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2021 HEDIS Reference Guidefor Primary Care

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2021 HEDIS Reference Guidefor Primary Care 2021 HEDIS Reference Guide for Primary Care Cervical Cancer Screening (CCS) Patient Profile MVP members 21–64 years of age who have been screened for cervical cancer. Appropriate screening is defined by one of the following criteria: • Women 21–64 years of age who have a cervical cytology performed within the last three years (the measurement year and up to two years prior) • Women 30–64 years of age who have a cervical high-risk human papillomavirus (hrHPV) testing performed within the last five years (Note: Evidence of hrHPV testing within the last 5 years also captures patients who had cotesting; therefore additional methods to identify cotesting are not necessary.) • Women 30-64 years of age who had cervical cytology cotesting within the last five years Those excluded are women who have had a hysterectomy with no residual cervix (complete, total, or radical abdominal or vaginal hysterectomy), cervical agenesis, or acquired absence of cervix any time during the member's history through December 31 of the measurement year. How to Implement Best Practices and Improve Performance • Documentation in the medical record must include the name of the cervical screening, date of the test, and the result. This may be documented in an office note or a lab report, and can be submitted. • Cervical biopsies are not valid for primary cervical cancer screening and cannot be submitted. • When documenting medical/surgical history, avoid the use of “hysterectomy” alone, as this is not sufficient evidence that the cervix was removed. Be specific: “TAH”, TVH”, etc. • Documentation of “hysterectomy” alone in combination with documentation that the “patient no longer needs cervical cancer screening,” does meet criteria. • Documentation of “hysterectomy” alone in conjunction with documentation of “vaginal pap smear” on the specimen report also meets criteria. • Lab reports stating that the sample was inadequate or “no cervical cells present” cannot be counted, as this is not considered appropriate screening. • Utilize the MVP Gaps in Care Report (GIC) for a list of all MVP members still in need of screening. • Consider the use of an electronic medical record flag system to alert you to these age or time-sensitive requirements. • Documentation submitted for this measure must comply with the guidelines stated here. • Documentation for new MVP members who have had a TAH, etc., must be submitted to MVP in order to remove this member from the measure. Information related to all 2021 HEDIS measures has been extracted from the NCQA 2021 HEDIS Technical Specifications Volume 2. MVPPR0023 (02/2021) ©2021 MVP Health Care 2021 HEDIS Reference Guide for Primary Care Page 2 Cervical Cancer Screening (CCS) 2021 Coding for Cervical Cancer Screening (CCS) Codes for CCS Use of these codes will make the member a pass for CCS CPT: 88150, 88141-43, 88147-48, 88152-4, 88164-7, 88174-5 HCPCS: G0123-4, G0141, G0143-5, G0147-8, P3000-1, Q0091 LOINC: 10524-7, 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0, Cervical Cytology Lab Test 47527-7, 47528-5 SNOMED CT US: 171149006, 416107004, 417036008, 439958008, 440623000, 448651000124104 SNOMED CT US: 37 codes including 168406009, 168407000, 16815002, 269958004, Cervical Cytology Results or Findings 269963000, 416030007, 416033009, 439776006, 98791000119102 CPT: 87620-2, 87624-5, HCPCS: G0476 High Risk HPV Lab Test LOINC: 21440-3, 30167-1, 38372-9, 59263-4, 59264-2, 59420-0, 69002-4, 71431-1, 75694-0, 77379-6, 77399-4, 77400-0, 82354-2, 82456-5, 82675-0 SNOMED CT US: 35904009, 448651000124104 High Risk HPV Test Results or Findings SNOMED CT US: 718591004 Exclusion from CCS Use of these codes will exclude member from CCS ICD10CM: Q51.5, Z90.710, Z90.712 Absence of Cervix Diagnosis SNOMED CT US: 37687000, 248911005, 428078001, 429290001, 429763009, 723171001, 107388910001119107 HCPCS: G9474-79, Q5003-8, Q5010, S9126, T2042-46 Hospice Encounter SNOMED CT US: 183919006, 183920000, 183921001, 350336008, 305911006 UB Rev: 0115, 0125, 0135, 0145, 0155, 0235, 0650-52, 0655-59 CPT: 99377-78 Hospice Intervention HCPCS: G08182 SNOMED CT US: 170935008, 170936009, 385763009 CPT: 51925, 56308, 57540, 57545, 57550, 58150, 58152, 58200, 58210, 58240, 58260, 58267, 58270, 58275, 58280, 58285, 58548, 58550, 58575, 58951, 58956, 59135, Hysterectomy with No Residual Cervix 57555-6, 58262-3, 58290-4, 58552-4, 58570-3, 58953-4 ICD-10 PCS: 0UTC0ZZ, 0UTC4ZZ, 0UTC7ZZ, 0UTC8ZZ SNOMED CT US: 718973001, 718974007-718976009, 761865002, 761866001, Palliative Care Assessment 761867005, 457511000124100 HCPCS: G9054, M1017 ICD-10 CM: Z51.5 Palliative Encounter SNOMED CT US: 305284002, 305381007, 305686008, 305824005, 441874000, 713281006, 4901000124101 SNOMED CT US: 103735009, 105402000, 395669003, 395670002, 395694002, Palliative Intervention 395695001, 443761007, 1841000124106, 433181000124107 MVP Customer Care Center for Provider Services mvphealthcare.com 1-800-684-9286 Monday–Friday, 8:30 am–5 pm Eastern Time.
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