diabetes Screening Description Codes Codes to Identify Glucose Tests

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

Codes to Identify HbA1c Tests

CPTreg 83036 83037 CPTreg II 3044F (if HbA1clt7) 3045F (if HbA1c 7-9) 3046F (if HbA1cgt9)

Description Generic Name Brand Name Miscellaneous Aripiprazole Asenapine Brexpiprazole Abilify Saphris Rexulti Vraylar antipsychotic agents Cariprazine Clozapine Haloperidol Clozaril Haldol Fanapt Loxipac

Iloperidone Loxapine Lurisadone Loxitane Latuda Moban Zyprexa Molindone Olanzapine Paliperidone Invega Orap Seroquel Seroquel XR Pimozide Quetiapine Quetiapine Risperdal Geodon fumarate Risperidone Ziprasidone

Phenothiazine Chlorpromazine Fluphenazine Thorazine Prolixin Trilafon Etrafon antipsychotics Perphenazine Perphenazineshy Compazine Mellaril Stelazine

amitriptyline Prochlorperazine Thioridazine Trifluperazine

Psychotherapeutic Fluoxetine-olanzapine Symbyax combinations Thioxanthenes Thiothixene Navane Long-acting Aripiprazole Fluphenazine decanoate Abilify Maintena Prolixin Haldol injections Haloperidol decanoate Olanzapine Decanoate INJ Zyprexa Relprew

Paliperidone palmitate Risperidone Invega Sustenna Risperdal Consta

Adults 18-64 years of age with schizophrenia or bipolar disorder who were dispensed an antipsychotic medication and had a diabetes screening test (glucose test or HbA1c test) during the measurement year

MEASURE DESCRIPTION

67

bull Document all elements of the exam including medications diagnosis and results of A1c bull Code appropriately using the above codes as guidelines bull Help patients with scheduling a follow-up appointment in 1-3 months with their PCP to screen for

diabetes If the patient is not ready to schedule appointment make note or flag chart to contact the patient with a reminder to schedule an appointment

bull Ensure patient (andor caregiver) is aware of the risk of diabetes and have awareness of the symptoms of new onset of diabetes while taking antipsychotic medication

bull Schedule lab screening test through PCP prior to next appointment bull The Behavioral health (BH) provider can order diabetic lab tests for patients who do not have regular

bull Patients with chronic conditions and behavioral health conditions should be referred to Molina Healthcare Case Management Program for evaluation at (800) 869-7165 Ext 751411

HEDISreg TIPS APPROPRIATE TREATMENT FOR CHILDREN WITH URI (URI)

USING CORRECT BILLING CODES MEASURE DESCRIPTION Codes to Identify URI Children 3 months to 18 years of age

diagnosed with Upper Respiratory Infection (URI) should not be dispensed an antibiotic within 3 days of the diagnosis

Note Claimsencounters with more than one diagnosis (eg competing diagnoses) are excluded from the measure

Description Acute nasoshypharyngitis (common cold)

ICD-9 Codes 460

ICD-10 Codes J00

Acute laryngoshypharyngitis

4650 J060

Acute URI or 4658 4659 J069

Codes to Identify Common Competing Diagnoses Description Otitis media

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

Pneumonia 481-486 J13-J18 (base codes)

69

bull Document all elements of the exam including diagnosis patient counseling and comfort measures bull Code appropriately using the above codes as guidelines bull Submit any co-morbidcompeting diagnosis codes that apply (examples listed in the ldquoCodes to

Identify Competing Diagnosesrdquo table above) bull Educate patient on comfort measures (eg acetaminophen for fever rest extra fluids) and advise

patient to call back if symptoms worsen (antibiotic can be prescribed if necessary after 3 days of initial diagnosis)

bull Consider re-submitting an encounter if you missed a second diagnosis code and you see a patient on the needed services report published by Molina Healthcare

bull Patient educational materials on antibiotics resistance and common infections can be found at httpwwwcdcgovgetsmartindexhtml

bull Refer to the Clinical Practice Guideline (CPG) at httpwwwmolinahealthcarecomproviderswa medicaidresourcePDFjudicious-use-of-antibiotics-practice-guideline-2015pdf

HEDISreg TIPS WELL-CHILD VISITS FIRST 15 MONTHS OF LIFE (W15)

MEASURE DESCRIPTION Children who turned 15 months old during the measurement year and who had at least 6 well-child visits with a PCP prior to turning 15 months

Well-child visits consists of all of the following bull A health history bull A physical exam bull A physical developmental history bull Health educationanticipatory guidance bull A mental developmental history

USING CORRECT BILLING CODES Description Codes Well-Child Visits CPTreg 99381 99382 99391 99392 99461

HCPCS G0438 G0439 ICD-9 V202 V2031 V2032 V703 V705 V706 V708 V709 ICD-10 Z00110 Z00111 Z00121 Z00129 Z005 Z008 Z020-Z022 Z025-Z026 Z0271 Z0279 Z0281-Z0283 Z0289 Z029

bull Avoid missed opportunities by taking advantage of every office visit (including sick visits) to provide well care components when applicable

bull Use day care physicals into well-care visits by performing the required services and submitting appropriate codes

bull Document all elements of a preventative exam including health history developmental history physical exam and educationanticipatory guidance

bull Use standardized templates in charts and in EMRs that allow checkboxes for standard counseling activities

bull Refer to the Clinical Practice Guidelines (CPG) for Preventative Health of Children and Adolescents at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Children-Adolescentspdf

bull Molina Healthcare adheres to the Bright FuturesAmerican Academy of Pediatrics (AAP) Periodicity Schedule found at httpswwwbrightfuturesorgpocketpdfappendicespdf

bull Molina Healthcare offers a member health incentive program called Healthy 15 Month Old Molina members earn reward points redeemable for health related items For more information please call Health Education Line at (800) 869-7175 Ext 141428

71

HEDISreg TIPS WELL-CHILD VISITS 3 ndash 6 YEARS (W34)

MEASURE DESCRIPTION Children 3 to 6 years of age who had one or more well-child visits with a PCP during the measurement year

Well-child visits consist of all of the following bull A health history bull A physical exam bull A physical developmental history bull Health educationanticipatory guidance bull A mental developmental history

USING CORRECT BILLING CODES Description Codes Well-Child Visits CPTreg 99382 99383 99392 99393

HCPCS G0438 G0439 ICD-9 V202 V703 V705 V706 V708 V709 ICD-10 Z00121 Z00129 Z005 Z008 Z020-Z022 Z025-Z026 Z0271 Z0279 Z0281-Z0283 Z0289 Z029

bull Make sportsday care physicals into well-care visits by performing the required services and submitting appropriate codes

bull Code appropriately using the above codes as guidelines bull Document all elements of a preventative exam including health history developmental history

physical exam and educationanticipatory guidance bull Use standardized templates in charts and in EMRs that allow checkboxes for standard counseling

activities bull Refer to the Clinical Practice Guideline (CPG) for Preventative Health of Children and Adolescents

at httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Children-Adolescentspdf bull Molina Healthcare offers a member health incentive program Well Child Check Ups Ages 3 4 5 and

6 Medicaid members earn reward points redeemable for health related items For more information please call Health Education Line at (800) 869-7175 Ext 141428

72

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

USING CORRECT BILLING CODES MEASURE DESCRIPTION Children 3-17 years of age who had an outpatient visit with a primary care physician or OBGYN and who had evidence of the following during the measurement year bull BMI percentile documentation or BMI

percentile plotted on age- growth chart (height weight and BMI percentile must be documented)

bull Counseling for nutrition or referral for nutrition education

bull Counseling for physical activity or referral for physical activity

Description Codes BMI Percentile lt5 ICD-9 V8551 for age ICD-10 Z6851 BMI Percentile 5 ICD-9 V8552 to lt85 for age ICD-10 Z6852 BMI Percentile 85 ICD-9 V8553 to lt95 for age ICD-10 Z6853 BMI Percentile ICD-9 V8554 ge95 for age ICD-10 Z6854 Counseling for Nutrition

CPTreg 97802-97804 ICD-9 V653 ICD-10 Z713 HCPCS G0270 G0271 G0447 S9449 S9452 S9470

Counseling for Physical Activity

ICD-9 V6541 ICD-10 Z025 HCPCS S9451 G0447

73

bull Code appropriately using the above codes as a guideline bull Document all elements of a preventative exam including health history developmental history

physical exam and educationanticipatory guidance bull Code appropriately using the above codes as guidelines bull Place BMI percentile charts near scales (ask for Molina copies or access them at

httpswwwcdcgovhealthyweightassessingbmiindexhtml bull When documenting BMI percentile include Height weight and BMI percentile Document current nutrition behaviors (eg appetite or meal patterns eating and dieting habits)

bull When counseling for nutrition document Current nutrition behaviors (eg appetite or meal patterns eating and dieting habits)

bull When counseling for physical activity document Physical activity counselingeducation (eg child rides tricycle in yard) Current physical activity behaviors (eg exercise routine participation in sports activities and

exam for sports participation) While ldquocleared for sportsrdquo does not count a sports physical does count Include specific mention of physical activity recommendations to meet criteria for notation of

anticipatory guidance bull Refer to the Clinical Practice Guideline (CPG) for Preventative Health Children and Adolescents at

httpwwwmolinahealthcarecomproviderswamedicaidPDFPHG-Children-Adolescentspdf bull Molina Healthcare offers a member health incentive program for Child and Adolescent Well Care

Medicaid members earn reward points redeemable for health related items For more information please call Health Education Line at (800) 869-7175 Ext 141428

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 2: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

TABLE OF CONTENTS Welcome to 2017 HEDIS TIPS3 Molina Provider Contacts 4 Adults with Acute Bronchitis (AAB) 6 Adults Access to PreventiveAmbulatory Health Services (AAP)7 Adult BMI Assessment (ABA)8 Follow Up Care for Children Prescribed ADHD Medication (ADD) 9 Annual Dental Visits (ADV)10 Antidepressant Medication Management (AMM) 11 Asthma Medication Ratio (AMR) 13 Use of Multiple Concurrent Antipsychotics in Children and Adolescents (APC)15 Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM) 16 First Line Psychosocial Care for Child Adolescents on Antipsychotics (APP)18 Disease Modifying Anti-Rheumatic Drug Therapy (DMARD) for Rheumatoid Arthritis (ART) 20 Adolescent Well-Care Visit (AWC)21 Breast Cancer Screening (BCS) 22 Children and Adolescents Access to Primary Care Practitioners (CAP) 23 Controlling High Blood Pressure (CBP)24 Cervical Cancer Screening (CCS)25 Comprehensive Diabetes Care (CDC) 26 Chlamydia Screening (CHL) 28 Childhood Immunization Status (CIS) 29 Care for Older Adults (COA) 31 Colorectal Cancer Screening (COL) 33 Appropriate Testing for Children with Pharyngitis (CWP) 35 Frequency of Ongoing Prenatal Care (FPC)36 Follow Up After Hospitalization for Mental Health (FUH) 38 Initiation amp Engagement of Alcohol amp Other Drug Dependence Treatment (IET) 39 Immunizations for Adolescents (IMA) 41 Low Back Pain (LBP) 42 Lead Screening in Children (LSC) 43 Medication Management for People with Asthma (MMA) 44 Annual Monitoring for Patients on Persistent Medications (MPM) 46 Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS) 47 Osteoporosis Management for Fractures (OMW)48 Persistence of Beta-Blocker Treatment after a Heart Attack (PBH) 50 Pharmacotherapy Management of COPD Exacerbation (PCE) 52 Postpartum Care (PPC)54

3

Dental Phone (855) 322-4082 Fax (866) 772-0285

4

Spanish (888) 648-3537 (TTY 711)

5

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 3: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

3

Dental Phone (855) 322-4082 Fax (866) 772-0285

4

Spanish (888) 648-3537 (TTY 711)

5

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 4: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

3

Dental Phone (855) 322-4082 Fax (866) 772-0285

4

Spanish (888) 648-3537 (TTY 711)

5

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 5: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Dental Phone (855) 322-4082 Fax (866) 772-0285

4

Spanish (888) 648-3537 (TTY 711)

5

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 6: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Spanish (888) 648-3537 (TTY 711)

5

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 7: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

J432 J438 J439 J982 J983

COPD 49320 J440 J441 49321 J449 49322 496

Otitis media 38200 3823 3824 3829

H66 H67 H66009 H663X9 H6640 H6690

0340 462 463

J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

6

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 8: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

7

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 9: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

age-growth chart

Code ICD-10 Code

V8551 Z6851

V8552 Z6852

V8553 Z6853

V8554 Z6854

8

Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Description Codes

Follow-up Visits

Description Codes

Follow-up Visits

CPTreg 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876

WITH POS 03 05 07 09 11 12 13 14 15 16 17 18 19 20 22 33 49 50 52 53 71 72

CPTreg 99221-99223 99231-99233 99238 99239 99251-99255 WITH POS 52 53

9

10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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10

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 12: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

29625 29630shy29635 2980 311

F320-F324 F329 F330-F333 F3341 F339

Parnatereg

11

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 13: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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J45998

13

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 15: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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15

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 17: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

CPTreg 82465 83718 84478

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

16

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 18: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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5900751WA0317

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Page 19: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

18

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 20: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 21: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Tofacitinib

7142 71481 ICD-10-CM M0500 M069 M0560 M0510

J0717 J1438 J1600 J1602 J1745 J3262 J7502 J7515-J7518 J9250 J9260 J9310

20

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 22: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

21

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 23: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Codes CPT 77055-77057

ICD-9 V4571 ICD-10 Z9013

22

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 24: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

23

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 25: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

24

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 26: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Absence of Cervix

25

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 27: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Codes ICD-9 25000-25093 3572

CPTreg II 2022F 2024F 2026F 3072F

26

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 28: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 29: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

87110 87270 87320 87490shy87492 87810

28

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 30: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

IPV CPTreg 90698 90713 90723 CVX 10 110 120

MMR CPTreg 90707 90710 CVX 03 94

Measles and rubella

CPTreg 90708 CVX 04

HiB CPTreg 90644-90648 90698 90721 90748 CVX 46-51 120 148

Newborn Hepatitis B

ICD-9 9955 ICD-10 3E0234Z

VZV CPTreg 90710 90716 CVX 21 94

29

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 31: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 32: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Medication Review

Medication List

CPTreg II 1170F

Pain Assessment

31

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 33: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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33

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

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Page 35: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 36: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

35

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 37: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

36

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 38: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 39: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Follow-up Visits

38

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 40: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

0510 0513 0515-0517 0519-0523 0526-0529 0900 0902-0907 0911shy0917 0919 0944 0945 0982 0983

CPTreg POS 90791 90792 90832-90834 90836-90840 90845 90847 90849 90853 90875 90876 WITH

03 05 07 09 11 12 13 14 1516171819 20 22 33 49 50 52 53 57 71 72

39

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 41: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 42: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

CPTreg 9064990650 90651 CVX 62118165

41

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 43: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

42

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 44: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

43

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 45: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

treatment period

49381 49382 49390-49392 J45901 J45902 J45909 J45990 J45991

49300 49302 49301 J4540 J4541 J4542

49392 49391 49390 J45901 J45902 J45909 J45990 J45991 J45998

44

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 46: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

45

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 47: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

80051 84132

Serum Creatinine

82565 82575

Digoxin Level 80162

46

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 48: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

47

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 49: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

HCPCS J0897 J1740 J3487 J3488 J3489 Q2051

48

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 50: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 51: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

41001 41011 41021 41031 41041 41051 41061 41071 41081 41091

l2101 l2102 l2109 l2111 l2119 l2121 l2129 l213 l214

50

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 52: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 53: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Triamcinolone

Umeclidinium

52

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 54: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 55: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

54

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 56: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 57: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

56

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 58: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 59: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

58

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 60: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 61: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

HCPCS J2794 J0401 J1631 J2358 J2426 J2680

MEASURE DESCRIPTION

60

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 62: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 63: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

62

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 64: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

63

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 65: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 66: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

Chronic bronchitis

4910 4911 49120-49122 4918 4919

J410 J411 J418 J42 J449 J441 J440

Emphysema 4920 4928 J430 J431 J432 J438 J439

COPD 49320 49321 49322 496

J440 J441 J449

94060 94070 94375 94620

65

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 67: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

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Page 68: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

CPTreg 80047 80048 80050 80053 80069 82947 82950 82951

MEASURE DESCRIPTION

67

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

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Page 69: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 70: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

ICD-9 Codes 460

ICD-10 Codes J00

4650 J060

ICD-9 Code 38200-38202

ICD-10 Codes H66009 H66019 H679

Acute sinusitis

4618 4619 J0180 J0190

0340 462 463 J020 J028 J029 J0300 J0301 J0380 J0381 J0390 J0391

Chronic sinusitis

4738 4739 J328 J329

69

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 71: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 72: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

71

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 73: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

72

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 74: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

73

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 75: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

MolinaHealthcarecom

5900751WA0317

_GoBack

Page 76: HEDIS Provider Toolkit 2017 Washington · bronchitis is not indicated unless there is a comorbid diagnosis or a bacterial infection (examples listed on the right). Only about 10%

MolinaHealthcarecom

5900751WA0317

_GoBack

Date post:	02-Feb-2020
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