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Blue Cross Blue Shield of Rhode Island·RI · OB-GYN, Family Medicine, Internal Medicine·Physician
We identified it
Jun 20, 2026
Summary
This HEDIS quality measure guidance provides specific CPT, HCPCS, and ICD-10 codes for documenting prenatal and postpartum care visits to ensure proper quality reporting. It outlines timing requirements (first trimester prenatal visits, postpartum visits between 7-84 days after delivery) and acceptable documentation standards.
Action Required
Immediately: Billing and clinical staff must ensure proper documentation for prenatal visits includes pregnancy diagnosis, LMP/EDD, and evidence of prenatal care (fetal heart tones, screening tests, etc.). For postpartum visits, document pelvic exam, vital signs, breast/abdomen evaluation, or notation of 'PP care/PP check' between 7-84 days post-delivery. Update EMR templates to include required HEDIS documentation elements to ensure quality measure compliance.