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Johns Hopkins Health Plans

WCV - Child and Adolescent Well-Care Visits

Product Lines:
EHP, Priority Partners and USFHP.

Measurement Period: January 1 - December 31 

Description:
The percentage of persons 3–21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement period.

Provider Specialty: PCP, OB/GYN

Stratifications: 
Age as of the last day of the measurement period.

  • 3–11 years.
  • 12–17 years.
  • 18–21 years.

Report stratification by race and ethnicity. 

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners.  

Improvement Notation:
Increased score indicates improvement.

Initial Population:

  • Measure Item Count: Person.
  • Age: 3–21 years of age as of the last day of the measurement period.
  • Benefits: Medical.
  • Continuous Enrollment: The measurement period.
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Data Collection:

  • Administrative.
  • Supplemental.

Denominator:
The initial population minus denominator exclusions.

Numerator:
Numerator 1: Well-child visits in the first 15 months.
Persons with six or more well-child visits on different dates of service with a PCP on or before the 15-month birthday. Either of the following meet criteria:

  • A well-care visit.
  • An encounter for well-care. 

Numerator 2: Well-child visits for age 15 months–30 months.
Two or more well-child visits on different dates of service with a PCP between the child’s 15-month birthday plus 1 day and the 30-month birthday. Either of the following meets criteria:

  • A well-care visit.
  • An encounter for well-care. 

 

Best Practice and Measure Tips

  • Visits must be with a PCP. The PCP does not have to be the practitioner assigned to the child.
  • Assessment or treatment of an acute or chronic condition does not count towards the measure.
  • Well-care visits can be performed anytime in the measurement/calendar year.
  • This measure is based on the American Academy of Pediatrics Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents (published by the National Center for Education in Maternal and Child Health). Visit the Bright Futures website for more information about well-child visits (https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/).
  • Not allowed: Telehealth well visits.

To meet administrative measure requirements, JHHC reminds all LOB well-care visits can be done in conjunction with sick visits, as long as they are billed appropriately.

How can a provider turn a sick visit into a well visit?

  • If provider is seeing a patient for Evaluation and Management (E/M) services and all well-care visits components are completed: Attach modifier 25 or 59 to the well-child procedure code so it’s reviewed as a significant, separately identifiable procedure.
  • Modifier 25 is used to indicate a significant and separately identifiable evaluation and management (E/M) service by the same physician on the same day another procedure or service was performed.
  • Modifier 59 is used to indicate that 2 or more procedures were performed at the same visit, but to different sites on the body.
  • Be sure to give additional guidance that is not related to the sick visit.
  • Examples:
    • Is the child wearing their seatbelt?
    • Discussion of oral health.
    • Document home or school life.
    • Are they participating in a team sport?
    • Are they adjusting to a new school?
    • Visit the Bright Futures website for more information about well-child visits (https://brightfutures.aap.org/materials-and-tools/guidelines-and-pocket-guide/).

Measure Exclusions

Denominator Exclusions:

  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.

Numerator Exclusions:

  • Telehealth visits.
  • Laboratory claims (POS 81).

Exclusion Codes

Online Assessments

  • CPT: 98016, 98970, 98971, 98972, 98980, 98981, 99421, 99422, 99423, 99457, 99458
  • HCPCS: G0071, G2010, G2012, G2250, G2251, G2252

Telehealth POS

  • 02- Telehealth Provided Other than in Patient’s Home
  • 10- Telehealth Provided in Patient’s Home

Telephone Visits

  • CPT: 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98966, 98967, 98968, 99441, 99442, 99443
  • SNOMED CT US Edition: 185317003, 314849005, 386472008, 386473003, 401267002 

Measure Codes

Be sure to use age-appropriate codes.

Well-Care

  • CPT: 99382, 99383, 99384, 99385, 99392, 99393, 99394, 99395
  • HCPCS: G0438, G0439, S0302, S0610, S0612, S0613
  • ICD-10-CM: Z00.00, Z00.01,  Z00.121, Z00.129, Z00.2, Z00.3, Z01.411, Z01.419, Z02.5, Z02.84, Z76.1, Z76.2
  • SNOMED CT US Edition: 170150003, 170159002, 170168000, 170281004, 170290006, 171387006, 171394009, 171395005, 171409007, 171410002, 171416008, 171417004, 270356004, 410634009, 410635005, 410636006, 410637002, 410638007, 410639004, 410640002, 410641003, 410642005, 410643000, 410644006, 410645007, 410646008, 410647004, 410648009, 410649001, 410650001, 783260003, 1269518002, 444971000124105, 669251000168104, 669261000168102, 669271000168108, 669281000168106