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2018 HEDIS PPC Codes Quick Reference Guide for Prenatal and Postpartum Care (PPC)

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2018 HEDIS PPC Codes Quick Reference Guide for Prenatal and Postpartum Care (PPC) 2018 HEDIS PPC Codes Quick Reference Guide for Prenatal and Postpartum Care (PPC) Measure Name Denominator Event Numerator Requirement Line of Business Live births — Deliveries on or between November 6 of the year Postpartum Care (PPC-P) prior to the measurement year Postpartum Care visit must occur (21–56 days days) after delivery. Medicaid and November 5 of the measurement year. Live births — Deliveries on or between November 6 of the year Prenatal Visits – Timeliness of First Timeliness of Prenatal Care: initial prenatal visit must be within first Medicaid prior to the measurement year Visit (PPC-T) trimester or within 42 days of enrollment with health plan. and November 5 of the measurement year. 2018 HEDIS PPC FPC Codes Quick Links Decision Tree for Prenatal Care Visits (PPC-T) when Provider Type is an OB/GYN or PCP Any of the following options meets criteria: Provider Type: Stand Alone Prenatal Option 1 OB/GYN or PCP Visits Codes Provider Type: Option 2 OB/GYN Prenatal Visits Codes with Obstetric Panel Provider Type: Pregnancy Option 2A PCP Prenatal Visits Codes with Diagnosis Codes and Obstetric Panel Provider Type: Prenatal Visits Codes with Prenatal Option 3 OB/GYN Ultrasound Codes Prenatal Option 3A Provider Type: Prenatal Visits Codes with Pregnancy and Ultrasound PCP Diagnosis Codes Codes Provider Type: Pregnancy Option 4 OB/GYN Prenatal Visits Codes with Diagnosis Codes Provider Type: Toxoplasma Rubella Antibody Cytomegalovirus Herpes Simplex Option 5 OB/GYN Prenatal Visits Codes with Antibody Codes with Codes with Antibody Codes with Antibody Codes Provider Type: Pregnancy Toxoplasma Rubella Antibody Cytomegalovirus Herpes Simplex Option 5A PCP Prenatal Visits Codes with Diagnosis Codes and Antibody Codes and Codes and Antibody Codes and Antibody Codes Provider Type: Prenatal Visits Codes with Rubella Antibody and ABO Codes Option 6 OB/GYN Codes Provider Type: Prenatal Visits Codes with Pregnancy and Rubella Antibody and ABO Codes Option 6A PCP Diagnosis Codes Codes Provider Type: Rubella Antibody Option 7 OB/GYN Prenatal Visits Codes with Codes and Rh Codes Provider Type: Prenatal Visits Codes with Pregnancy and Rubella Antibody and Rh Codes Option 7A PCP Diagnosis Codes Codes Provider Type: Rubella Antibody ABO and Rh Option 8 OB/GYN Prenatal Visits Codes with Codes and Codes Provider Type: Pregnancy Rubella Antibody ABO and Rh Option 8A PCP Prenatal Visits Codes with Diagnosis Codes and Codes and Codes Decision Tree for Postpartum Care Visits (PPC-P): A postpartum visit for a pelvic exam or postpartum care on or between 21 and 56 days after delivery. Any of the following options meets criteria: Option 1 Provider Type: OB/GYN or PCP Postpartum Visits Codes Option 2 Provider Type: OB/GYN or PCP Cervical Cytology Codes 1 Value Set Name Code Definition Code System Postpartum Visits 57170 CPT Postpartum Visits 58300 CPT Postpartum Visits 59430 CPT Postpartum Visits 99501 CPT Postpartum Visits 0503F CPT Postpartum Visits G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination (G0101) HCPCS Postpartum Visits Z01.411 [Z01.411] Encounter for gynecological examination (general) (routine) with abnor- ICD10CM mal findings Postpartum Visits Z01.419 [Z01.419] Encounter for gynecological examination (general) (routine) without ICD10CM abnormal findings Postpartum Visits Z01.42 [Z01.42] Encounter for cervical smear to confirm findings of recent normal smear ICD10CM following initial abnormal smear Postpartum Visits Z30.430 [Z30.430] Encounter for insertion of intrauterine contraceptive device ICD10CM Postpartum Visits Z39.1 [Z39.1] Encounter for care and examination of lactating mother ICD10CM Postpartum Visits Z39.2 [Z39.2] Encounter for routine postpartum follow-up ICD10CM Postpartum Visits V24.1 Postpartum care and examination of lactating mother ICD9CM Postpartum Visits V24.2 Routine postpartum follow-up ICD9CM Postpartum Visits V25.11 Encounter for insertion of intrauterine contraceptive device ICD9CM Postpartum Visits V25.12 Encounter for removal of intrauterine contraceptive device ICD9CM Postpartum Visits V25.13 Encounter for removal and reinsertion of intrauterine contraceptive device ICD9CM Postpartum Visits V72.31 Routine gynecological examination ICD9CM Postpartum Visits V72.32 Encounter for Papanicolaou cervical smear to confirm findings of recent normal ICD9CM smear following initial abnormal smear Postpartum Visits V76.2 Screening for malignant neoplasms of cervix ICD9CM Postpartum Visits 89.26 Gynecological examination ICD9PCS 2 Back to 2018 HEDIS PPC Codes Quick Links Value Set Name Code Definition Code System Cervical Cytology 88141 CPT Cervical Cytology 88142 CPT Cervical Cytology 88143 CPT Cervical Cytology 88147 CPT Cervical Cytology 88148 CPT Cervical Cytology 88150 CPT Cervical Cytology 88152 CPT Cervical Cytology 88153 CPT Cervical Cytology 88154 CPT Cervical Cytology 88164 CPT Cervical Cytology 88165 CPT Cervical Cytology 88166 CPT Cervical Cytology 88167 CPT Cervical Cytology 88174 CPT Cervical Cytology 88175 CPT Cervical Cytology G0123 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated HCPCS thin layer preparation, screening by cytotechnologist under physician supervision (G0123) Cervical Cytology G0124 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated HCPCS thin layer preparation, requiring interpretation by physician (G0124) Cervical Cytology G0141 Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, HCPCS requiring interpretation by physician (G0141) Cervical Cytology G0143 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated HCPCS thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision (G0143) Cervical Cytology G0144 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated HCPCS thin layer preparation, with screening by automated system, under physician supervision (G0144) Cervical Cytology G0145 Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated HCPCS thin layer preparation, with screening by automated system and manual rescreening under physician supervision (G0145) Cervical Cytology G0147 Screening cytopathology smears, cervical or vaginal, performed by automated system under physician HCPCS supervision (G0147) Cervical Cytology G0148 Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening HCPCS (G0148) Cervical Cytology P3000 Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision HCPCS (P3000) Cervical Cytology P3001 Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician HCPCS (P3001) Back to 2018 HEDIS PPC Codes Quick Links 3 Value Set Name Code Definition Code System Cervical Cytology Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory HCPCS (Q0091) Cervical Cytology 10524-7 Microscopic observation [Identifier] in Cervix by Cyto stain LOINC Cervical Cytology 18500-9 Microscopic observation [Identifier] in Cervix by Cyto stain.thin prep LOINC Cervical Cytology 19762-4 General categories [interpretation] of Cervical or vaginal smear or scraping by Cyto stain LOINC Cervical Cytology 19764-0 Statement of adequacy [interpretation] of Cervical or vaginal smear or scraping by Cyto stain LOINC Cervical Cytology 19765-7 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain LOINC Cervical Cytology 19766-5 Microscopic observation [Identifier] in Cervical or vaginal smear or scraping by Cyto stain Narrative LOINC Cervical Cytology 19774-9 Cytology study comment Cervical or vaginal smear or scraping Cyto stain LOINC Cervical Cytology 33717-0 Cytology Cervical or vaginal smear or scraping study LOINC Cervical Cytology 47527-7 Cytology report of Cervical or vaginal smear or scraping Cyto stain.thin prep LOINC Cervical Cytology 47528-5 Cytology report of Cervical or vaginal smear or scraping Cyto stain LOINC Cervical Cytology 0923 UBREV 4 Back to 2018 HEDIS PPC Codes Quick Links Value Set Name Code Definition Code System Stand Alone Prenatal Visits 99500 CPT Stand Alone Prenatal Visits 0500F CPT Stand Alone Prenatal Visits 0501F CPT Stand Alone Prenatal Visits 0502F CPT Stand Alone Prenatal Visits H1000 Prenatal care, at-risk assessment (H1000) HCPCS Stand Alone Prenatal Visits H1001 Prenatal care, at-risk enhanced service; antepartum management (H1001) HCPCS Stand Alone Prenatal Visits H1002 Prenatal care, at risk enhanced service; care coordination (H1002) HCPCS Stand Alone Prenatal Visits H1003 Prenatal care, at-risk enhanced service; education (H1003) HCPCS Stand Alone Prenatal Visits H1004 Prenatal care, at-risk enhanced service; follow-up home visit (H1004) HCPCS Back to 2018 HEDIS PPC Codes Quick Links 5 Value Set Name Code Definition Code System Prenatal Visits 99201 CPT Prenatal Visits 99202 CPT Prenatal Visits 99203 CPT Prenatal Visits 99204 CPT Prenatal Visits 99205 CPT Prenatal Visits 99211 CPT Prenatal Visits 99212 CPT Prenatal Visits 99213 CPT Prenatal Visits 99214 CPT Prenatal Visits 99215 CPT Prenatal Visits 99241 CPT Prenatal Visits 99242 CPT Prenatal Visits 99243 CPT Prenatal Visits 99244 CPT
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