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Lori Andersen Asst. Director, Policy Measures

HEDIS 2014 Code Transition. Lori Andersen Asst. Director, Policy Measures. Objectives. ICD-10 Status Update Review the HEDIS 2014 Code Transition Impacts on Volume 2 and other HEDIS Publications Questions Feedback. ICD-10 Compliance Date.

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Lori Andersen Asst. Director, Policy Measures

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  1. HEDIS 2014 Code Transition Lori AndersenAsst. Director, Policy Measures

  2. Objectives • ICD-10 Status Update • Review the HEDIS 2014 Code Transition • Impacts on Volume 2 and other HEDIS Publications • Questions • Feedback

  3. ICD-10 Compliance Date • In 2012 CMS announced a Final Rule that requires the use of ICD-10 codes effective October 1, 2014 • Claims for dates of service on or before September 30, 2014 will use ICD-9 codes • Claims for dates of service on or after October 1, 2014 must use ICD-10 codes • This change impacts HEDIS 2015 which collects performance information about the 2014 calendar year • NCQA will include ICD-10 codes in HEDIS 2015

  4. ICD-10 Status Update • ICD-10 codes have been identified for all but two measures • Final Review and Comment period scheduled for July 1 – December 15, 2013 • Timing considerations • Impact Assessment planning underway • Impacts on products that incorporate trending • Impacts on products that incorporate performance based scoring

  5. What’s Different? • Much greater specificity! • Diagnosis codes increase from 13K to 68K (92K in our resource) • Procedure codes increase from 4K to 87K • Changes to format and structure • Concepts added • Concepts moved • Concepts deleted

  6. HEDIS 2014 • Effective with HEDIS 2014 code tables will be removed from HEDIS publications and released in an electronic format (Value Set Directory) • Value Set refers to the set of codes that identifies a condition or procedure • HEDIS Volume 2 publication package will include the Value Set Directory • Cost neutral • Value Set Directory includes all codes used to report HEDIS, listed individually • Volume 2 lists ICD-9 code 401 • Value Set includes 401.0, 401.1, 401.9

  7. Why Change? • Feasibility • ICD-10: An increase in the number of diagnosis and procedure codes, combined with the need to list codes individually, makes tables very large. • Improvement • Managing codes electronically will allow NCQA and customers to manage a large volume of information more efficiently and more accurately. • Using Value Sets standardizes terminology and definitions across measures and products.

  8. Specific Changes • Some HEDIS tables contain codes for a single concept, and any code meets criteria for reporting • All codes will be included in a single Value Set • Some HEDIS tables separate codes by Description • If different Descriptions are required for reporting, a Value Set will be created for each Description • If different Descriptions are not required for reporting, a single Value Set will be created • Value Set naming convention • Value Set references in HEDIS Publications

  9. Breast Cancer Screening

  10. Breast Cancer Screening

  11. Breast Cancer Screening

  12. Specific Changes • Multiple tables combined into a single, standardized Value Set • Pregnancy • ESRD • HIV • Outpatient • Acute Inpatient • Nonacute Inpatient • ED

  13. Pregnancy

  14. Chlamydia Screening in Women Value Sets: • Pregnancy • Pregnancy Test (a.k.a CHL-D) • Chlamydia Screening (a.k.a CHL-C) • Sexual Activity

  15. Specific Changes • Codes for Visit Types will be combined into a single, standardized Value Set • Outpatient, Acute Inpatient, Nonacute Inpatient, ED • HEDIS 2013 – codes are customized based on age bands • HEDIS 2014 – a single, comprehensive set of codes is used for all measures regardless of age criteria • Codes not applicable to a measure will not occur • 99382 (Preventive medicine evaluation ages 5-11): will not show up in ABA EPOP • Will result in code changes to some measures (during HEDIS 2014 transition year)

  16. Facilitate Transition • Documentation will describe changes between 2013 Description and 2014 Value Set • Codes for URI and acute nasopharyngitis (formerly listed separately by Description in Table URI-A) are combined into a single URI Value Set. • Codes for acute pharyngitis, acute tonsillitis and streptococcal sore throat are combined into a single Pharyngitis Value Set.

  17. Facilitate Transition • A Summary of Changes for coding changes will be provided • In electronic format as part of the Value Set Directory • Considerations for HEDIS 2014 transition year? • Will be provided: • Value Sets used, by measure • Measures that use the Value Set, by Value Set

  18. Facilitate Transition • Code definitions will be included in the Value Set Directory when possible • CPT has licensing restrictions and cannot be included • TBD – Value Set Directory format • XML • Excel • Ongoing communication with customers • Value Set Directory Support

  19. Questions

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