Appendix: Coding

Breast Cancer Screening

3014F         Screening mammography results documented and reviewed

Colorectal Cancer Screening

3017F         Colorectal cancer screening results documented and reviewed

G0328        FOBT

Note: Z12.11 is the diagnosis code for screening for malignant neoplasm of the colon.

Annual Flu Vaccines

90630         Influenza split virus vaccine, quadrivalent, preservative free, for intradermal use

90653         Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use

90654         Influenza virus vaccine, split virus, preservative-free, for intradermal use

90656         Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals three years and older, for intramuscular use

90660         Influenza virus vaccine, live, for intranasal use

90661         Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use

90662         Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

90672         Influenza virus vaccine, quadrivalent, live, for intranasal use

90673         Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

90686         Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals three years of age and older, for intramuscular use

90688         Influenza virus vaccine, quadrivalent, split virus, when administered to individuals three years of age and older, for intramuscular use

Q2035        Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use (Afluria®)

Q2036        Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use (Flulaval®)

Q2037        Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use (Fluvirin®)

Q2038        Influenza virus vaccine, split virus, when administered to individuals three years of age and older, for intramuscular use (Fluzone®)

Q2039        Influenza virus vaccine, when administered to individuals three years of age and older, intramuscular use (not otherwise specified)

Annual Flu Vaccines - Administration

G0008        Seasonal Influenza Virus Vaccine Administration G8482 Influenza immunization administered or previously received

G8483        Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)

G8484        Influenza immunization was not administered, reason not given

Improving or Maintaining Physical Health

1170F         Functional status assessed

Improving or Maintaining Mental Health

G8431        Screening for depression is documented as being positive and a follow-up plan is documented

3351F         Negative screen for depressive symptoms as categorized by using a standardized depression screening/assessment tool (MDD)

3352F         No significant depressive symptoms as categorized by using a standardized depression assessment tool (MDD)

3353F         Mild to moderate depressive symptoms as categorized by using a standardized depression screening/ assessment tool (MDD)

3354F         Clinically significant depressive symptoms as categorized by using a standardized depression screening/assessment tool (MDD)

3725F         Screening for depression performed G0444       Annual depression screening, 15 minutes

G8510        Screening for depression is documented as negative, a follow-up plan is not required

G9212        DSM-IVTM criteria for major depressive disorder documented at the initial evaluation

G9393        Patient with an initial PHQ-9 score greater than nine who achieves remission at 12 months as demonstrated by a 12-month (+/- 30 days) PHQ-9 score of less than five

G9395        Patient with an initial PHQ-9 score greater than nine who did not achieve remission at 12 months as demonstrated by a 12-month (+/- 30 days) PHQ-9 score greater than or equal to five

G9396        Patient with an initial PHQ-9 score greater than nine who was not assessed for remission at 12 months (+/- 30 days)

Adult BMI Assessment

G8417        BMI is documented above normal parameters and a follow-up plan is documented

G8418        BMI is documented below normal parameters and a follow-up plan is documented

G8419        BMI documented outside normal parameters, no follow-up plan documented, no reason given

G8420        BMI is documented within normal parameters and no follow-up plan is required

G8421        BMI not documented and no reason is given

G8422       BMI not documented, documentation the patient is not eligible for BMI calculation

COA – Medication Review

G8427         Eligible clinician attests to documenting in the medical record they obtained, updated or reviewed patients’ current medications

1159F         Medication list documented in medical record

1160F         Review of all meds by prescriber or clinical pharmacists documented in medical record

G8428        Current list of medications not documented as obtained, updated or reviewed by the eligible clinician, reason not given

G8430        Eligible clinician attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated or reviewed by the eligible clinician

Medication Adherence Tips

1159F         Medication list documented in medical record

1160F         Medication list documented in medical record

COA - Functional Status Assessment

1170F         Functional status assessed

COA – Pain Assessment

G8442         Pain assessment not documented as being performed, documentation patients are not eligible for a pain assessment using a standardized tool

1125F         Pain severity quantified; pain present

1126F         Pain severity quantified; no pain present

Improving Bladder Control

0509F         Urinary incontinence plan of care documented or

0509F-8P    Urinary incontinence plan of care not implemented, no reason given

Diabetes Care – Eye Exam

2022F         Dilated eye exam with interpretation

2024F         Seven standard field stereoscopic photos with interpretation

2026F         Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed

3072F         Low risk for retinopathy (no evidence of retinopathy in the prior year)

Hypertension – Controlling Blood Pressure

G8473        Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy prescribed

G8474        Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ACE inhibitor, diseases of the aortic or mitral valve, other medical reasons, patient declined, other patient reasons, lack of drug availability, other reasons attributable to the healthcare system)

G8475        Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy not prescribed, reason not given

G8476        Most recent blood pressure has a systolic measurement of < 140mm Hg and a diastolic measurement of < 90mm Hg

G8477        Most recent blood pressure has a systolic measurement of >=140mm Hg and/or a diastolic measurement of >=90mm Hg section

G8478        Blood pressure measurement not performed or documented, reason not given