Use HEDIS® Guidelines to Help Keep Your Older Patients Healthy.

Advanced Care Planning

A discussion about preferences for resuscitation, life-sustaining treatment and end-of-life care.

Documentation required

Presence of advanced care plan in the medical record or documentation of the discussion with the date it was discussed.

Acceptable medical records

• Actionable medical orders
• Living will
• Surrogate decision maker
• Advance directive

Codes

CPT 1157F (Advance care plan or similar legal document present in the medical record)

OR

CPT 1158F (Advance care planning discussion documented in the medical record)

Functional Status Assessment

Documentation required

Evidence of a complete functional status assessment and the date it was performed.

Acceptable medical record (include one of the following):

• Notation that Activities of Daily Living (ADL) were assessed
• Results of assessment using a standardized functional assessment tool
• Notation that Instrumental Activities of Daily Living (IADL) were assessed
• Notation that at least three of the following four components were assessed: cognitive status, ambulation status, hearing/vision/speech, other functional independence.

Codes

CPT 1170F (Functional status assessed)

Pain Assessment

Documentation required

Evidence of a pain assessment and the date it was performed (may include positive or negative findings for pain).

Acceptable medical record

Results of a standardized pain assessment tool such as:

• Numeric rating scales
• Present Pain Inventory
• Pictorial Pain Scale
• Brief Pain Inventory
• PROMIS Pain Intensity Scale
• FLACC scale
• Pain Thermometer
• Visual Analogue Scale
• Chronic Pain Grade
• Pain Assessment in Advanced Dementia (PAINAD) Scale

Medication Review

A review of all of a member’s medications (including prescriptions, OTCs and herbal/supplemental therapies) conducted by a prescribing practitioner or clinical pharmacist.

Documentation required

Medication list in the medical record with date when it was performed or note that the member is not taking any medications with date.

Acceptable medical record

• Current medication list
• Notation of
  medication review
• OR date & notation that member is not taking any medication

Document the results of any screenings. Get credit for the work you’ve done! Pre-collection of this patient information is a valuable tool that meets the needs of your patient, while also satisfying HEDIS® measures.

Contact our Quality Advocate Team at (855) 339-4890, Monday – Friday 8:30 am to 5:30 pm

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