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Weight Assessment and Counseling for Nutrition & Physical Activity for Children/Adolescents (WCC)

Date: 04/01/22

WCC Key Points

  • Measure consists of three components:
    • Body Mass Index (BMI) Percentile
    • Nutrition Counseling/Education
    • Physical Activity Counseling/Education
  • All members ages 3-17
  • All three components may occur during a well visit, sick visit, or telehealth visit.

Coding Summary

WCC Component & ICD-10 Code

  • BMI <5th percentile - Z68.51
  • BMI 5th to <85th percentile - Z68.52
  • BMI 85th to <95th percentile - Z68.53
  • BMI > or = to 95th percentile - Z68.54
  • Nutritional Counseling - Z71.3
  • Physical Activity Counseling - Z71.82, Z02.5

BMI Percentile

Documentation must include height, weight, and BMI percentile during the measurement year.

Either of the following meets criteria for BMI percentile:

  • BMI percentile
  • BMI percentile plotted on an age-growth chart

Ranges and thresholds do not meet criteria for this indicator. A distinct BMI percentile is required.

Coding: To improve HEDIS scores, add the appropriate ICD-10 informational codes Z68.51-Z68.54 below to claim:

BMI Percentile and ICD-10 Code

  • BMI <5th percentile - Z68.51
  • BMI 5th to <85th percentile - Z68.52
  • BMI 85th to <95th percentile - Z68.53
  • BMI > or = to 95th percentile - Z68.54

Nutritional Counseling

Coding: To improve HEDIS scores, add ICD-10 informational code Z71.3 to claim.

Acceptable Documentation

  • Discussion of current nutrition behaviors (e.g., eating habits, dieting behaviors)
  • Documentation of quality/type of diet (e.g., “diet good,” “diet regular,” “diet well balanced,” “balanced meals”)
  • Member/parent/guardian received educational materials on nutrition during a face-to-face visit (e.g., 5-2-1-0)
  • Anticipatory guidance for nutrition (e.g., 5-2-1-0)
  • Weight or obesity counseling (Note: Weight or obesity counseling counts for both Nutrition and Physical Activity Counseling.)
  • Providing referrals to food and nutrition programs if needed (e.g., WIC)
  • Counseling or referral for nutrition education (e.g., “counseled on healthy eating habits”)
  • Checklist indicating nutrition was addressed (must be marked: circled, checked, or underlined)

Unacceptable Documentation

  • Documentation of appetite alone without discussion of nutrition factors (e.g., “appetite good,” “eats well”)
  • A physical exam finding or observation alone (e.g., “well nourished”)
  • Sending member educational material via email or directing to a website to research information on their own
  • Notation of “health education” or “anticipatory guidance” without specific mention of nutrition
  • Documentation of healthy behaviors without specific mention of nutrition (e.g., “healthy lifestyle,” “caffeine: soda approximately 16 ounces a day”)
  • Diet prescribed specific to an acute or chronic condition (e.g., ADA diet that was provided specifically to manage the diabetes, the BRAT diet for gastroenteritis)
  • Questionnaires filled out by the parent with no indication that provider discussed or reviewed
  • Checklist not marked in any way

Physical Activity Counseling

Coding: To improve HEDIS scores, add ICD-10 informational code Z71.82 to claim. Sports physical code Z02.5 may also be used. A sports physical alone does not qualify as WCV/WCC.

Acceptable Documentation

  • Discussion of current physical activity behaviors like exercise routine, participation in sports activities (e.g., “no sports,” “physical activity: WNL,” “Physical activity: active, plays sports”)
  • A sports physical exam completed during visit
  • Member received educational materials on physical activity during a face-to-face visit (e.g., 5-2-1-0)
  • Anticipatory guidance specific to the child’s physical activity (e.g., “encourage opportunities for physical activity,” “regular exercise 3 times a week,” “exercise education,” 5-2-1-0)
  • Weight or obesity counseling (Note: Weight or obesity counseling counts for both Nutrition and Physical Activity Counseling.)
  • Counseling or referral for physical activity
  • Bike safety and water safety discussion with specific mention of physical activity recommendations
  • Checklist indicating physical activity was addressed (must be marked: circled, checked, or underlined)

Unacceptable Documentation

  • Documentation of “plays with peers” without any other mention of physical activity
  • Notation of “cleared for gym class” alone without documentation of discussion
  • Sending member educational material via email or directing to a website to research information on their own
  • Notation of “health education” or “anticipatory guidance” without specific mention of physical activity
  • Notation solely related to screen time (computer or television) without specific mention of physical activity
  • Services specific to an acute or chronic condition do not meet criteria (e.g., referral to physical therapy for an injury, sports contraindicated until injury/illness is resolved)
  • Notation of anticipatory guidance related solely to safety (e.g., wears helmet, water safety) without specific mention of physical activity recommendations
  • Checklist not marked in any way

Printable version of this guide.