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HEDIS 2008 Summary Table of Measures, Product Lines and Changes

HEDIS 2008 Measures

Effectiveness of Care Guidelines for Effectiveness of Care Measures Childhood Immunization Status

Commercial

Applicable to: Medicaid

Medicare · No changes for 2008.

Changes to HEDIS 2008

· Deleted "documented history of illness" and "seropositive test result" as numerator · · · ·

evidence for DTaP, IPV, HiB and pneumococcal conjugate. Require four acellular pertussis vaccines for the DTaP antigen. Deleted CPT code 90709 from Table CIS-A. Deleted HCPCS codes Q3021, Q3023 from Table CIS-A. Deleted ICD-9-CM Diagnosis codes 032, 033, 037, 038.41, 041.5, 045, 138, 320.0, 482.2, V02.4, V12.02 from Table CIS-A. · Replaced ICD-9-CM Diagnosis code 323.5 with 323.51 in Table CIS-B.

Adolescent Immunization Status Lead Screening in Children Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening

· Retired measure. NCQA has retired the Adolescent Immunization Status (AIS) measure

with the intent to refocus the specifications for HEDIS 2009.

· First-year measure. · Added CPT codes 77055­77057 to Table BCS-A. · Added CPT codes 19303­19307 to Table BCS-B. · Deleted CPT codes 88144, 88145 from Table CCS-A. · Moved ICD-9-CM Procedure code 45.42 from Flexible sigmoidoscopy description to · · · · · ·

Colonoscopy description in Table COL-A. Added CPT codes 44157, 44158 to Table COL-B.

Chlamydia Screening in Women

Added Table CHL-A: Prescriptions to Identify Contraceptives. Added CPT codes 76813, 87660, 87808 to Table CHL-B. Deleted CPT codes 76802, 76810, 76812, 76814 from Table CHL-B. Added HCPCS code S0180 to Table CHL-B. Added ICD-9-CM Diagnosis code V69.2 to Table CHL-B.

Glaucoma Screening in Older Adults

· No changes to this measure.

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

Appendix 1--Summary Table of Measures, Product Lines and Changes

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HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Effectiveness of Care Appropriate Testing for Children With Pharyngitis

Commercial

Applicable to: Medicaid

Medicare

Changes to HEDIS 2008 · Standardized Episode definitions; the first eligible episode is referred to as the Index · · · · · · · · ·

Episode Start Date (IESD). Combined outpatient and ED codes into one table (Table CWP-B). Deleted UB Type of Bill code 13x from Table CWP-B. Added clarithromycin and moxifloxacin to Table CWP-C.

Appropriate Treatment for Children With Upper Respiratory Infection

Added Negative Competing Diagnosis criteria. Standardized Episode definitions; the first eligible episode is referred to as the Index Episode Start Date (IESD). Combined outpatient and ED codes into one table (Table URI-B). Deleted UB Type of Bill code 13x from Table URI-B. Added Table URI-C: Codes to Identify Competing Diagnoses. Deleted Table URI-D: Antibiotic Medications; changed reference to reflect Table CWP-C.

Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis

· Inverted the measure rate and renamed measure. · Standardized Episode definitions; the first eligible episode is referred to as the Index · Combined outpatient and ED codes into one table (Table AAB-B). · Deleted UB Type of Bill code 13x from Table AAB-B. · Deleted the Codes to Identify Competing Diagnoses table; changed table reference to · Deleted total exclusions data element from Table AAB-1/2. · Standardized Episode definitions; the episode start date and new episode terms are

now referred to as the Index Episode Start Date (IESD). reflect Table URI-C. Episode Start Date (IESD).

Use of Spirometry Testing in the Assessment and Diagnosis of COPD Pharmacotherapy of COPD Exacerbation Use of Appropriate Medications for People With Asthma Cholesterol Management for Patients With Cardiovascular Conditions

· First-year measure. · Separated the asthma medications into two tables (ASM-C, ASM-D). · No changes to this measure.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

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HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Effectiveness of Care Controlling High Blood Pressure

Commercial

Applicable to: Medicaid

Medicare · · · · ·

Changes to HEDIS 2008

Removed age stratifications. Added Anchor Date criteria. Added additional denominator terms for confirmation of hypertension. Added HCPCS codes G0392, G0393 to Table CBP-C. The optional exclusion for identifying inpatient admissions refers organizations to a more comprehensive code table to identify nonacute inpatient encounters.

Beta-Blocker Treatment After a Heart Attack Persistence of Beta-Blocker Treatment After a Heart Attack Comprehensive Diabetes Care

· Retired measure. · Decreased the lower age limit from 35 to 18. · · · · · · · · · · · · · · · · ·

Added glimepiride-pioglitazone and metformin-sitagliptin to Table CDC-A. Added CPT Category II codes 3044F, 3045F to Tables CDC-D and CDC-E. Added Table CDC-F: Codes to Identify HbA1c Levels <7%. Added CPT codes 67030, 67031, 67036, 67121, 67220, 67221 to Table CDC-G. Added HCPCS codes G0392, G0393 to Table CDC-K. Expanded ICD-9-CM Diagnosis codes in Table CDC-K (evidence of treatment for nephropathy description) to include the entire range of 580­588. Added eprosartan-hydrochlorothiazide and hydrochlorothiazide-olmesartan to Table CDC-L. Added Table CDC-M: Codes to Identify Systolic and Diastolic BP Levels <130/80. Added CPT Category II codes 3074F, 3075F to Table CDC-N. Clarified how to identify the medical record from which to abstract the BP level. Clarified that organizations should not use a BP from an acute inpatient stay. Added Anchor Date criteria. Added J codes to Table ART-C. Deleted total exclusions data element from Table ART-1/2/3. Added Anchor Date criteria. Added CPT codes 77078­77083 to Table OMW-B. Standardized Episode definitions; the episode start date and new episode terms are now referred to as the Index Episode Start Date (IESD).

Disease Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis Osteoporosis Management in Women Who Had a Fracture Use of Imaging Studies for Low Back Pain

_________________

Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

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HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Effectiveness of Care Antidepressant Medication Management

Commercial

Applicable to: Medicaid

Medicare

Changes to HEDIS 2008 · Deleted ICD-9-CM Diagnosis codes 296.26, 296.36 from Table AMM-A. · Added Table AMM-B: Codes to Identify Substance Abuse. · Added CPT codes 98960­98962, 99078, 99217­99223, 99231­99233, 99238, 99239,

99251­99255, 99261­99263, 99411, 99412, 99510 to Table AMM-C. Added POS codes to Table AMM-C. Added a POS code requirement to select CPT codes in Table AMM-C. Added HCPCS codes H0035, H2001, H2012, S0201, S9480 to Table AMM-C. Added UB Revenue codes 0510, 0515­0517, 0519­0523, 0526­0529, 077x, 0902­ 0904, 0917, 0919, 0982, 0983 to Table AMM-C. · Deleted UB Revenue codes 0906, 0909, 0910, 0961 from Table AMM-C. · Clarified requirements for identifying Optimal Practitioner Contacts (Table AMM-C).

· · · ·

Follow-Up Care for Children Prescribed ADHD Medication

· Intensive outpatient and partial hospitalization visits count as follow-up visits to identify · Deleted UB Type of Bill codes from Table ADD-B. · Added CPT codes 90816­90819, 90821­90824, 90826­-90829, 98960­98962, 99217­ · · · · · · ·

99223, 99231­99233, 99238, 99239, 99251­99255, 99261­99263, 99411, 99412, 99510 to Table ADD-B. Deleted CPT codes 96100, 96101, 96110, 96111, 96115, 96116, 96118, 99354, 99355 from Table ADD-B. Added POS codes to Table ADD-B. Added a POS code requirement to select CPT codes in Table ADD-B. Added HCPCS codes H0035, H2001, H2012, S0201, S9480 to Table ADD-B. Added UB Revenue codes 0516, 0526-0528, 077x, 0904, 0911-0913, 0917 to Table ADD-B. Deleted UB Revenue codes 0909, 0910, 0918, 0961, 0988 from Table ADD-B. Deleted total exclusions data element from Table ADD-1/2. the numerator.

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

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HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Effectiveness of Care Follow-Up After Hospitalization for Mental Illness

Commercial

Applicable to: Medicaid

Medicare

Changes to HEDIS 2008 · Added Table FUH-B: Codes to Identify Nonacute Care. · Added CPT codes 98960­98962, 99078, 99217­99223, 99231­99233, 99238, 99239,

99251­99255, 99261­99263, 99411, 99412 to Table FUH-C. Added POS codes to Table FUH-C. Added a POS code requirement to select CPT codes in Table FUH-C. Added HCPCS code S0201 to Table FUH-C. Added UB Revenue codes 0510, 0515­0517, 0519­0523, 0526­0529, 077x, 0902­ 0904, 0917, 0919, 0982, 0983 to Table FUH-C. · Deleted UB Revenue codes 0906, 0909, 0910, 0961 from Table FUH-C.

· · · ·

Annual Monitoring for Patients on Persistent Medications

· Deleted the ACE Inhibitors and ARBs table; changed table reference to reflect CDC-K. · The optional exclusion for identifying inpatient admissions refers organizations to a · Deleted total exclusions data element from Table MPM-1/2/3. · Standardized Episode definitions; the first episode is referred to as the Index Episode · Added HCPCS codes G0392, G0393 to Table DDE-H. · Renamed measure. · This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and

summary of changes are contained in HEDIS 2008, Volume 6: Specifications for the Medicare Health Outcomes Survey. summary of changes are contained in HEDIS 2008, Volume 6: Specifications for the Medicare Health Outcomes Survey. summary of changes are contained in HEDIS 2008, Volume 6: Specifications for the Medicare Health Outcomes Survey. summary of changes are contained in HEDIS 2008, Volume 6: Specifications for the Medicare Health Outcomes Survey. Start Date (IESD). more comprehensive code table to identify nonacute inpatient encounters.

Potentially Harmful Drug-Disease Interactions in the Elderly Use of High Risk Medications in the Elderly Fall Risk Management

Management of Urinary Incontinence in Older Adults Osteoporosis Testing in Older Women Physical Activity in Older Adults

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

1-6

HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Effectiveness of Care Flu Shots for Adults Ages 50­64 Flu Shots for Older Adults Medical Assistance With Smoking Cessation Pneumonia Vaccination Status for Older Adults Access/Availability of Care Adults' Access to Preventive/ Ambulatory Health Services Children's and Adolescents' Access to Primary Care Practitioners Annual Dental Visit Initiation and Engagement of Alcohol and Other Drug Dependence Treatment

Commercial

Applicable to: Medicaid

Medicare

Changes to HEDIS 2008 · This measure is collected using survey methodology. Detailed specifications and

summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures. summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures. summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures. summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures.

· This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and

· No changes to this measure. · No changes to this measure. · No changes to this measure. · Removed the following age stratifications: 18-25, 26-34, 35-64, 65+ years. · Added CPT codes 90816­-90819, 90821­90824, 98960­98962, 99078, 99221­99223, · · · · · · ·

99231­99233, 99238, 99239, 99251­-99255, 99261­99263, 99411, 99412, 99510 to Table IET-B. Deleted CPT codes 90870, 90871, 99420 from Table IET-B. Added HCPCS codes H0022, S0201 to Table IET-B. Deleted HCPCS code H0006 from Table IET-B. Added UB Revenue codes 0510, 0513, 0515-0517, 0519­0523, 0526­0529, 077x, 0900, 0902­0907, 0911­0917, 0919, 0944, 0945, 0982, 0983 to Table IET-B. Added POS codes to Table IET-B. Added POS requirement to select codes in Table IET-B. Added UB Revenue codes 0116, 0126, 0136, 0146, 0156 to Table IET-C.

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

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HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Access/Availability of Care Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (continued)

Commercial

Applicable to: Medicaid

Medicare · · · ·

Changes to HEDIS 2008

Deleted HCPCS code S9475 from Table IET-C. Deleted ICD-9-CM Procedure codes 94.63, 94.66, 94.69 from Table IET-C. Added UB Revenue code 0981 to Table IET-D. Added ICD-9-CM Procedure codes 94.61, 94.63, 94.64, 94.66, 94.67, 94.69 to Table IET-E.

Prenatal and Postpartum Care

· Added ICD-9-CM Diagnosis codes 649.x1, 649.x2 to Table PPC-B. · Added CPT codes 76813 to Tables PPC-C (Decision Rules 2-3) and PPC-D. · Deleted CPT codes 76802, 76810, 76812, 76814 from Tables PPC-C (Decision Rules · Added HCPCS codes H1000­H1005 to Tables PPC-C (Decision Rules 2­4) and

PPC-D. 2-3) and PPC-D.

Call Abandonment Call Answer Timeliness Satisfaction With the Experience of Care CAHPS Health Plan Survey 4.0H, Adult Version CAHPS Health Plan Survey 3.0H, Child Version Children With Chronic Conditions Use of Services Guidelines for Use of Services Measures Frequency of Ongoing Prenatal Care Well-Child Visits in the First 15 Months of Life

_________________

· No changes to this measure. · No changes to this measure. · This measure is collected using survey methodology. Detailed specifications and

summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures. summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures. summary of changes are contained in HEDIS 2008, Volume 3: Specifications for Survey Measures.

· This measure is collected using survey methodology. Detailed specifications and · This measure is collected using survey methodology. Detailed specifications and

· No changes to this measure. · Clarified criteria for identifying visits during a member's last enrollment segment. · Clarified criteria for months of pregnancy enrolled in the organization in Table FPC-A. · No changes to this measure.

Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

1-8

HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Use of Services Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Adolescent Well-Care Visits Frequency of Selected Procedures

Commercial

Applicable to: Medicaid

Medicare · No changes to this measure. · No changes to this measure.

Changes to HEDIS 2008

· Added CPT codes 19301­19307, 22857, 22862, 22865, 58541-58544, 58548 to Table · Moved ICD-9-CM Procedure code 00.80 from Total hip replacement to Total knee · Deleted CPT codes 62263­62319 from Table FSP-A. · Added UB Revenue codes 0524, 0525 to Table AMB-A to include the entire 052x · Deleted UB Type of Bill code 13x from Tables AMB-B and AMB-D. · Added DRGs 560­579 to Tables IPU-A and IPU-B. · Deleted UB Revenue codes 0524, 0525 from Table NON-A. · Retired measure. · Retired measure. · · · · · · · · ·

Replaced the term intermediate with intensive outpatient and partial hospitalization. Replaced the term ambulatory with outpatient and ED. Reconfigured the code tables. All code tables in the measure are revised. Added ICD-9-CM Procedure codes 94.61, 94.64, 94.67 to Table IAD-B. The table now includes all valid fourth digits of the code (94.6x). Added CPT codes 99221­99223, 99231­99233, 99238, 99239, 99251­99255, 99261­ 99263 to Table IAD-C. Added HCPCS codes H0022, H0049, H0050 to Table IAD-D. Added CPT codes 96101, 96110, 96111, 96116, 96118, 98960­98962, 99078, 99411, 99412, 99510 to Table IAD-D. Added HCPCS code S0201 to Table IAD-C. Added UB Revenue codes 0527, 0528, 077x, 0904, 0917, 0981-0983 to Table IAD-D. range. replacement in Table FSP-A. FSP-A.

Ambulatory Care

Inpatient Utilization--General Hospital/ Acute Care Inpatient Utilization--Nonacute Care Discharges and ALOS--Maternity Care Births and ALOS, Newborns Identification of Alcohol and Other Drug Services

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

1-9

HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Use of Services Identification of Alcohol and Other Drug Services (continued)

Commercial

Applicable to: Medicaid

Medicare · · · · ·

Changes to HEDIS 2008

Deleted UB Revenue codes 0909, 0910, 0961 from Table IAD-D. Added POS codes to Tables IAD-C and IAD-D. Added POS code requirement to select codes in Tables IAD-C and IAD-D. Deleted UB Type of Bill codes from code tables in the measure. Retired measure.

Chemical Dependency Utilization-- Inpatient Discharges and ALOS Mental Health Utilization--Inpatient Discharges and ALOS Mental Health Utilization

· Retired measure. · · · · · · · · · · ·

Replaced the term intermediate with intensive outpatient and partial hospitalization. Replaced the term ambulatory with outpatient and ED. Reconfigured the code tables. All code tables in the measure are revised. Added CPT codes 99221­99223, 99231­99233, 99238, 99239, 99251­99255, 99261­ 99263 to Table MPT-C. Added HCPCS code S0201 to Table MPT-C. Added CPT codes 96101, 96110, 96111, 96116, 96118, 98960­98962, 99078, 99411, 99412, 99510 to Table MPT-D. Added UB Revenue codes 0527, 0528, 077x, 0904, 0917, 0981-0983 to Table MPT-D. Deleted UB Revenue codes 0909, 0910, 0961 from Table MPT-D. Added POS codes to Tables MPT-C and MPT-D. Added POS code requirement to select codes in Tables MPT-C and MPT-D. Deleted UB Type of Bill codes from code tables in the measure.

Antibiotic Utilization Outpatient Drug Utilization

· No changes to this measure. · No changes to this measure.

_________________ Current Procedure Terminology © 2005 American Medical Association. All rights reserved.

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

1-10

HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

Cost of Care

Cost of Care Guidelines for Cost of Care Measures

Commercial

Applicable to: Medicaid

Medicare

Changes to HEDIS 2008 · Changed measurement year and Episode Treatment Period references to treatment · Clarified that organization-specific use of standard codes requires correct mapping for · Clarified per diem multiplier instructions for calculating inpatient facility length of stay. · Revised the RLB member months calculation to count enrollment in treatment period · Revised the RLB standard cost calculation of pharmacy services. Include only

pharmacy services with a low back pain diagnosis. on member exclusions found during chart review. only. those codes. period.

Relative Resource Use for People With Diabetes

· Clarified that for the CDC measure, members should not be excluded from RDI based · Revised cardiovascular conditions comorbidity criteria (i.e., event and diagnosis · · · · · · · · ·

criteria). Added HCPCS codes G0392, G0393 to Table RDI-B. Added HCPCS codes to Table RDI-H. Added UB Revenue codes 1001, 1002 to Table RDI-H. Added DRGs 560­579 to Table RDI-H. Added POS codes to Table RDI-H. Deleted UB Revenue codes 0524, 0525 from Table RDI-H. Deleted Unknown Age from all reporting tables.

Relative Resource Use for People With Asthma

Added Definitions section. Revised cardiovascular conditions comorbidity criteria (i.e., event and diagnosis criteria). · Deleted Inpatient Facility Discharge table; changed table reference to reflect Table RDI-H. · Deleted Unknown Age from all reporting tables.

Relative Resource Use for People With Acute Low Back Pain

· Standardized Episode definitions; the episode start date and new episode terms are · Added Table RLB-A: Medications for Acute Low Back Pain to identify pharmacy · Deleted UB Revenue codes 0524, 0525 from Table RLB-B. · Deleted Unknown Age from all reporting tables. · First-year measure.

services associated with the treatment of low back pain. now referred to as the Index Episode Start Date (IESD).

Relative Resource Use for People With Cardiovascular Conditions

HEDIS 2008, Volume 2

Appendix 1--Summary Table of Measures, Product Lines and Changes

1-11

HEDIS 2008 Summary Table of Measures, Product Lines and Changes (continued)

HEDIS 2008 Measures

Cost of Care Relative Resource Use for People With Uncomplicated Hypertension Relative Resource Use for People With COPD Health Plan Descriptive Information Board Certification

Commercial

Applicable to: Medicaid

Medicare · First-year measure. · First-year measure.

Changes to HEDIS 2008

· Changed board certification criteria to require active status. · Replaced Primary Care Physicians category with Family Medicine and Internal · Replaced Pediatric Physician Specialists category with Pediatricians category to

Medicine categories. capture the number of physicians whose board certification is active in pediatrics (not inclusive of pediatric subspecialties).

Enrollment by Product Line Enrollment by State Language Diversity of Membership Race/Ethnicity Diversity of Membership Weeks of Pregnancy at Time of Enrollment Health Plan Stability Years in Business/Total Membership Informed Health Care Choices

· No changes to this measure. · No changes to this measure. · No changes to this measure. · No changes to this measure. · No changes to this measure.

· Added Medicaid product line to PPO and POS products in Table YIB-1/2/3.

There are currently no measures in this domain.

HEDIS 2008, Volume 2

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