2019 Quality Assurance Reporting Requirements (QARR) Technical Specifications Manual

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RE: Clarification #1 for 2019 Quality Assurance Reporting Requirements Technical Specifications

Dear Colleague:

This clarification contains information about changes made to the 2019 Quality Assurance Reporting Requirements (QARR) Technical specifications manual (dated October 15, 2018).

The information contained in this clarification has been incorporated into a revised version of the 2019 QARR manual. This revised 2019 QARR Technical Specification Manual (dated December 17, 2018) is attached to this letter and is available on our public web site here. The revised manual should be used in plans’ processing for 2019 QARR.

Additionally, this letter addresses changes made to the 2019 NYS Patient–Level Detail (PLD) File Specifications. The changes to the PLD File Specifications have been incorporated into a revised version (dated December 13, 2018) and attached to this letter to be used in plans’ processing for 2019 QARR PLD submissions.

Listed below are the changes or further explanation:

Adolescent Preventive Care Measures (Page 22–26):

CHANGES TO THE MEASURE:

  • Numerator 1 administrative specifications updated: HCPCS code added to Counseling Related to Sexual Activity.
  • Numerator 2 administrative specifications updated: CPT II and HCPCS codes added to the Codes for Depression Screening.
  • Numerator 3 administrative specifications updated: HCPCS codes added to Codes for Tobacco Cessation Counseling or Services.
  • Numerator 4 administrative specifications updated: HCPCS codes added to Codes for Alcohol and Substance Use Counseling or Services.
  • Clarified Medical Record Specifications for Numerator 4: Notation of prescription for drug use treatment medication added.

Codes for Counseling Related to Sexual Activity

Description ICD–10–CM Diagnosis CPT II Codes HCPCS
Counseling for HIV Z71.7    
Counseling for Other STIs Z70.8    
Counseling of Oral and Other Contraceptives Z30.0, Z30.01, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016, Z30.017, Z30.018, Z30.019, Z30.02, Z30.09    
Screening or counseling for High–Risk Sexual Behavior Z72,5, Z72.51, Z72.52, Z72.53, Z70.0, Z70.1, Z70.2, Z70.3, Z70.9 4293F G0445
Documentation of sexual activity     G9818

Codes for Depression Screening

Description ICD–10–CM Diagnosis CPT II HCPCS
Depression screening Z13.31 1220F, 3085F, 3351F, 3352F, 3353F, 3354F, 3725F G0444, G8431, G8510, G8511, S3005
Active Depression Diagnosis     G9717
Antidepressant Pharmacotherapy   4063F, 4064F  

Codes for Tobacco Cessation Counseling or Services

Description ICD–10–CM Diagnosis or Procedure CPT CPT II HCPCS
Tobacco Use Assessment     1000F, 1031F, 1032F, 1033F, 1034F, 1035F, 1036F G9275, G9276, G9459, G9902, G9903, G9904, G9906
Tobacco Cessation Counseling or Services Z71.6 99406, 99407 4000F, 4001F, 4004F G9458, G9907, G9909
Tobacco Cessation Classes       S9453
Smoking Cessation Medication       S4990, S4991, S4995

Codes for Alcohol and Substance Use Counseling or Services

Description ICD–10–CM Diagnosis or Procedure CPT CPT II HCPCS
Alcohol and/or drug assessment or screening   99408, 99409 3016F, 4290F G0396, G0397, G0442, G9518, G9622, G9623, H0001, H0049
Alcohol and or Drug

Use Counseling Services
Z71.41

Z71.51
  4306F, 4320F G0443, G9621, H0005, H0006, H0007, H0022, H0047, H0050, T1007
Drug Use Treatment Medication       J0570, J0571, J0572, J0573, J0574, J0575, S0109
Initiation of Pharmacotherapy Upon New Episode of Opioid Dependence (Page 34):
  • Updated language pertaining to ED visits that result in an inpatient stay:
    • Removed: An ED visit results in an inpatient stay when an ED visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the admission date for the inpatient stay occurs on the ED date of service or one calendar day after. An ED visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay.
    • New Language: For members whose index episode was an ED visit that resulted in an inpatient stay, or other inpatient stay, use the inpatient discharge as the IESD. Refer to General Guideline 44 for new instructions.
Live Birth File Record Format Edits (page 48):
  • Columns 95 and 96 were not included in the original specifications. Record format locations have been updated for the following columns: Product Line, Mother´s Client ID Number (CIN), and Baby´s Client ID Number* (CIN).
    Product Line 95–96 Left Justified 1 = MA
    2 = HIVSNP
    3 = HARP
    4 = CPPO
    5 = CHMO
    6 = QHMO
    7 = QPOS
    8 = QPPO
    9 = QEPO
    10=CEPO
    11 = EP
    Mother´s Client ID Number (CIN) 97–104 For Medicaid:
    AA#####A
    For CHP:
    0####### or
    5#######
    Omit for commercial; it is not applicable.
    (Medicaid, HIVSNP, HARP, and CHP only)
    Baby´s Client ID Number* (CIN) 105–112 For Medicaid:
    AA#####A
    For CHP:
    0####### or
    5#######
    Omit for commercial; it is not applicable.
    (Medicaid, HIVSNP, HARP, and CHP only)
NYS Specific Measures Summary–File Edits (Page 56):
  • The location column was edited for the following columns: ADL Rate 2–Depression, ADL Numerator 3 Tobacco Use, ADL Rate 3–Tobacco Use, and ADL Numerator 4 Substance Use locations.
    ADL Rate 2– Depression 67–71 Must include 4 digits after decimal (e.g., .2018), except for when rate=1, must include 3 digits after decimal (e.g., 1.000) Current year´s administrative rate (before exclusions)
    ADL Numerator 3 Tobacco Use 72–77   Number of numerator events by administrative data in eligible population (before exclusions)
    ADL Rate 3– Tobacco Use 78–82 Must include 4 digits after decimal (e.g., .2018), except for when rate=1, must include 3 digits after decimal (e.g., 1.000) Current year´s administrative rate (before exclusions)
    ADL Numerator 4 Substance Use 83–88   Number of numerator events by administrative data in eligible population (before exclusions)
NYS PLD File Specification Updates – Product Lines:
  • Updated the Medicaid, Commercial and MarketPlace Exchange GENERAL INFO rows to contain product–specific product lines only.
    GENERAL INFO 18 7 24 Product Line Medicaid, HIVSNP, HARP
    GENERAL INFO 18 7 24 Product Line CPPO, CEPO, CHMO, EP
    GENERAL INFO 18 7 24 Product Line QHP_HMO, QHP_POS, QHP_PPO, QHP_EPO

If there are any questions about the information contained in this clarification, please feel free to contact me at (518) 486–9012 or via email at nysqarr@health.ny.gov.

Sincerely,
Lindsay Cogan, PhD, MS
Director
Division of Quality Measurement
Office of Quality and Patient Safety
New York State Department of Health

Enclosures
cc:       A. Schettine

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