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HEDIS 2020 – What’s New, What’s Changing

Date:
November 21, 2019

To: All Providers

As the end of 2019 approaches, we want to summarize some of the HEDIS changes coming in 2020.

Screenings

  • Breast cancer screening (BCS)
    • Updated CPT and ICD-10 codes to identify patients who may be excluded due to the advanced illness and frailty exclusion
  • Cervical cancer screening (CCS)
    • Screening methods updated to include primary high-risk HPV testing
  • Colorectal cancer screening (COL)
    • Compliance codes added for test results for both Fecal Occult Blood Test (FOBT) and Cologuard (FIT-DNA)
    • Hybrid specification updated to indicate a screening test result is not required ONLY if documentation is clearly part of the patient’s medical history; date of screening test must be documented regardless

Child and Adolescent Measures

  • Appropriate Testing for Pharyngitis (CWP)
    • Previously called Children with Pharyngitis
    • Expanded age range to 3 years and older
    • Medicare added
  • Childhood Immunization Status (CIS)
    • Added live attenuated influenza virus (LAIV) as compliant (intranasal flu vaccine)
  • Immunizations for Adolescents (IMA)
    • Documentation of immunizations under “meningococcal conjugate vaccine” or “meningococcal polysaccharide vaccine” meet criteria
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC)
    • Referral to WIC will meet criteria for the Counseling for Nutrition CPT code

Diabetes – New CPT II Coding

  • Comprehensive Diabetes Care (CDC)
    • Effective 10/1/2019:
      • 2022F – Dilated Retinal Exam with evidence of retinopathy (Positive eye exam, 2019 only)
      • 2023F – Dilated Retinal Exam without evidence of retinopathy (Negative eye exam, 2018 or 2019) 
    • Effective 1/1/2020:
      • 3051F – Hemoglobin A1c ≥7.0% and <8.0%
      • 3052F – Hemoglobin ≥8.0% and ≤9.0%

New Measures for 2020

  • Follow-Up After High Intensity Care for Substance Use Disorder (FUI)
    • Number of patients 13 and older with substance use disorder (SUD) that received a follow-up after:
      • Acute inpatient hospitalization
      • Residential treatment
      • Detoxification visits or discharges
    • Must receive a follow-up within:
      • 7 days after the visit or discharge, and
      • 30 days after the visit or discharge
  • Pharmacotherapy for Opioid Use Disorder (POD)
    • Number of patients 16 and older with opioid use disorder (OUD) who receive 180 continuous days of OUD medication treatment

Coding to the highest specificity year-round will minimize medical record requests from us. If you have questions or you’d like coding guidance, please contact your BlueCross BlueShield account representative. Click on the link below to view the full list of HEDIS 2020 changes on our provider website incentives page.

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