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
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ICD-10 Compliance Date
 In 2012 CMS announced a Final Rule that
requires the use of ICD-10 codes effective
October 1, 2014
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•
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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
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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
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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
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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
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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.
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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
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Breast Cancer Screening
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Breast Cancer Screening
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Breast Cancer Screening
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Specific Changes
 Multiple tables combined into a single,
standardized Value Set
• Pregnancy
• ESRD
• HIV
• Outpatient
• Acute Inpatient
• Nonacute Inpatient
• ED
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Pregnancy
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Chlamydia Screening in Women
Value Sets:
 Pregnancy
 Pregnancy Test (a.k.a CHL-D)
 Chlamydia Screening (a.k.a CHL-C)
 Sexual Activity
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Specific Changes
 Codes for Visit Types will be combined into a
single, standardized Value Set
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•
•
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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)
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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.
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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
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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
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Questions
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