Using CPT® II Codes to Close Gaps in Care

Date: 07/06/22

Accurate and thorough documentation is essential to helping our members reach their best health. Using accurate CPT II and HCPCS codes can make it easier to identify and close gaps in patient care, as well as ensure that we have a robust collection of data for performance measurement. When you verify that you performed quality procedures and closed gaps in patient care, you’re documenting and affirming your commitment to providing excellent care to our members.

CPT II codes should be submitted in conjunction with CPT or other billing codes. Incorporating CPT II codes will decrease the need for record abstraction and chart reviews, thus minimizing your administrative burden.

You should bill CPT II codes in the procedure code field, using them to describe some of the clinical components included in evaluation and management or services.

Using CPT II codes can help close care gaps related to the following:

• ACE/ARB therapy
• Comprehensive diabetes care, including:
  • HbA1C levels
  • Nephropathy
  • Diabetic retinal eye exams
• Controlling blood pressure
• Medication reconciliation
• Care of older adults, including:
  • Advanced care planning
  • Pain assessment
  • Medication list and review
  • Functional status assessment
• Prenatal and postpartum care

To help encourage accurate coding, we maintain coding and documentation guidelines for our product lines on our provider resources website at ARHealthWellness.com. From the Provider Resources dropdown menu, select either Wellcare by Allwell Coding Tip Sheets and Forms or Ambetter Coding Tip Sheets and Forms.

Note that the information listed on our website is not all-inclusive and should be used as a supplemental reference only. For the most current ICD-10, CPT, CPT II, and HCPCS coding and documentation guidelines, visit cms.gov. Official HEDIS® measures are available at ncqa.org.

For additional resources, contact the Quality Improvement team at QI_AR_HEDIS@centene.com.