Weight Assessment Counseling for Children and Adolescents
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
Weight assessment counseling for children and adolescents looks for your patients 3-17 years of age who had evidence of body mass index (BMI) percentile documentation, counseling for nutrition and counseling for physical activity.
- HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.
Tips for improving your scores
This HEDIS measure has three components that need to be documented once per calendar year on all of your patients between the ages of 3-17.
- BMI Percentile during the measurement year.
- Counseling for Nutrition during the measurement year.
- Counseling for Physical Activity during the measurement year.
Record the date along with each of the following services:
- BMI percentile that should be plotted on appropriate age-growth chart in patients' medical record.
- BMI value for adolescents between the ages of 16 and 17.
Common billing codes accepted by HEDIS® for weight assessment counseling for children and adolescents.
| BMI Description | International Classification of Diseases – 9th Edition ICD-9 | International Classification of Diseases – 10th Edition ICD-10 |
|---|---|---|
| Less than 5th percentile for age | V85.51 | Z68.51 |
| 5th percentile to less than 85th percentile for age | V85.52 | Z68.52 |
| 85th percentile to less than 95th percentile for age | V85.53 | Z68.53 |
| Equal to or greater than 95th percentile for age | V85.54 | Z68.54 |
Common billing codes accepted by HEDIS® for counseling for nutrition and counseling for physical activity.
| Nutrition Counseling and Physical Activity Codes | Current Procedural Terminology (CPT®) | ICD 9 | ICD 10 | Healthcare Common Procedure Coding System (HCPCS) |
|---|---|---|---|---|
| Counseling for nutrition | 97802-97804 | V65.3 | Z71.3 | G0270 |
| Counseling for physical activity | V65.41 | Z02.5 | G0271 | |
| G0447 | ||||
| S9449 | ||||
| S9451 | ||||
| S9452 | ||||
| S9470 |
Submitting the above codes may reduce medical record audits.
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.