Lori AndersenAsst. Director, Policy Measures

HEDIS 2014 Code Transition

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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• 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• 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