No. The HEDIS 2015 Value Set Directory will not include invalid ICD-9 codes; it will only include ICD-9 codes that are valid for billing. The HEDIS 2014 value sets included invalid ICD-9 codes; these will be removed, effective with HEDIS 2015.
FAQ Directory
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4.15.2014 HEDIS and ICD-10 Will the HEDIS 2015 Value Set Directory include invalid codes (codes that are not valid for billing)?
4.15.2014 Distributing Information to Practitioners May an organization that does not contract with practitioners directly use a physician organization to distribute information?
4.15.2014 Outpatient Procedures Utilization – Percentage Done in Preferred Facility (OSU) In the MY 2012 specifications, in the step for counting total outpatient procedures both Option A and Option B allowed both POS and UB Type of Bill codes. In the MY 2013 specifications, it appears that Option A only allows POS codes and Option B only UB Type of Bill codes. Is this change intentional?
Thank you for bringing this to our attention. When converting coding table references to value set references, the Option A UBTOB language and Option B POS language was inadvertently omitted. For OSU, Options A and B should include both POS and UB Type of Bill codes and should read as follows:
Any of the following code options meet criteria:
· Option A: Ambulatory Surgery Option A Value Set with Ambulatory Surgery POS Value Set .
· Option A: Ambulatory Surgery Option A Value Set with Ambulatory Surgery UBTOB Value Set.
· Option B: Ambulatory Surgery Procedure Value Set with Ambulatory Surgery UBREV Value Set and Ambulatory Surgery UBTOB Value Set.
· Option B: Ambulatory Surgery Procedure Value Set with Ambulatory Surgery UBREV Value Set and Ambulatory Surgery POS Value Set.
This will be corrected in the next release of the manual.
This applies to the following Programs and Years:
IHA P4P4.15.2014 HEDIS and ICD-10 The ICD-10 implementation date has been delayed. Will NCQA include ICD-10 codes in HEDIS 2015?
No. Because of the delay in ICD-10 implementation, ICD-10 codes will not be used during the HEDIS 2015 measurement year (the 2014 calendar year) and therefore will not be included in the HEDIS 2015 Value Set Directory.
Purchasers of HEDIS 2015 technical specifications will receive a separate file with ICD-10 codes proposed for inclusion in future releases of HEDIS, but the codes will not be considered part of the 2015 measure specifications.
This applies to the following Programs and Years:
HEDIS 20144.15.2014 Encounter Rate by Service Type (ENRST) We noticed some rate fluctuations this year and found that many of the laboratory/pathology procedure codes from the MY 2012 code tables were not included in the MY 2013 Value Set Directory. MY 2012 included CPT codes 80047-89398. This year, the codes only go up to 80076 and then skip to the 89xxx series. These changes are not documented in the VSD Summary of Changes. Should these codes be included in this year’s P4P reporting?
The December 2, 2013, release of the MY2013 P4P Value Set Directory (VSD) was incomplete for two value sets used to report the Encounter Rate by Service Type (ENRST) measure. Therefore, we are releasing a 2014-03-19 version of the VSD that contains the following changes:
· Laboratory and Pathology Services Value Set: Added 1331 CPT codes
· Radiology and Imaging Services Value Set: Added 21 CPT codes
The added codes can be identified in the VSD as follows:
· In the P4P Value Sets to Codes spreadsheet, set the filter in column C (Value Set Version) to “2014-03-19” to identify added codes.
· In the P4P Summary of Changes spreadsheet, set the filter in column F (Revised) to “2014-03-19” to identify added codes.
To access the correct value sets, go to the download center at https://downloads.ncqa.org/customer/Login.aspx and log in.
If you have any questions, contact p4p@ncqa.org.
This applies to the following Programs and Years:
IHA P4P4.15.2014 P4P and ICD-10 The ICD-10 implementation date has been delayed. Will P4P include ICD-10 codes in P4P MY 2014?
No. Because of the delay in ICD-10 implementation, ICD-10 codes will not be used during P4P MY 2014 and therefore will not be included in the P4P MY 2014 Value Set Directory.
Purchasers of the P4P MY 2014 Value Set Directory will receive a separate file with ICD-10 codes proposed for inclusion in future releases of P4P specifications, but the codes will not be considered part of the MY 2014 measure specifications.
This applies to the following Programs and Years:
IHA P4P3.15.2014 Definition of SPMI What is the definition of severe and persistent mental illness (SPMI)?
A mental, behavioral or emotional disorder according to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, in members 18 years and older, that results in functional impairment which substantially interferes with or limits one or more major life activities (e.g., maintaining interpersonal relationships, activities of daily living, self-care, employment, recreation) that have occurred within the last year. All of these disorders may have acute episodes as part of the chronic course of the disorder. An organization may also use its state's definition or the definition of another appropriate regulatory authority.
This applies to the following Programs and Years:
3.15.2014 Plan Sponsors Individual and Family Plans (Exchanges) Should RR 5, Element C be scored NA for individual or family plans within an Exchange product line because there are no plan sponsors (i.e., employer, employee organization or association, committee, joint board of trustees, or other similar group)?
3.11.2014 Meaningful Use of Health IT (MUHIT) Under the “Who We Measure” section of the MUHIT domain, the MY 2013 P4P Manual states, “P4P defines PCPs as ‘physicians or nonphysicians (e.g., physician assistants, nurse practitioners) who offer primary care services.’ ” Should pediatricians be included in the denominator?
A physician organization (PO) may select three definitions to use in determining the denominator for the MUHIT measures: the definition of “primary care practitioner,” or the CMS definition of “eligible professional” for Medicare or the CMS definition of “eligible professional” for Medicaid. All three definitions include physicians.
If a PO uses the “primary care practitioner” definition, it must include all physicians who are considered PCPs and are serving the commercial HMO/POS population. Because pediatricians serve as PCPs for children, they are included.
If a PO uses the CMS “eligible professional” definitions, all physicians serving the commercial HMO/POS population must be included. Because the focus of P4P is the commercial population, physicians are not required to have attested to CMS or the state for MU, to be included.
This applies to the following Programs and Years:
IHA P4P
3.11.2014
Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women (ECS) The following codes appeared in the MY 2012 specifications and code tables but do not show up in the MY 2013 P4P Value Set Directory under a value set or in the Measure Updates as a removal. Should the following codes be used for reporting in MY 2013?
• ICD-9-CM 91.46.
• CPT 88155.
The following code appears in the MY 2013 P4P Value Set Directory but does not show up in the Manual Updates as an addition. Should this code be used for reporting in MY 2013?
• ICD-9-CM V7647.
The MY 2013 P4P Value Set Directory is correct. ICD-9-CM 91.46 and CPT 88155 were deleted from the Cervical Cytology value set and ICD-9-CM V76.47 was added to the Hysterectomy value set. These changes were not listed in the MY 2013 P4P Measure Updates.
This applies to the following Programs and Years:
IHA P4P3.11.2014 Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women (ECS) In Rate 3, step 3 of the ECS measure, the cervical cytology without co-tests specification states, If two or more claims/encounters with qualifying numerator codes for cervical cytology occur within 120 days of each other, count only the first one. <p>Should this rule apply to women with multiple cervical cytology and HPV co-tests in the third or fourth year prior to the measurement year? In these cases, should the cervical cytology tests be >120 days apart?
The 120-day rule should also apply to Rate 3, step 3 of the ECS measure. If there are multiple cervical cytology and HPV co-tests during the three or four years prior to the measurement year, and these occur within 120 days of each other, count only the first test.
This applies to the following Programs and Years:
IHA P4P3.11.2014 Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS) The MY 2013 P4P Value Set Directory does not include a Cervical Cancer Value Set for the Non-Recommended Cervical Cancer Screening in Adolescent Females (NCS) measure. Where can I find these codes?
The Cervical Cancer Value Set was not included in the MY 2013 P4P Value Set Directory. The codes included in the Hypertension Value Set are:
- ICD-9-CM 180.0.
- ICD-9-CM 180.
- ICD-9-CM 180.1.
- ICD-9-CM 180.8.
- ICD-9-CM 180.9.
- ICD-9-CM 233.1.
- ICD-9-CM V10.41.
The other NCS Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. These Value Sets for NCS already exist as part of other measures. The Cervical Cancer Value Set will be included in the next release of the P4P Value Set Directory, which will also list the NCS measure separately.