Spring 2010

Weight assessment and counseling for nutrition and physical activity

According to the Centers for Disease Control and Prevention (CDC), childhood and adolescent obesity has reached epidemic proportions placing these populations at greater risk for developing chronic diseases and other health conditions. This could have a significant economic impact on the health care system.

The 2007 National Survey of Children’s Health (NSCH) results indicate Florida ranks 35th in overall prevalence with 33.1 percent of children considered either overweight or obese1.

In an effort to reduce obesity and chronic disease conditions among the pediatric age groups, Blue Cross and Blue Shield of Florida (BCBSF) supports the 2010 Healthcare Effectiveness Data and Information Set (HEDIS®) measure Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC). This measure will monitor obesity among our younger members2.

Documentation of the WCC measure for children or adolescents, age 3-17 years, must include a note on all three sections (listed below) of the member’s chart in order to meet the requirements:

  1. Date of Body Mass Index (BMI) Percentile – must be documented and evidence of either of the following:

    The CDC BMI information is available at www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

    Members who are 3-15 years of age on the date of service, only BMI percentile or BMI percentile plotted on an age-growth chart meets criteria. For adolescents 16-17 years of age on the date of service, a BMI value expressed as kg/m2 is acceptable.

  2. Counseling for physical activity or referral for physical activity – must indicate the date and document at least one of the following:

    • Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities, exam for sports participation)

    • Checklist indicating physical activity was addressed

    • Counseling or referral for physical activity

    • Member received educational materials on physical activity

    • Anticipatory guidance or physical activity

  3. Counseling for nutrition or referral for nutrition education – must indicate the date and document at least one of the following:

    • Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors)

    • Checklist indicating nutrition was addressed

    • Counseling or referral for nutrition education

    • Member received educational materials on nutrition

    • Anticipatory guidance for nutrition

There is a free personalized online activity plan and resources and tools available to members on physical activity and nutrition through our website, www.bcbsfl.com; click on MyBlueService, Living Healthy with WebMD, then Health Management Centers.

1National Survey on Children’s Health, Retrieved December 17, 2009 from http://nschdata.org/Content/07ObesityReportCards.aspx

22009 National Committee for Quality Assurance (NCQA).

Coding

Using the correct Current Procedural Terminology (CPT) and ICD-9 diagnosis codes, based on 2010 HEDIS specifications, helps you capture all the data needed for a complete Healthy Lifestyle Record of your patient.

Reimbursement for these codes is included in the well child visit.

Outpatient visits

CPT ICD-9-CM Diagnosis
99201-99205, 99211-99215, 99217-99220,
99241-99245, 99341-99345, 99347-99350,

99382-99384, 99392-99394, 99401-99404,
99411, 99412, 99420, 99455, 99456

99429 (unlisted)

V20.2, V70.0, V70.3, V70.5, V70.6, V70.8 V70.9

BMI percentile, counseling for nutrition and counseling for physical activity

Description CPT ICD-9-CM Diagnosis HCPCS
BMI percentile   V85.51 – V85.54  
Counseling for nutrition 97802-97804 V65.3 G0270-G0271, S9449, S9452, S9470
Counseling for physical activity   V65.41 S9451

Exclusions – members who have a diagnosis of pregnancy

Description ICD-9-CM Diagnosis
Pregnancy 630-679.00, V22, V23, V28

If you have questions or need additional information, contact your physician relations specialist or BCBSF’s Provider Contact Center at (800) 727-2227.

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