A wellness visit is an important time to discuss healthy choices that may prevent future chronic conditions including diabetes, cardiovascular diseases, and some cancers.
The Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) — which is an important part of the annual well visit — can provide parents and young people guidance on maintaining or moving toward a healthier lifestyle.
However, there are several misconceptions related to annual well visits and the WCC that need to be addressed:
FACT: Providers don’t have to wait a year plus a day to schedule their patient’s next wellness visit. The Highmark Preventative Schedule is based on the calendar year and resets Jan. 1 of each year. Completing annual visits and recommended screenings before the child’s birthday provides the greatest compliance with multiple quality metrics.
FACT: Patients 3-17 years of age who have had at least one visit during the calendar year with a Primary Care Physician (PCP) or Obstetrician-Gynecologist (OBGYN) are included. Well visits are part of the metric, but so are sick visits, telephone / virtual visits, and other in-person visits.
FACT: Documentation to support the completion of activities and corresponding codes is required, but the method of completion may vary. The three measures, along with documentation examples, can be found below.
Include the appropriate codes for each of the three components above for full measure compliance.
VISIT DIAGNOSIS:
Encounter for routine child health examination without abnormal findings (primary) [Z00.129] | ||
Nutrition Counseling | Z71.3 | Dietary counseling and surveillance |
Physical Activity Counseling | Z02.5 | Encounter for examination for participation in sport |
Physical Activity Counseling | Z71.82 | Exercise counseling |
BMI Percentile | Z68.52 | BMI pediatric, 5th percentile to less than 85th percentile for age |
Log into Availity®, select the state where you practice, choose Payer Spaces, and then, under Applications, select the Provider Resource Center. Once there, select EDUCATION/MANUALS from the left menu, choose HEDIS®, and then click Overview of the 2024 NCQA HEDIS measures. You can find more information on page 92 regarding the measure for Weight Assessment & Counseling for Children/Adolescents.
HEDIS® — which is an acronym for Healthcare Effectiveness Data and Information Set — is a registered trademark of the National Committee for Quality Assurance (NCQA).