Quality ManagementCommercialMay 31, 2023

Including CPT category II codes on claims can help your practice improve HEDIS results

Reduce the number of medical records Anthem Blue Cross requests from you during the HEDIS® medical record review season and improve your practice’s HEDIS performance by adding specific CPT® category II codes to your claims. These codes will help us identify additional information about the visit and improve the accuracy of reporting HEDIS quality measures.

Hemoglobin A1c Control for Patients with Diabetes (HBD)

Description

CPT code

Most recent hemoglobin A1c (HbA1c) level less than 7% (DM)

3044F

Most recent hemoglobin A1c (HbA1c) level greater than 9% (DM)

3046F

Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7% and less than 8% (DM)

3051F

Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8% and less than or equal to 9% (DM)

3052F

Eye Exam for Patients with Diabetes (EED)

Description

CPT code

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed, with evidence of retinopathy

2022F

Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy

2023F

Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed: with evidence of retinopathy

2024F

Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed: without evidence of retinopathy

2025F

Eye imaging validated to match diagnosis from seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed: with evidence of retinopathy

2026F

Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed: without evidence of retinopathy

2033F

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

3072F

Blood Pressure Control for Patients with Diabetes (BPD) and Controlling Blood Pressure (CBP)

Description

CPT code

Most recent diastolic blood pressure less than 80 mm Hg (HTN,CKD,CAD) (DM)

3078F

Most recent diastolic blood pressure 80 to 89 mm Hg (HTN, CKD, CAD) (DM)

3079F

Most recent diastolic blood pressure greater than or equal to 90 mm Hg (HTN, CKD, CAD) (DM)

3080F

Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)

3074F

Most recent systolic blood pressure 130 to 139 mm Hg (DM) (HTN, CKD, CAD)

3075F

Most recent systolic blood pressure greater than or equal to 140 mm Hg (HTN, CKD, CAD) (DM)

3077F

Prenatal and Postpartum Care (PPC)

Description

CPT code

Stand-alone prenatal visits

0500F: Initial prenatal care visit — Report at the first prenatal encounter with a healthcare professional providing obstetrical care. Report also the date of visit and, in a separate field, the date of the last menstrual period (LMP) (prenatal).

or

0501F: Prenatal flow sheet documented in medical record by first prenatal visit — At a minimum, the documentation includes blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery. Report the date of visit and, in a separate field, the date of the last menstrual period (LMP).

Note: If reporting 0501F prenatal flow sheet, it is not necessary to report 0500F initial prenatal care visit (prenatal).

Stand-alone prenatal visits

0502F: Subsequent prenatal care visit (prenatal).

Excludes: Patients who are seen for a condition unrelated to pregnancy or prenatal care(for example, an upper respiratory infection); patients seen for consultation only, not for continuing care.

Postpartum care visit

0503F: Make sure the visit is on or between seven and 84 days of delivery.

Note: The codes listed are for informational purposes only and are not intended to suggest or guide reimbursement. If applicable, refer to your provider contract or health plan contact for reimbursement information. For a complete list of CPT codes, go to the American Medical Association website at ama‑assn.org/topics/cpt-codes.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CABC-CM-024793-23

PUBLICATIONS: June 2023 Provider Newsletter