A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 9, September 2023
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 debunked:
MYTH #1: “Well child visits are only covered every 365+1 days.”
FACT: Providers don’t have to wait a year and a day to schedule their patient’s next wellness visit. The Highmark preventive schedule is based on the calendar year and resets January 1 of each year. Completing annual visits and recommended screenings by the child’s birthday provides the greatest compliance with multiple quality metrics.
MYTH #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. This includes well visits, but also sick visits, and telephone and virtual visits, in addition to in-person visits.
MYTH #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 are required, but the method of completion may vary. The three measures, along with a few samples of documentation, can be found below.
Include the appropriate codes for each of the three components above for full measure compliance.Body Mass Index (BMI) Percentile
- Include height, weight, and BMI percentile. Specific percentiles, such as <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.
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.
| 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 |
Log in to the Highmark provider portal and go to the Provider Resource Center. Once there, select EDUCATION/MANUALS from the left menu, choose HEDIS®, and then click HEDIS Provider Information Document. You can find more information pages 18-19 on the measure for Weight Assessment & Counseling for Children/Adolescents.
HEDIS® is an acronym for Healthcare Effectiveness Data and Information Set.
