2018 Measure Value Set Weight Assessment and Counseling.Xlsx
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PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Numerator Value Set Name Code Definition Code System [Z68.51] Body mass index (BMI) pediatric, less than 5th BMI Percentile Z68.51 ICD10CM percentile for age [Z68.52] Body mass index (BMI) pediatric, 5th BMI Percentile Z68.52 ICD10CM percentile to less than 85th percentile for age [Z68.53] Body mass index (BMI) pediatric, 85th BMI Percentile Z68.53 ICD10CM percentile to less than 95th percentile for age [Z68.54] Body mass index (BMI) pediatric, greater than BMI Percentile Z68.54 ICD10CM or equal to 95th percentile for age Body Mass Index, pediatric, less than 5th percentile for BMI Percentile V85.51 age ICD9CM Body Mass Index, pediatric, 5th percentile to less than BMI Percentile V85.52 85th percentile for age ICD9CM Body Mass Index, pediatric, 85th percentile to less BMI Percentile V85.53 than 95th percentile for age ICD9CM Body Mass Index, pediatric, greater than or equal to BMI Percentile V85.54 95th percentile for age ICD9CM Nutrition Counseling 97802 CPT Nutrition Counseling 97803 CPT Nutrition Counseling 97804 CPT Face‐to‐face behavioral counseling for obesity, 15 Nutrition Counseling G0447 HCPCS minutes (G0447) Nutrition Counseling S9470 Nutritional counseling, dietitian visit (S9470) HCPCS Nutrition Counseling Z71.3 [Z71.3] Dietary counseling and surveillance ICD10CM Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with Nutrition Counseling G0270 the patient, each 15 minutes (G0270) HCPCS 1 of 136 April 2018 PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Numerator Value Set Name Code Definition Code System Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more Nutrition Counseling G0271 individuals), each 30 minutes (G0271) HCPCS Weight management classes, non‐physician provider, Nutrition Counseling S9449 per session (S9449) HCPCS Nutrition classes, non‐physician provider, per session Nutrition Counseling S9452 (S9452) HCPCS Other Specified Z71.89 Other Specified Counseling* ICD10CM Counseling Physical Activity Face‐to‐face behavioral counseling for obesity, 15 G0447 HCPCS Counseling minutes (G0447) Physical Activity Exercise classes, non‐physician provider, per session Counseling S9451 (S9451) HCPCS Physical Activity [Z02.5] Encounter for examination for participation in Z02.5 ICD10CM Counseling sport Physical Activity Z71.82 Exercise counseling Counseling ICD10CM *For HMSA's quality programs, numerator credit will be awarded when using this code to indicate that physical activity counseling occurred. Use of this code may be defined in different ways for other payors or regulatory agencies. 2 of 136 April 2018 PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Denominator Value Set Name Code Definition Code System Outpatient 99201 CPT Outpatient 99202 CPT Outpatient 99203 CPT Outpatient 99204 CPT Outpatient 99205 CPT Outpatient 99211 CPT Outpatient 99212 CPT Outpatient 99213 CPT Outpatient 99214 CPT Outpatient 99215 CPT Outpatient 99241 CPT Outpatient 99242 CPT Outpatient 99243 CPT Outpatient 99244 CPT Outpatient 99245 CPT Outpatient 99341 CPT Outpatient 99342 CPT Outpatient 99343 CPT Outpatient 99344 CPT Outpatient 99345 CPT Outpatient 99347 CPT Outpatient 99348 CPT Outpatient 99349 CPT Outpatient 99350 CPT Outpatient 99381 CPT Outpatient 99382 CPT Outpatient 99383 CPT Outpatient 99384 CPT Outpatient 99385 CPT Outpatient 99386 CPT Outpatient 99387 CPT Outpatient 99391 CPT Outpatient 99392 CPT Outpatient 99393 CPT Outpatient 99394 CPT Outpatient 99395 CPT Outpatient 99396 CPT Outpatient 99397 CPT Outpatient 99401 CPT Outpatient 99402 CPT Outpatient 99403 CPT Outpatient 99404 CPT Outpatient 99411 CPT Outpatient 99412 CPT Outpatient 99420 CPT 3 of 136 April 2018 PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Denominator Value Set Name Code Definition Code System Outpatient 99429 CPT Outpatient 99455 CPT Outpatient 99456 CPT Initial preventive physical examination; face‐to‐face Outpatient G0402 visit, services limited to new beneficiary during the first HCPCS 12 months of medicare enrollment (G0402) Annual wellness visit; includes a personalized Outpatient G0438 HCPCS prevention plan of service (pps), initial visit (G0438) Annual wellness visit, includes a personalized Outpatient G0439 prevention plan of service (pps), subsequent visit HCPCS (G0439) Hospital outpatient clinic visit for assessment and Outpatient G0463 HCPCS management of a patient (G0463) Outpatient T1015 Clinic visit/encounter, all‐inclusive (T1015) HCPCS Outpatient 510 UBREV Outpatient 511 UBREV Outpatient 512 UBREV Outpatient 513 UBREV Outpatient 514 UBREV Outpatient 515 UBREV Outpatient 516 UBREV Outpatient 517 UBREV Outpatient 519 UBREV Outpatient 520 UBREV Outpatient 521 UBREV Outpatient 522 UBREV Outpatient 523 UBREV Outpatient 526 UBREV Outpatient 527 UBREV Outpatient 528 UBREV Outpatient 529 UBREV Outpatient 982 UBREV Outpatient 983 UBREV 4 of 136 April 2018 PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Exclusions Value Set Name Code Definition Code System Pregnancy O00.0 [O00.0] Abdominal pregnancy ICD10CM Pregnancy O00.1 [O00.1] Tubal pregnancy ICD10CM Pregnancy O00.2 [O00.2] Ovarian pregnancy ICD10CM Pregnancy O00.8 [O00.8] Other ectopic pregnancy ICD10CM Pregnancy O00.9 [O00.9] Ectopic pregnancy, unspecified ICD10CM Pregnancy O01.0 [O01.0] Classical hydatidiform mole ICD10CM Pregnancy O01.1 [O01.1] Incomplete and partial hydatidiform mole ICD10CM Pregnancy O01.9 [O01.9] Hydatidiform mole, unspecified ICD10CM Pregnancy O02.0 [O02.0] Blighted ovum and nonhydatidiform mole ICD10CM Pregnancy O02.1 [O02.1] Missed abortion ICD10CM Pregnancy O02.81 [O02.81] Inappropriate change in quantitative human ICD10CM chorionic gonadotropin (hCG) in early pregnancy Pregnancy O02.89 [O02.89] Other abnormal products of conception ICD10CM Pregnancy O02.9 [O02.9] Abnormal product of conception, unspecified ICD10CM Pregnancy O03.0 [O03.0] Genital tract and pelvic infection following ICD10CM incomplete spontaneous abortion Pregnancy O03.1 [O03.1] Delayed or excessive hemorrhage following ICD10CM incomplete spontaneous abortion Pregnancy O03.2 [O03.2] Embolism following incomplete spontaneous ICD10CM abortion Pregnancy O03.30 [O03.30] Unspecified complication following ICD10CM incomplete spontaneous abortion Pregnancy O03.31 [O03.31] Shock following incomplete spontaneous ICD10CM abortion Pregnancy O03.32 [O03.32] Renal failure following incomplete ICD10CM spontaneous abortion Pregnancy O03.33 [O03.33] Metabolic disorder following incomplete ICD10CM spontaneous abortion Pregnancy O03.34 [O03.34] Damage to pelvic organs following ICD10CM incomplete spontaneous abortion Pregnancy O03.35 [O03.35] Other venous complications following ICD10CM incomplete spontaneous abortion Pregnancy O03.36 [O03.36] Cardiac arrest following incomplete ICD10CM spontaneous abortion Pregnancy O03.37 [O03.37] Sepsis following incomplete spontaneous ICD10CM abortion Pregnancy O03.38 [O03.38] Urinary tract infection following incomplete ICD10CM spontaneous abortion Pregnancy O03.39 [O03.39] Incomplete spontaneous abortion with other ICD10CM complications 5 of 136 April 2018 PT ‐ 2018 Measure Value Set_Weight Assessment and Counseling.xlsx Exclusions Value Set Name Code Definition Code System Pregnancy O03.4 [O03.4] Incomplete spontaneous abortion without ICD10CM complication Pregnancy O03.5 [O03.5] Genital tract and pelvic infection following ICD10CM complete or unspecified spontaneous abortion Pregnancy O03.6 [O03.6] Delayed or excessive hemorrhage following ICD10CM complete or unspecified spontaneous abortion Pregnancy O03.7 [O03.7] Embolism following complete or unspecified ICD10CM spontaneous abortion Pregnancy O03.80 [O03.80] Unspecified complication following complete ICD10CM or unspecified spontaneous abortion Pregnancy O03.81 [O03.81] Shock following complete or unspecified ICD10CM spontaneous abortion Pregnancy O03.82 [O03.82] Renal failure following complete or ICD10CM unspecified spontaneous abortion Pregnancy O03.83 [O03.83] Metabolic disorder following complete or ICD10CM unspecified spontaneous abortion Pregnancy O03.84 [O03.84] Damage to pelvic organs following complete ICD10CM or unspecified spontaneous abortion Pregnancy O03.85 [O03.85] Other venous complications following ICD10CM complete or unspecified spontaneous abortion Pregnancy O03.86 [O03.86] Cardiac arrest following complete or ICD10CM unspecified spontaneous abortion Pregnancy O03.87 [O03.87] Sepsis following complete or unspecified ICD10CM spontaneous abortion Pregnancy O03.88 [O03.88] Urinary tract infection following complete or ICD10CM unspecified spontaneous abortion Pregnancy O03.89 [O03.89] Complete or unspecified spontaneous ICD10CM abortion with other complications Pregnancy O03.9 [O03.9] Complete or unspecified spontaneous abortion ICD10CM without complication Pregnancy O04.5 [O04.5] Genital tract and pelvic infection following ICD10CM (induced) termination of pregnancy Pregnancy O04.6 [O04.6] Delayed or excessive hemorrhage following ICD10CM (induced) termination of pregnancy Pregnancy O04.7 [O04.7] Embolism following (induced) termination of ICD10CM pregnancy Pregnancy