Child and Adolescent Well-Care Visits (WCV) & Weight Assessment & Counseling for Nutrition and Physical Activity (WCC)

Patients between ages 3-21 years of age

Patients with at least one comprehensive well-care visit (can be Telehealth with video) with a PCP or an OB/GYN practitioner during the measurement year (Emergency Department visits do not count).

Appropriate documentation:

• Medical documentation must indicate the height, weight, and BMI percentile during measurement year (height, weight, and BMI percentile MUST be from the same data source).

• Counseling for nutrition can entail discussions regarding eating habits, dieting behaviors, nutrition, referral for nutrition education, anticipatory guidance for nutrition, and weight or obesity counseling (not limited to this list).

• Counseling for physical activity can entail discussions regarding exercise routine, participation in sports, sports participation exam, anticipatory guidance for physical activity/exercise, and weight or obesity counseling.

Tips:

• Education on the importance of screening.

• Allows member reported biometric values (BMI, height, and weight).

• Nutrition and physical activity counseling can be rendered during a telehealth visit.

• Documentation must include specific information discussed and should not include general statements such as education on nutrition, diet or physical activity provided, well-nourished, or anticipatory guidance without specifically mentioning the discussion details.

• Wearing a helmet or water safety and notation solely related to screen time (computer or television) is not compliant.

• Services specific to an acute or chronic condition do not count (i.e. patient with chronic knee pain is able to run without limping or patient has decreased appetite as a result of the flu).

• Developmental milestones alone are not compliant (i.e. can hop on one foot).

• Obesity or eating disorder meets compliance for nutrition and physical activity.

Billing Codes:

Visits:

o CPT:

§ 1-4 yrs. old: 99382, 99392
§ 5-11 yrs. old: 99383, 99393
§ 12-17 yrs. old: 99384, 99394
§ >18 yrs. old: 99385, 99395

o ICD-10:

§ General Exam (0-11 yrs.):

• Z00.110, Z00.111, Z00.121, Z00.129, Z00.8, Z02.0, Z02.5, Z02.6, Z02,71, Z02.79,
Z02.82, Z02.83, Z02.89, Z02.9, Z76.1, Z76.2

§ General Exam (>12 yrs. old):

• Z00.00, Z00.01, Z00.121, Z00.129, Z00.8, Z02.0, Z02.4, Z02.5, Z02.6, Z02.71,
Z02.79, Z02.82, Z02.83, Z02.89, Z02.9, Z76.1, Z76.2

o Telehealth Modifier:

§ GT: via interactive audio and video telecommunications system
§ 95: synchronous telemedicine service rendered via a real-time interactive audio and
video telecommunications system

Assessments and Screenings:

o Pediatric BMI (3-17 yrs.):

ICD-10:

• <5th percentile: Z68.51
• 5th to <85th percentile: Z68.52
• 85th to <95th percentile: Z68.53
• >95th percentile: Z68.54

o Nutritional Counseling:

§ CPT:

• 97802-97804

§ ICD-10:

• Z71.3

§ HCPCS:

• G0270, G0271, G0447, S9449, S9452, S9470

o Physical Counseling:

§ ICD-10:

• Z71.82 Exercise Counseling
• Z02.5 Sports Physical

§ HCPCS:

• G0447, S9451