2017 Coding Reference Guide for OBGYNCurrent Procedural Terminology ©2014 American Medical Association. All rights reserved.Current Procedural Terminology (CPT) and Uniform Bill (UB) codes are stated to the minimum specificity required.

MVPPR0013 (Revised 05/2017)

MVP Health Care® | HEDIS 2017 Coding Reference Guide for OBGYN 2

Contents

HEDIS 2017 Preventive Care Measures .................................................................................................................................................................3

Prenatal and Postpartum Care (PPC) ..................................................................................................................................................................................................... 3

Frequency of Ongoing Prenatal Care (FPC) (QARR) ............................................................................................................................................................................. 3

Breast Cancer Screening (Admin) (BCS) ................................................................................................................................................................................................ 4

Chlamydia Screening in Women (Admin) (CHL) ................................................................................................................................................................................... 4

Cervical Cancer Screening (Hybrid) (CCS) ............................................................................................................................................................................................. 4

MVP Health Care® | HEDIS 2017 Coding Reference Guide for OBGYN 3

HEDIS 2017 Preventive Care Measures

Appropriate Care and Associated Codes to Bill

CPT and CPT II ICD–10 HCPCS

Prenatal and Postpartum Care (PPC)

The percentage of deliveries of live births on or between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care.

• Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester, on the enrollment start date or within 42 days of enrollment in the organization.

• Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Prenatal Bundles services:59400, 59425, 59426, 59510, 59610, 59618

Prenatal:99201-99205, 99211-99215, 99241-99245, 99500, 0500F, 0501F, 0502F

Postpartum Bundle services:59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622

Postpartum:

57170, 58300, 59430, 99501, 0503F

Postpartum:

Z01.419, Z01.42, Z30.430, Z39.1, Z39.2Prenatal:

H1005, G0463, T1015Postpartum Bundle services:G0101

Frequency of Ongoing Prenatal Care (FPC) (QARR)

The percentage of Medicaid deliveries on or between November 6 of the year prior to the measurement year and November 5 of the measurement year that had the following number of expected prenatal visits:

• <21 percent expected visits

• 21 percent-40 percent of expected visits

• 41 percent-60 percent of expected visits

• 61 percent-80 percent of expected visits

• ≥81 percent of expected visits

Prenatal Bundles services:

59400, 59425, 59426, 59510, 59610, 59618Prenatal:99201-99205, 99211-99215, 99241-99245, 99500, 0500F, 0501F, 0502F

Prenatal:

H1000 - H1005, G0463, T1015

MVP Health Care® | HEDIS 2017 Coding Reference Guide for OBGYN 4

Appropriate Care and Associated Codes to Bill

CPT ICD–10 HCPCS UB Revenue

Breast Cancer Screening (Admin) (BCS)The percentage of women 50–74 years of age who had a mammogram to screen for breast cancer within the measurement year.

77055–77057 Z90.11, Z90.12, Z90.13 G0202 0403

Chlamydia Screening in Women (Admin) (CHL)The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year.

Medicaid Quality Program incentive for collecting Chlamydia specimen—$8.00.

Providers who collect either a urine or endocervical swab specimen to send for Chlamydia should bill MVP using the following codes:

• CPT code 99000 (handling laboratory specimen, AND

• z-code z11.8 encounter for screening for other infectious and parasitic diseases.

87110, 87270, 87320, 87490–87492, 87810 Verify that these codes are used by your laboratory service provider to process specimens (for more detail please refer to the Supporting Excellence program description).

Codes to Identify Sexual Activity:81025, 84702, 84703, 87110, 87270, 87320, 87490–87492, 87661, 87810

Cervical Cancer Screening (Hybrid) (CCS)The percentage of women 21–64 years of age who were screened for cervical cancer by either of the following:

• Women age 21–64 who had cervical cytology performed every three years.

• Women age 30–64 who had cervical cytology/human Papillomavirus (HPV) co-testing performed every five years

Cervical Cytology:88141–88143, 88147, 88148, 88150, 88152–88154, 88164–88167, 88174, 88175

HPV Test:87620–87622, 87624-87625

Cervical Cytology:G0123, G0124, G0141, G0143–G0145, G0147, G0148, P3000, P3001

HPV Test:G0476Q0091 Bill this specimen collection code to receive the Medicaid Quality Program incentive of $50.00 (for more detail please refer to the program description).

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HEDIS 2017 Preventive Care Measures