Oakland Southfield Physicians

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Blue Cross Complete Offers Well Child Coding Tips

Posted: 09/22/2020

The Healthcare Effectiveness Data & Information Set (HEDIS) is a widely used set of quality measures, developed and maintained by the National Committee for Quality Assurance (NCQA). Blue Cross Complete of Michigan reports HEDIS data to NCQA about the use of services including well child visits. Coding HEDIS measures accurately can assist you in identifying and eliminating gaps in care; help ensure timely and appropriate care; monitor preventive care; and facilitate timely claim adjudication, incentives, and payments.

In accordance with The Centers for Medicare & Medicaid Services (CMS) and The American Medical Association (AMA), listed below are some helpful tips for coding well-child visits:

Early periodic screening and diagnostic treatment visits (EPSDT

When medically appropriate, members within the documented age range should have a well-visit exam during a follow-up visit or sick visit. In accordance with AMA CPT coding guidelines, all EPSDT visits should include the following components:

  1. Health and developmental history (including age and gender appropriate history).
  2. Physical exam (multiple systems).
  3. Lab tests if appropriate e.g., lead screening.
  4. Immunizations (use all visits, preventive and sick if medically appropriate).
  5. Health education and anticipatory guidance (including risk factor reduction and interventions).

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