Well-Child Visits in the First 15 Months of Life
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
Well-child visits in the first 15 months of life verifies if your patients had six or more well-child visits before the age of 15 months.
- HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.
Tips for improving your scores
- Schedule patients' next appointment before they leave the office.
- Institute a system for patient reminders and recall messages.
- Verify and add additional patient contact information at each visit for future reminder efforts.
To count as a well-child visit, documentation from the medical record must include a note indicating a visit with a primary care physician, the date the well-child visit occurred and evidence of all of the following:
- A health and developmental history (physical and mental)
- A physical exam
- Health education/anticipatory guidance
Preventive services may be provided during visits other than well-child visits. If sick- and well-child exams occur at the same visit, document all the components of the visit. Well-child visits can be reported in addition to the problem-oriented visit. Report the problem-oriented evaluation and management E&M code with the 25 modifier.
Common billing codes accepted by HEDIS® for well child visits within the first 15 months of life.
| Current Procedural Terminology (CPT®) | International Classification of Diseases - 9th Edition (ICD-9) | International Classification of Diseases - 10th Edition (ICD-10) | Healthcare Common Procedure Coding System (HCPCS) |
|---|---|---|---|
| 99381-99385 | V20.2 | Z00.110 and Z00.111 | G0438 |
| 99391-99395 | V70.0 | Z00.121 and Z00.129 | G0439 |
| 99461 | V70.3 | Z02.0-Z02.9 | |
| V70.5 | Z00.00-Z00.01 | ||
| V70.6 | Z00.5, Z00.8 | ||
| V70.8 | |||
| V70.9 | |||
| V20.31 | |||
| V20.32 |
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.