Lori Andersen Asst. Director, Policy Measures HEDIS 2014 Code Transition

2 Objectives  ICD-10 Status Update  Review the HEDIS 2014 Code Transition  Impacts on Volume 2 and other HEDIS Publications  Questions  Feedback

3 ICD-10 Compliance Date  In 2012 CMS announced a Final Rule that requires the use of ICD-10 codes effective October 1, 2014 Claims for dates of service on or before September 30, 2014 will use ICD-9 codes Claims for dates of service on or after October 1, 2014 must use ICD-10 codes This change impacts HEDIS 2015 which collects performance information about the 2014 calendar year  NCQA will include ICD-10 codes in HEDIS 2015

4 ICD-10 Status Update  ICD-10 codes have been identified for all but two measures  Final Review and Comment period scheduled for July 1 – December 15, 2013 Timing considerations  Impact Assessment planning underway Impacts on products that incorporate trending Impacts on products that incorporate performance based scoring

5 What’s Different?  Much greater specificity! Diagnosis codes increase from 13K to 68K (92K in our resource) Procedure codes increase from 4K to 87K  Changes to format and structure  Concepts added  Concepts moved  Concepts deleted

6 HEDIS 2014  Effective with HEDIS 2014 code tables will be removed from HEDIS publications and released in an electronic format (Value Set Directory) Value Set refers to the set of codes that identifies a condition or procedure  HEDIS Volume 2 publication package will include the Value Set Directory Cost neutral  Value Set Directory includes all codes used to report HEDIS, listed individually Volume 2 lists ICD-9 code 401 Value Set includes 401.0, 401.1, 401.9

7 Why Change?  Feasibility ICD-10: An increase in the number of diagnosis and procedure codes, combined with the need to list codes individually, makes tables very large.  Improvement Managing codes electronically will allow NCQA and customers to manage a large volume of information more efficiently and more accurately. Using Value Sets standardizes terminology and definitions across measures and products.

8 Specific Changes  Some HEDIS tables contain codes for a single concept, and any code meets criteria for reporting All codes will be included in a single Value Set  Some HEDIS tables separate codes by Description If different Descriptions are required for reporting, a Value Set will be created for each Description If different Descriptions are not required for reporting, a single Value Set will be created  Value Set naming convention  Value Set references in HEDIS Publications

9 Breast Cancer Screening

10 Breast Cancer Screening

11 Breast Cancer Screening

12 Specific Changes  Multiple tables combined into a single, standardized Value Set Pregnancy ESRD HIV Outpatient Acute Inpatient Nonacute Inpatient ED

13 Pregnancy

14 Chlamydia Screening in Women Value Sets:  Pregnancy  Pregnancy Test (a.k.a CHL-D)  Chlamydia Screening (a.k.a CHL-C)  Sexual Activity

15 Specific Changes  Codes for Visit Types will be combined into a single, standardized Value Set Outpatient, Acute Inpatient, Nonacute Inpatient, ED HEDIS 2013 – codes are customized based on age bands HEDIS 2014 – a single, comprehensive set of codes is used for all measures regardless of age criteria Codes not applicable to a measure will not occur (Preventive medicine evaluation ages 5-11): will not show up in ABA EPOP Will result in code changes to some measures (during HEDIS 2014 transition year)

16 Facilitate Transition  Documentation will describe changes between 2013 Description and 2014 Value Set Codes for URI and acute nasopharyngitis (formerly listed separately by Description in Table URI-A) are combined into a single URI Value Set. Codes for acute pharyngitis, acute tonsillitis and streptococcal sore throat are combined into a single Pharyngitis Value Set.

17 Facilitate Transition  A Summary of Changes for coding changes will be provided In electronic format as part of the Value Set Directory Considerations for HEDIS 2014 transition year?  Will be provided: Value Sets used, by measure Measures that use the Value Set, by Value Set

18 Facilitate Transition  Code definitions will be included in the Value Set Directory when possible CPT has licensing restrictions and cannot be included  TBD – Value Set Directory format XML Excel  Ongoing communication with customers  Value Set Directory Support

19 Questions