Improve HEDIS scores through claims coding

What are CPT^® Category II and Z codes?

CPT Category II codes are performance measurement tracking codes. Z codes are health status diagnosis codes. Certain CPT II codes and Z codes facilitate data collection for HEDIS^® measures. Used together, they can give you credit for quality of care without the need for medical record review and can help close gaps for HEDIS measures.

CPT Category II codes describe clinical performance measures that are usually included in the evaluation and management process such as A1c or blood pressure values. They are entered in the procedure code field similar to CPT Category I codes.

Z codes are ICD-10 diagnosis codes that describe a patient’s health status. By submitting a claim with the appropriate Z code to indicate a patient’s body mass index, the need to submit the member’s medical record to validate BMI documentation may be eliminated.

Click here for a claims coding tip sheet with CPT II and ICD-10 codes for HEDIS measures.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.