CMS117v12 – Childhood Immunization Status

Children who turn 2 years of age during the measurement period and who have a visit during the measurement period.

A qualifying visit in this case includes any of the following:

• Office Visit
• Home Healthcare Services
• Preventive Care, Established Office Visit, 0 to 17
• Preventive Care Services, Initial Office Visit, 0 to 17
• Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified healthcare professional
• Online Assessments
• Telephone Visits

– NUMERATOR

1. DTaP

Children with any of the following on or before the child’s second birthday meet criteria:

– At least four DTaP vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.

– Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.

– Encephalitis due to the diphtheria, tetanus or pertussis vaccine.

2. IPV

Children with either of the following on or before the child’s second birthday meet criteria:

– At least three IPV vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.

– Anaphylaxis due to the IPV vaccine.

3. MMR

Children with any of the following meet criteria:

– At least one MMR vaccination on or between the child’s first and second birthdays.

– Anaphylaxis due to the MMR vaccine on or before the child’s second birthday.

– All of the following anytime on or before the child’s second birthday (on the same or different date of service):

– History of measles.

– History of mumps.

– History of rubella.

4. HiB

Children with either of the following meet criteria on or before the child’s second birthday:

– At least three HiB vaccinations, with different dates of service. Do not count a vaccination administered prior to 42 days after birth.

– Anaphylaxis due to the HiB vaccine.

5. Hep B

Children with any of the following on or before the child’s second birthday meet criteria:

– At least three hepatitis B vaccinations, with different dates of service.

– One of the three vaccinations can be a newborn hepatitis B vaccination during the eight-day period that begins on the date of birth and ends seven days after the date of birth. For example, if the member’s date of birth is December 1, the newborn hepatitis B vaccination must be on or between December 1 and December 8.

– Anaphylaxis due to the hepatitis B vaccine.

– History of hepatitis B illness.

6. VZV

Children with any of the following meet criteria:

– At least one VZV vaccination, with a date of service on or between the child’s first and second birthdays.

– Anaphylaxis due to the VZV vaccine on or before the child’s second birthday.

– History of varicella zoster (e.g., chicken pox) illness on or before the child’s second birthday.

7. PCV

Children with either of the following on or before the child’s second birthday meet criteria:

– At least four pneumococcal conjugate vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

– Anaphylaxis due to the pneumococcal vaccine.

8. Hep A

Children with any of the following meet criteria:

– At least one hepatitis A vaccination, with a date of service on or between the child’s first and second birthdays.

– Anaphylaxis due to the hepatitis A vaccine on or before the child’s second birthday.

– History of hepatitis A illness on or before the child’s second birthday.

9. RV

Children with any of the following meet criteria:

– At least two doses of the two-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

– At least three doses of the three-dose rotavirus vaccine on different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

– At least one dose of the two-dose rotavirus vaccine and at least two doses of the three-dose rotavirus vaccine, all on different dates of service, on or before the child’s second birthday. Do not count a vaccination administered prior to 42 days after birth.

– Anaphylaxis due to the rotavirus vaccine on or before the child’s second birthday.

10. Flu

Children with either of the following on or before their second birthday meet criteria:

– At least two influenza vaccinations, with different dates of service on or before the child’s second birthday. Do not count a vaccination administered prior to 6 months (180 days) after birth.

– One of the two vaccinations can be a Live Attenuated Influenza Vaccine (LAIV) vaccination administered on the child’s second birthday. Do not count a LAIV vaccination administered before the child’s second birthday.

– Anaphylaxis due to the influenza vaccine.

– DENOMINATOR EXCLUSION

• Children with any of the following on or before the child’s second birthday:

– Severe combined immunodeficiency

– Immunodeficiency

– HIV

– Lymphoreticular cancer, multiple myeloma or leukemia

– Intussusception

• Children who are in hospice care for any part of the measurement period.

For Denominator:

To record an encounter, navigate to Patient > Provider Note > Create Superbill. Here, under the ‘Procedures’-CPTs’ heading, enter the relevant encounter code.

For Numerator:

• Vaccine administration can be documented via Patient > Provider Note > Immunization. Here, click ‘Add’, then hover over ‘+Dosage’ and select ‘Administer Vaccine’. From the list that appears, choose the relevant vaccine group. This opens an ‘Administer Vaccine’ window where a specific vaccine is searched for and the administration details filled out. Once done, click ‘Save’.

• To record diagnoses of:
  • Anaphylaxis
  • Encephalitis
  • History of measles
  • History of mumps
  • History of rubella
  • History of hepatitis B
  • History of varicella zoster
  • History of hepatitis A

use the workflow Patient > Provider Note > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out any details as needed and once done, click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

For Denominator Exclusions:

• The diagnoses
  • HIV
  • Severe Combined Immunodeficiency
  • Lymphoreticular cancer, multiple myeloma or leukemia
  • Intussusception

can be documented through Patient > Provider Note > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out any details as needed and once done, click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.

• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.