Childhood immunization status (CIS)

Healthcare Effectiveness Data Information Set^® (HEDIS) is a widely used set of performance measures developed and maintained by NCQA. These are used to drive improvement efforts surrounding best practices.

Childhood immunization status (CIS)

Measure description: the percentage of children who had the recommended vaccines by their second birthday (see numerator); different vaccines can be given on the same day (the same vaccine must be given on different DOS)

Measure population (denominator): children who turn two years of age during the measurement year

Exclusions:

• Children who had any of the following on or before their second birthday:
  • Immunodeficiency, severe combined immunodeficiency
  • HIV
  • Lymphoreticular cancer, multiple myeloma, leukemia
  • Intussusception
• Received hospice services anytime during the measurement year
• Deceased during the measurement year

Measure compliance (numerator): children who had any of the following (from each row) on or before their second birthday:

Note:

• Combination vaccines must have evidence of all antigens.
• The below count towards compliance for the vaccine. Document with event date:
  • For DTaP: Encephalitis due to the vaccine
  • For ALL vaccines:
    • Anaphylaxis due to the vaccine
    • Evidence of the antigen or combination vaccine
  • For Hep B, MMR, VZV, and Hep A, count any of the following:
    • Documented history of illness
• Must be done by second birthday (when scheduling, check the calendar and schedule prior to second birthday)
• For rotavirus, if documentation does not indicate whether the two-dose schedule or three-dose schedule was used, assume a three-dose schedule.

Acceptable documentation:

• A certificate of immunization prepared by an authorized healthcare provider or agency including the specific dates and types of immunizations administered
• A note indicating the name of the specific antigen and immunization date
• A note in the medical record indicating the member received the immunization at delivery or in the hospital (use the date of birth as the date administered)

For combination vaccinations that require more than one antigen (DTaP, MMR), evidence of all antigens must be documented. LAIV only counts if administered on the second birthday.

Not acceptable:

• A note that says the member is up to date with all immunizations but does not list the dates and names of all immunizations
• Influenza: Do not count a vaccination administered prior to six months (180 days after birth).
• DTaP, IPV, HiB, Pneumococcal conjugate, Rotavirus: Do not count a vaccination administered prior to 42 days after birth.

Measure codes:

• DTaP:
  • CPT^®: 90697, 90698, 90700, 90723
• IPV:
  • CPT: 90697, 90698, 90713, 90723
• MMR:
  • CPT: 90707, 90710
• HIB:
  • CPT: 90644, 90647, 90648, 90697, 90698, 90748
• Hep B:
  • CPT: 90697, 90723, 90740, 90744, 90747, 90748
  • HCPCS: G0010
• VZV:
  • CPT: 90710, 90716
• PCV:
  • CPT: 90670
  • HCPCS: G0009
• Hep A:
  • CPT: 90633
• Rotavirus:
  • CPT: 90681 (two dose), 90680 (three dose)
• Influenza:
  • CPT: 90655, 90657, 90661, 90673, 90674, 90756, 90685-90689
  • HCPCS: G0008
• Influenza LAIV:
  • CPT: 90660, 90672

Helpful HEDIS tips:

• MMR, VZV, and Hep A need to be given on or between the child’s first and second birthdays.
• For DTaP, IPV, HIB, PCV, and RV, do not count a vaccination administered prior to 42 days after birth.
• For flu, one of the two vaccines can be a live attenuated influenza vaccine (LAIV) if given on the second birthday.
• For flu, do not count a vaccination administered prior to six months (180 days) after birth.
• Review the child’s immunization status at every visit and provide necessary vaccines.
• Provide parents with recommended immunization schedules and stress the importance of keeping their children immunized in a timely manner. Ensure the next immunization appointment is scheduled prior to leaving the provider’s office.
• The immunization will not be valid for HEDIS purposes if given even one day after the second birthday.
• Practitioners spending time addressing parental concerns and providing strong recommendations has shown to increase parental compliance with recommended immunizations.
• Reminders by mail, email, and text have been shown to be effective in increasing immunization rates.
• Make sure to request previous immunization records for new or recently transferred patients.
• If the child shouldn’t be immunized because he or she has already had the disease, be sure to document this information, including the date.

Resources:

• NCQA: Ncqa.org