|
October 2017
CPT Category II and Z codes aid data collection and lessen administrative work for offices
Doctors may want to consider using CPT Category II and Z codes as they ease an office’s administrative burden. They also decrease – not eliminate – the need for medical record reviews to determine if certain standards are met.
What are CPT Category II and Z codes?
CPT Category II codes are tracking codes, while Z codes are for body mass index diagnosis. Certain CPT Category II codes and Z codes facilitate data collection for Healthcare Effectiveness Data and Information Set, or HEDIS®, measures. Used together, these codes can give you credit for quality care without the need for medical record review and can help close gaps in HEDIS measures.
Here’s a closer look:
- CPT Category II codes describe components that are usually included in the evaluation and management process such as A1c or blood pressure test results. Like CPT Category I codes, they are billed in the procedure code field.
- CPT Category II codes are adopted and reviewed by the Performance Measure Advisory Group. PMAG is made up of experts in performance measurement from organizations such as the American Medical Association, the National Committee for Quality Assurance, the Centers for Medicare & Medicaid Services and others.
- Z codes can facilitate data collection, for instance, if a doctor submits a claim with the appropriate ICD-10 diagnosis code to indicate a patient’s BMI. This will alleviate the need to review the member’s medical record for BMI documentation.
Closing HEDIS gaps with CPT Category II codes
Keep these tips in mind when billing CPT Category II codes:
- Manage and document all acute and chronic patient conditions appropriately.
- Ensure that services provided and diagnoses are documented in the medical record.
- Submit accurate and timely claims for every office visit.
- Report all services completed on a claim.
Here’s a list and description of CPT Category II codes that meet HEDIS measures.
Medication reconciliation post-discharge measure |
1111F |
Discharge medications reconciled with the current medication list in outpatient medical record |
Comprehensive diabetes care measure |
2022F |
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed |
3072F |
Low risk for retinopathy (no evidence of retinopathy in the prior year) |
3044F |
Most recent hemoglobin A1c (HbA1c) level less than 7.0% |
3045F |
Most recent hemoglobin A1c (HbA1c) level 7.0-9.0% |
3046F |
Most recent hemoglobin A1c (HbA1c) level greater than 9.0% |
3060F |
Positive microalbuminuria test result documented and reviewed |
3061F |
Negative microalbuminuria test result documented and reviewed |
3062F |
Positive macroalbuminuria test result documented and reviewed |
3066F |
Documentation of treatment for nephropathy (includes visit to nephrologist,
receiving dialysis, treatment for end stage renal disease, chronic renal failure, acute renal failure or renal insufficiency) |
4010F |
Angiotensin converting enzyme, or ACE, inhibitor or angiotensin receptor blocker, or ARB, therapy prescribed or currently being taken |
Reviewing BMI results with Z codes
ICD-10 BMI results should be included in your office visit claims, typically with the patient’s annual wellness visit or physical. Make sure you document your patient’s height, weight and BMI in the patient’s medical record and that your medical billing coders include the ICD-10 BMI code.
BMI percentiles |
ICD-10 BMI codes |
For under 21 |
Z68.51 – Z68.54 |
For over 21 |
Z68.1 – Z68.45 |
HEDIS® is a registered trademark of the National Committee for Quality Assurance.
|
