Should HCPCS Level II code T1015 be included in encounter value sets?

XMLWordPrintable

    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Done
    • Priority: Moderate
    • Component/s: Guidance, Measure, ValueSet
    • None
    • Eric Gunther
    • Azara Healthcare
    • According to HCPCS, T codes are for use for state Medicaid services and are not reimbursable through Medicare. Measure developers reviewed the T1015 code and determined it is too broad to meet measures' intent.
    • Missing patients in denominators

      This issue impacts pretty much all the EP eCQM's for us, since they all contain some denominator criteria that involves searching for encounters based on SNOMED/CPT/HCPCS. We have found a number of patients whose only evidence of a qualifying encounter is an instance of a HCPCS Level II code T1015 for "Clinic visit/encounter, all-inclusive" (http://www.icd9data.com/HCPCS/2011/T/T1015.htm).

      I do see that most of the encounter value sets (see BMI Encounter Code Set for example - 2.16.840.1.113883.3.600.1.1751) include some HCPCS Level II codes, but they are mostly "G" codes like G0438 for "Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit".

      Would you consider T1015 for inclusion in all the encounter value sets?

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Eric Gunther (Inactive)
            Votes:
            0 Vote for this issue
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: