Quality and Coding Tools
Helpful resources to make coding easier
These guides and trainings are intended to support providers in provision of high-quality member care, as well as accurate and complete coding and documentation. Written with busy providers in mind, these tools are regularly updated to ensure guidance reflects current HEDIS measure technical specifications, ICD-10 and CPTII updates, and industry standard best practices.
Quality
- AAB – Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
- ADD – Follow-Up Care for Children Prescribed ADHD Medication
- Advanced Illness and Frailty Exclusions Guide
- AMM – Antidepressant Medication Management
- AMR – Asthma Medication Ratio
- BCS – Breast Cancer Screening
- CBP – Controlling High Blood Pressure
- CCS – Cervical Cancer Screening
- CIS – Childhood Immunization Status
- COL – Colorectal Cancer Screening
- COU – Risk of Continued Opioid Use
- CWP – Appropriate Testing for Pharyngitis
- Diabetes Management
- DSF – Depression Screening and Follow-up for Adolescents and Adults
- Emergency Department Use for Migraines
- Hospice and Palliative Care Exclusions Guide
- IMA – Immunizations for Adolescents
- LBP – Use of Imaging Studies for Low Back Pain
- PCE – Pharmacotherapy Management of COPD Exacerbation
- PCR – Plan All Cause Readmissions
- PPC – Prenatal and Postpartum Care
- SPC – Statin Therapy for Patients with Cardiovascular Disease
- SPD – Statin Therapy for Patients with Diabetes
- URI – Treatment for Upper Respiratory Infection
- W30 – Well Child Visits: First 30 Months of Life
- WCV – Child and Adolescent Well-Care Visits
Diagnostic documentation and coding
- Acute and Chronic Respiratory Failure
- Acute Cerebrovascular Accidents/Stroke
- Cancer: Active vs. Historical
- Chronic Obstructive Pulmonary Disease
- Coagulation Therapy vs Defect
- Commercial and Medicare Advantage Hierarchical Condition Categories (HCC)
- Concurrent Chart Review: Provider Query Best Practices
- CPT 99499 for Supplemental Diagnosis Code Submission
- Deep Vein Thrombosis and Pulmonary Embolism
- Diabetes
- Documentation and Coding Web Tutorials
- Immunodeficiency and Immune Disorders
- Major Depressive Disorder
- Morbid Obesity
- Preventive Visits and Chronic/Complex Conditions
- Seizures and Epilepsy
- Substance Use Related Disorders
- Top Diagnostic Documentation and Coding Opportunities