Codes from the National Committee for Quality Assurance (NCQA) Advanced Illness Value Set and/or Frailty Value Sets for devices, diagnoses, encounters and symptoms are used to identify patients …
This is not an all-inclusive list but created to be of assistance to you in coding and telling a patient’s complexity and/or exclusion to a quality measure.
["Diagnosis": "Advanced Illness"] | eCQI Resource Center
Jul 15, 2025 · Inclusion Criteria: Includes concepts that represent a diagnosis of advanced illness when combined with older age and indications of frailty.
Use of HEDIS approved ICD-10-CM, CPT® and HCPCS codes can substantially reduce medical record requests for HEDIS data collection and improve HEDIS measure rates. The following list of …
Services measured by NCQA may not benefit older adults with limited life expectancy and advanced illness. Unnecessary tests or treatments could burden these patients or even be harmful. NCQA …
This resource intends to guide clinicians to understand what advanced illness and frailty diagnoses should be reported to exclude patients from HEDIS measures.
Frailty diagnoses billed for bed confinement status, falls or history of falling, dependence on frailty devices listed above, dependence on care provider, muscle wasting, muscle weakness or pressure …
In 2018, the National Committee for Quality Assurance (NCQA) made changes to specifications that impact Centers for Medicare & Medicaid (CMS) Star measures for patients with advanced illness and …
Dementia medications Advanced illness and frailty must be documented in the medical record and billed with the appropriate exclusion codes. Virtual care visits are acceptable when used to exclude a …
Below are common examples of advanced illness and frailty codes you can add to your supplemental data or claims when clinically appropriate. Two advanced illness codes billed on at least two (2) …