DHCS tau tshaj tawm txoj haujlwm Kev Them Nqi Raws li Tus Nqi Them Nqi uas yuav muab kev txhawb zog rau cov neeg muab kev pabcuam kom tau raws li cov kev ntsuas tshwj xeeb txhawm rau txhim kho kev saib xyuas rau qee tus nqi siab lossis cov neeg xav tau siab. Cov kev them nyiaj txhawb siab no yuav raug tsom rau cov chaw muab kev pabcuam uas ua tau raws li qhov kev ua tiav ntawm cov kev ntsuas tsom rau thaj chaw xws li:
- Kev coj cwj pwm kev noj qab haus huv kev koom ua ke
- Kev tswj kab mob ntev
- Prenatal/post-partum care
- Kev tiv thaiv menyuam yaus thaum ntxov
DHCS yuav them nyiaj txhawb zog ntxiv rau cov xwm txheej cuam tshuam rau cov neeg tau txais txiaj ntsig tau kuaj pom tias muaj kev siv tshuaj yeeb lossis mob hlwb loj, lossis cov neeg tsis muaj tsev nyob.
Txawm hais tias qhov kev taw qhia zaum kawg rau Cov Kev Npaj hais txog lub sijhawm them nyiaj, cov nqi thiab cov txheej txheem tseem tsis tau raug tso tawm, qhov kev zov me nyuam tau siv txij Lub Xya Hli 1, 2019, thiab Alliance tau ceeb toom rau cov neeg muab kev pabcuam kom koj tuaj yeem xyuas kom txhua qhov kev thov xa tuaj suav nrog cov coding xav tau los tsim nyog rau cov kev pabcuam ntxiv no. kev them nyiaj.
Leej twg tsim nyog rau qhov kev txhawb nqa no? Hom 1 (tus kheej) Tus Neeg Muab Kev Pabcuam Hauv Tebchaws (NPI) nyob rau hauv qhov chaw muab kev pabcuam lossis xaj xaj yuav tsum muaj nyob rau txhua qhov kev thov uas ua tau raws li qhov ntsuas.
specification Kev sib ntsib tshwm sim ntawm Tsoom Fwv Teb Chaws Muaj Peev Xwm Saib Xyuas Kev Noj Qab Haus Huv (FQHCs), Chaw Kho Mob Hauv Nroog, American Indian Health Clinics, lossis Cov Tsev Kho Mob Them Nqi Them Nqi Them Rov Qab tsis suav nrog kev them nyiaj.
Rau cov kev ntsuas cuam tshuam txog kev txhaj tshuaj, qhov kev cia siab yog tias txhua qhov kev txhaj tshuaj raug tshaj tawm los ntawm California Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (CDPH) California Immunization Registry (CAIR) 2.0 thiab yog li ntawd muaj nyob rau hauv cov ntaub ntawv ntxiv. Ib yam li ntawd, rau kev ntsuas ntshav Lead Screening, qhov kev cia siab yog tias cov tshuaj ntsuam ntshav tau qhia rau CDPH Blood Lead Registry yuav raug siv los ua cov ntaub ntawv ntxiv.
Ib qho kev them nyiaj zoo dua yuav raug siv rau cov kev pabcuam muab rau cov neeg tau txais txiaj ntsig nrog cov xwm txheej no:
- Kev Siv Tshuaj Tsis Zoo (CMS ICD-10 code teeb: https://www.medicaid.gov/license- agreement.html?file=%2Fmedicaid%2Fquality-of-care%2Fdownloads%2F2019-adult-value-set- directory.zip)
- Mob Puas Hlwb - (CMS ICD-10 codes: https://www.medicaid.gov/license- agreement.html?file=%2Fmedicaid%2Fquality-of-care%2Fdownloads%2F2019-adult-value-set- directory.zip)
- Tsis muaj tsev nyob ICD-10 Kev kuaj kab mob nrog cov txiaj ntsig hauv qab no: Z59.0 Tsis Muaj Tsev Nyob – Z59.1 Tsis Muaj Tsev Nyob.
Cov kev pabcuam tsim nyog tau txais kev them nyiaj suav nrog: kev saib xyuas ua ntej yug menyuam thiab tom qab yug menyuam (plaub ntsuas), menyuam yaus thaum ntxov (tsib ntsuas), kev saib xyuas neeg laus (tsib ntsuas) thiab kev noj qab haus huv (peb ntsuas).
Cov lus hauv qab no qhia txog cov kev pabcuam thiab cov lej rau VBP program.
| Kev Pabcuam | CODE | CEEB TOOM |
|---|---|---|
| Kev txhaj tshuaj tiv thaiv kab mob Prenatal Pertussis | TIAB SA 90715
Nrog ICD-10 code rau kev saib xyuas cev xeeb tub ('O09' los yog 'Z34' series) |
Ib zaug xa tuaj rau tus neeg mob |
| Kev saib xyuas ua ntej yug menyuam | ICD-10 code rau kev saib xyuas cev xeeb tub ('O09' los yog 'Z34' series) ntawm kev sib ntsib | Ib zaug xa tuaj rau tus neeg mob |
| Kev saib xyuas tom qab yug me nyuam Thaum Ntxov 1-21 hnub
22-84 hnub |
ICD-10 code rau kev mus ntsib tom qab yug menyuam (Z39.2) ntawm kev ntsib | Muaj ob txoj kev them nyiaj rau ib tus neeg mob
Hnub xa khoom ntawm kev thov |
| Contraception tom qab yug me nyuam: | Tables CCP-C txog CCP-D ntawm: https://www.medicaid.gov/license- agreement.html?file=%2Fmedicaid%2Fquality-of-
care%2Fdownloads%2F2019-adult-non-hedis- value-set-directory.zip |
Muab txoj hauv kev zoo tshaj plaws, txoj hauv kev zoo me ntsis, lossis kev ua yeeb yam ntev ntawm kev tiv thaiv kab mob hauv
60 hnub ntawm kev xa khoom |
| Well-Child mus ntsib 0-15 lub hlis | Ib qho ntawm cov hauv qab no:
PIB: 99381,99382,99383,99384,99385,99391, 99392, 99393, 99394, 99395, 99461, G0438, G0439 - ICD-10: Z0000, Z0001, Z00110, Z00111, Z00121, Z00129, Z005, Z008, Z020, Z021, Z022, Z023, Z024, Z025, Z026, Z0281, Z026, Z0281, Z0289, Z029 |
Cais nyiaj txhawb zog rau ib tus neeg muab kev pab rau txhua qhov kawg ntawm peb qhov kev mus ntsib menyuam yaus zaum kawg ntawm yim tag nrho -6th, 7th thiab 8th. (8 mus ntsib yog pom zoo thaum yug thiab 15 lub hlis) |
| Zoo-me nyuam mus ntsib 3-6 xyoo | Ib qho ntawm cov hauv qab no:
PIB: 99381,99382,99383,99384,99385,99391, 99392, 99393, 99394, 99395, 99461, G0438, G0439 ICD-10: Z0000, Z0001, Z00110, Z00111, Z00121, Z00121, Z00129, Z005, Z008, Z020, Z021, Z022, Z023, Z024, Z025, Z026, Z0281, 0289, 029 ib |
Kev them nyiaj rau kev mus ntsib tus menyuam thawj zaug hauv txhua lub xyoo (cov menyuam hnub nyoog 3, 4, 5, lossis 6 xyoo |
| Txhua Cov Tshuaj Tiv Thaiv Menyuam Yaus rau Cov Me Nyuam Ob xyoos | Kev them nyiaj rau tus neeg muab kev pab cuam rau txhua qhov tshuaj tiv thaiv zaum kawg uas tau muab rau cov menyuam yaus hnub nyoog thib ob hauv xyoo ntsuas: - Diphtheria, tetanus, pertussis (DTaP) - 4th vaccine - Inactivated Polio Vaccine (IPV) - 3rd vaccine - Hepatitis B - 3rd vaccine – Haemophilus Influenzae Type b (Hib) – 3rd vaccine – Pneumococcal conjugate – 4th vaccine – Rotavirus – 2nd or 3rd
tshuaj tiv thaiv kab mob khaub thuas - koob thib 2 |
Ib tus kws kho mob tuaj yeem tau txais txog xya qhov nyiaj them rau ib xyoos ib tus neeg mob. Yuav tsum tau saib rov qab ob xyoos rau txhua tus neeg mob txhawm rau txhawm rau txhawm rau txhaj tshuaj tiv thaiv kab mob thiab txheeb xyuas cov tshuaj tiv thaiv zaum kawg hauv koob. |
| Kev kuaj ntshav cov hlau lead | Txhua qhov tshwm sim ntawm CPT code 83655 ua ntej lossis rau
lub hnub yug thib ob |
Tus kws kho mob tuaj yeem tau txais ntau dua
ib qho kev them nyiaj |
| Kev kho hniav fluoride | Txhua qhov tshwm sim ntawm kev kho hniav fluoride varnish (CPT | Daim ntawv thov ntawm qhov ncauj fluoride kua roj vanish |
| kua roj vanish | 99188 lossis CDT D1206) rau cov menyuam yaus hnub nyoog qis dua rau xyoo | rau cov menyuam hnub nyoog 6 hli txog 5
xyoo. Mus txog 4 / xyoo |
| Tswj ntshav siab | Cov cai tswj systolic, code rau tswj diastolic, thiab kuaj ntshav siab yog: Tswj Systolic: - CPT 3074F (systolic ntshav siab tsawg dua 130) - CPT 3075F (systolic ntshav siab tsawg dua 130-39)
Tswj Diastolic: - CPT 3078F (diastolic ntshav siab tsawg dua 80) - CPT 3079F (diastolic ntshav siab tsawg dua 80-89) Ntshav siab: - ICD-10: I10 (qhov tseem ceeb kub siab) |
Hauv cov neeg mob hnub nyoog 18-85 nrog kuaj HTN, them nyiaj rau kev mus ntsib tus neeg mob tsis muaj xwm txheej ceev, lossis kev saib xyuas thaj chaw deb, cov ntaub ntawv tswj ntshav siab yuav tsum suav nrog cov cai tswj systolic, code rau tswj diastolic, thiab kuaj ntshav siab ntawm lub
tib hnub. |
| Mob ntshav qab zib | Kev them nyiaj rau tus kws kho mob rau txhua qhov kev kuaj mob ntshav qab zib (HbA1c) uas qhia cov txiaj ntsig rau cov tswv cuab 18 txog 75 xyoo raws li coded nrog: - CPT 3044F HbA1c < 7.0% - CPT 3045F tsis ntev los no HbA1c 7.0-9.0%6 FPT feem ntau tsis ntev los no HbA1c > 9.0% | Hnub nyoog 18-75. Nrog kev kuaj mob ntshav qab zib
Tsis pub ntau tshaj plaub qhov nyiaj hauv ib xyoos. Hnub rau cov txiaj ntsig HbA1c yuav tsum yog tsawg kawg 60 hnub sib nrug. |
| Tswj kev mob ntsws asthma | Asthma Value set:
J45.20 Mob ntsws asthma me me, tsis yooj yim J45.21 Mob ntsws asthma me me nrog (mob) exacerbation J45.22 Mob ntsws asthma me me nrog cov xwm txheej asthmaticus J45.30 Mob hawb pob mob hnyav, tsis yooj yim J45.31 me me tsis muaj zog (2. Mob hawb pob mob me me nrog cov xwm txheej mob ntsws asthmaticus J45.40 Mob hawb pob mob hnyav, tsis yooj yim J45.41 Mob hawb pob mob hawb pob nrog (mob) exacerbation J45.42 Mob hawb pob mob hawb pob nrog cov xwm txheej asthmaticus. J45.50 Mob hawb pob mob hnyav, tsis yooj yim J45.51 Mob hawb pob mob hnyav nrog (mob) mob hnyav J45.52 mob hawb pob mob hnyav nrog mob asthmaticus J45.901 Tsis muaj mob hawb pob nrog (mob) exacerbation J45.5 asthma ua tiav Kev mob ntsws asthma, tsis yooj yim J45.990 Kev tawm dag zog ntxias bronchospasm J45.991 hnoos variant asthma J45.998 Lwm yam mob hawb pob |
Cov neeg mob hnub nyoog 5-64. Kev them nyiaj rau tus kws kho mob uas tau muab cov tshuaj tiv thaiv kab mob hawb pob hauv lub xyoo rau cov neeg mob uas tau kuaj pom tus mob hawb pob raws li Tus Nqi Kho Mob hawb pob nyob rau hauv 12 lub hlis ntawm daim ntawv tshuaj. Txhua tus kws kho mob tau them ib xyoos ib zaug rau ib tus neeg mob. |
| Kev tshuaj xyuas kev siv luam yeeb | Kev them nyiaj rau tus muab kev pabcuam rau ib qho ntawm CPT cov lej hauv qab no: 99406, 99407, G0436, G0437, 4004F, lossis 1036F (sib npaug them rau txhua tus lej) | Cov neeg mob hnub nyoog 12 xyoos thiab tshaj. Ib qho kev them nyiaj rau ib tus kws kho mob rau ib tus neeg mob
ib xyoo. |
Cov ntaub ntawv ntxiv txog qhov kev zov me nyuam, suav nrog tus nqi ntawm cov nyiaj them thiab cov txheej txheem uas cov neeg muab kev pab them nqi yuav raug ua tiav yuav tshwm sim tom ntej. Muaj lus qhia ntxiv
ntawm no: https://www.dhcs.ca.gov/provgovpart/Pages/VBP_Measures_19.aspx. Thov xa cov lus nug rau Michelle Stott [email protected].
