A wellness visit is an important time to discuss healthy choices that may prevent future chronic conditions including diabetes, cardiovascular diseases, and some cancers.

The Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) — which is an important part of the annual well visit — can provide parents and young people guidance on maintaining or moving toward a healthier lifestyle.

However, there are several misconceptions related to annual well visits and the WCC that need to be addressed:

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Misconception #1:

“Well child visits are only covered every 365+1 days.”

FACT: Providers don’t have to wait a year plus a day to schedule their patient’s next wellness visit. The Highmark Preventative Schedule is based on the calendar year and resets Jan. 1 of each year. Completing annual visits and recommended screenings before the child’s birthday provides the greatest compliance with multiple quality metrics.

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Misconception #2:

“Only children evaluated in the office for a well-child visit are included in the metric.”

FACT: Patients 3-17 years of age who have had at least one visit during the calendar year with a Primary Care Physician (PCP) or Obstetrician-Gynecologist (OBGYN) are included. Well visits are part of the metric, but so are sick visits, telephone / virtual visits, and other in-person visits.

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Misconception #3:

“I have to include multiple and specific screening forms in my notes to meet the requirements.”

FACT: Documentation to support the completion of activities and corresponding codes is required, but the method of completion may vary. The three measures, along with documentation examples, can be found below.

Body Mass Index (BMI) Percentile

• Include height, weight, and BMI percentile. Specific percentiles, such as 54% or >95th%, ARE acceptable. Ranges are NOT acceptable, such as 50-75th percentile.

Counseling for Nutrition

• Include documentation of eating habits, dieting behavior, well-rounded diet, and snacking habits. Types of food eaten or meal frequency. May also include copies of nutrition checklists or provided education with noted discussions on content. Counseling is not required to be completed by a dietician. Documentation related to the child’s appetite DOES NOT meet the criteria.

Counseling for Physical Activity

• Include documentation of current physical activity behaviors such as exercise or sports participation. May include copies of a checklist indicating physical activity or educational materials provided with noted discussion on content. Documentation of members’ screen time as the only support for physical activity DOES NOT meet criteria.

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Include the appropriate codes for each of the three components above for full measure compliance.

One coding example:

VISIT DIAGNOSIS:

Encounter for routine child health examination without abnormal findings (primary) [Z00.129]
Nutrition Counseling	Z71.3	Dietary counseling and surveillance
Physical Activity Counseling	Z02.5	Encounter for examination for participation in sport
Physical Activity Counseling	Z71.82	Exercise counseling
BMI Percentile	Z68.52	BMI pediatric, 5th percentile to less than 85th percentile for age

Additional Information

Log into Availity^®, select the state where you practice, choose Payer Spaces, and then, under Applications, select the Provider Resource Center. Once there, select EDUCATION/MANUALS from the left menu, choose HEDIS^®, and then click Overview of the 2024 NCQA HEDIS measures. You can find more information on page 92 regarding the measure for Weight Assessment & Counseling for Children/Adolescents.

HEDIS^® — which is an acronym for Healthcare Effectiveness Data and Information Set — is a registered trademark of the National Committee for Quality Assurance (NCQA).