Helping you improve your scores, as you improve the health of your patients.

Healthcare Effectiveness Data and Information Set (HEDIS®) scores are not only important for you as a provider; they also help guide your patients to quality care. As your trusted partner with the mutual goal of helping people lead healthier lives, Cigna is happy to provide support in every way we can. Use this quick reference guide for tips and up-to-date procedure codes that will help you maintain and even improve your HEDIS scores.

What you need to know

Adult body mass index (BMI) assessment looks at patient 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented within the past two years.

For patients 21 years and older on the date of service, documentation must indicate the weight and BMI value, dated during the past two years. The weight and BMI value must be from the same data source.
For patients younger than 21 years on the date of service, documentation must indicate the height, weight and BMI percentile, dated during the past two years. The height, weight and BMI percentile must be from the same data source.

For BMI percentile, the following documentation meets criteria:

• BMI percentile documented as a value (e.g., 85th percentile).
• BMI percentile plotted on an age-growth chart.
• Optional exclusions include: Adult females who are pregnant during the year or the prior year of testing.
• HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.

Tips for improving your scores

At least once every two years, during an outpatient care visit for patients age 18-74:

• Take the patient's height and weight and record each-in the medical record.
• Calculate the BMI and record the value in the medical record.
• Counsel the patient on weight control, healthy eating and exercise.

Common billing codes accepted by HEDIS® for adult BMI assessment

	BMI<19	BMI 19-24.9	BMI 25-29.9	BMI 30-39.9	BMI>=40
International Classification of Diseases - 9th Edition (ICD-9)	V85.0	V85.1	V85.21-V85.25	V85.30-V85.39	V85.41-V85.45
International Classification of Diseases - 10th Edition (ICD-10)	Z68. 1	Z68.20-Z68.24	Z68.25-Z68.29	Z68.30-Z68.39	Z68.41-Z68.45

<sup>Billing and medical record documentation should always support the level of service provided at that visit.
®HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Reproduced with permission from HEDIS 2017, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). To purchase copies of this publication, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications.
Current Procedural Terminology (CPT) codes copyright 2016 American Medical Association. All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Uniform Bill Codes (“UB Codes”) are protected under federal copyright laws and are owned by the American Hospital Association (AHA). The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Software vendors and all others desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other use, must obtain a commercial use license directly from the AHA. To inquire about licensing, please contact ub04@healthforum.com.</sup>