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Johns Hopkins Health Plans

AIS-E- Adult Immunization Status

Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Eligible Population:
Members 19 years of age and older during the measurement year. This includes the HealthChoice Performance Measure reporting for Priority Partners only for Flu and Td.

Definition:
The percentage of members 19 years of age and older who are up to date on recommended routine vaccines for influenza, tetanus and diphtheria (Td) or tetanus, diphtheria and acellular pertussis (Tdap), zoster, pneumococcal and hepatitis B.

Numerator 1—Immunization Status: Influenza

  • Members who received an influenza vaccine, influenza Virus LAIV vaccine on or between July 1 of the year prior to the measurement period and June 30 of the measurement period, OR
  • Members with anaphylaxis due to the influenza vaccine any time before or during the measurement period.
  • Age Stratification (as of the start of the measurement period, for each product line):
    • 19–64 years.
    • 65 years and older.

Numerator 2—Immunization Status: Td/Tdap

  • Members who received at least one Td vaccine or one Tdap vaccine between 9 years prior to the start of the measurement period and the end of the measurement period, OR
  • Members with a history of at least one of the following contraindications any time before or during the measurement period:
    • Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine.
    • Encephalitis due to the diphtheria, tetanus or pertussis vaccine.
  • Age Stratification (as of the start of the measurement period, for each product line):
    • 19–64 years.
    • 65 years and older.

Numerator 3—Immunization Status: Zoster

  • Members who received two doses of the herpes zoster recombinant vaccine at least 28 days apart, on October 1, 2017, through the end of the measurement period, OR
  • Members with anaphylaxis due to the herpes zoster vaccine any time before or during the measurement period.
  • Age Stratification (as of the start of the measurement period, for each product line):
    • 50–64 years.
    • 65 years and older.

Numerator 4—Immunization Status: Pneumococcal

  • Members who received at least one dose of an adult pneumococcal vaccine on or after their 19th birthday, before or during the measurement period, OR
  • Members with anaphylaxis due to the pneumococcal vaccine any time before or during the measurement period.
  • Age Stratification (as of the start of the measurement period, for each product line):
    • 65 years and older.

Numerator 5—Immunization Status: Hepatitis B

  • Members who received at least three doses of the childhood hepatitis B vaccine with different dates of service on or before their 19th birthday.
    • One of the three vaccinations can be a newborn hepatitis B vaccination during the 8-day period that begins on the date of birth and ends 7 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.
  • Members who received a hepatitis B vaccine series on or after their 19th birthday, before or during the measurement period, including either of the following:
    • At least two doses of the recommended two-dose adult hepatitis B vaccine administered at least 28 days apart; OR
    • At least three doses of any other recommended adult hepatitis B vaccine administered on different days of service.
  • Members who had a hepatitis B surface antigen, hepatitis B surface antibody or total antibody to hepatitis B core antigen test, with a positive result any time before or during the measurement period. Any of the following meet criteria:
    • A test with a result greater than 10 mIU/mL.
    • A test with a finding of immunity (Hepatitis B Immunity Finding Value Set).
  • Members with a history of hepatitis B illness any time before or during the measurement period.
  • Members with anaphylaxis due to the hepatitis B vaccine any time before or during the measurement period.
  • Age Stratification (as of the start of the measurement period, for each product line):
    • 19–30 years.
    • 31–59 years.

Report stratification by race and ethnicity.

Continuous Enrollment:

  • The measurement period.

Best Practice and Measure Tips

  • New for Measure: Hepatitis B vaccine for adult at various ages.
    • This includes:
      • Three doses of the childhood hepatitis B vaccine.
      • Two or three doses of the adult hepatitis B vaccine series.
      • Hepatitis B antigen lab test, with a positive result.
      • History of hepatitis B illness.
      • Anaphylaxis due to the hepatitis B vaccine.
  • Advise patient on the importance of completing each vaccine series.
    • Provide handouts.
    • Educate members on vaccination and side effects.
    • Review immunization records at each visits and catch up with any missing immunizations.
  • Office improvement opportunity
    • Place guidelines to schedule visits within the CDC guidelines timeframe. Reference the CDC Immunization Vaccine Schedule: https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html
    • Contact member to re-schedule any missed appointment for their vaccination.
    • Use your electronic medical record (EMR) to set flags with immunization gap timeframes.
    • Ensure that members’ medical records include immunization history from all sources.
    • Train medical staff to answer questions about vaccinations, administer vaccinations, and document vaccinations.
    • Use measure codes and exclusion code listed below when submitting claims to make member compliant by administrative data.
    • DOCUMENT ANY PATIENT REFUSAL FOR IMMUNIZATIONS. This does not exclude member from measure.
    • The below count towards compliance for the vaccine. Document with event date:
      • Anaphylaxis due to the vaccine.
      • Evidence of the antigen or combination vaccine.
      • Documented history of the illness.

Acceptable documentation:

  • A certificate of immunization prepared by an authorized health care provider or agency including the specific dates and types of immunizations administered.
  • A note indicating the name of the specific antigen and immunization date.

Not Acceptable:

  • A note the "member is up to date" with all immunizations but does not list the dates and names of all immunizations.

Measure Exclusions

Required Exclusions:

  • Members in hospice or using hospice services anytime during the measurement year.
  • Members who die any time during the measurement period.

Measure Codes

Immunizations

  • Adult Influenza:
    • CPT: 90630, 90653, 90654, 90656, 90658, 90661, 90662, 90673, 90674, 90682, 90686, 90688, 90689, 90694, 90756
    • CVX: 88, 135, 140, 141, 144, 150, 153, 155, 158, 166, 168, 171, 185, 186, 197, 205
    • Anaphylaxis due to the influenza vaccine SNOMED CT: 471361000124100
  • Influenza Virus LAIV
    • CPT: 90672, 90660
    • CVX: 111, 149
  • Td
    • CPT: 90714
    • CVX: 09,13,138,139
  • Tdap:
    • CPT: 90715
    • CVX: 115
  • Td/Tdap
    • Anaphylaxis Due to Diphtheria, Tetanus or Pertussis Vaccine:
      • SNOMED CT: 428281000124107, 428291000124105
    • Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine
      • SNOMED CT: 192710009, 192711008, 192712001
  • Zoster
    • CPT: 90750
    • CVX: 187
    • Anaphylaxis Due to Herpes Zoster Vaccine SNOMED CT: 471371000124107, 471381000124105
  • Pneumococcal
    • CPT: 90670, 90671, 90677, 90732
    • HCPCS: G0009
    • CVX: 33,109, 133, 152, 215, 216
    • Anaphylaxis Due to the pneumococcal vaccine SNOMED CT: 471141000124102
  • Hepatitis B
    • Childhood hepatitis B vaccine
      • CPT: 90697, 90723, 90740,90744, 90747, 90748
      • HCPCS: G0010
      • CVX: 08, 44, 45, 51, 110, 146, 198
      • One of the three vaccinations can be a newborn hepatitis B vaccination ICD-10-PCS: 3E0234
    • Adult hepatitis B vaccine
      • Two (2) dose
      • CPT: 90743, 90739
      • CVX: 189
      • Three (3) dose
      • CPT: 90759, 90746, 90740, 90747, 90744
      • CVX: 43, 44, 45, 104, 220
    • Hepatitis B antigen lab test
      • A hepatitis B test with threshold of 10 with a result greater than 10 mIU/mL LOINC: 16935-9, 5193-8, 49495-5
      • A hepatitis B prevaccination test with a hepatitis B finding of immunity.
      • Prevaccination Tests LOINC: 10900-9, 13919-6, 13952-7, 16933-4, 16935-9, 22316-4, 22318-0, 22319-8, 22322-2, 24113-3, 31204-1, 32019-2, 32685-0, 39535-0, 40725-4, 48070-7, 49177-9, 5185-4, 5186-2, 5187-0, 5188-8, 51914-0, 5193-8, 5194-6, 5195-3, 5196-1, 5197-9, 58405-2, 58452-4, 63557-3, 65633-0, 70154-0, 75378-0, 75409-3, 75410-1, 7905-3, 83100-8, 95234-1, 99385-7
      • Immunity finding SNOMED CT: 105811000119100, 10828004, 165806002, 260373001, 271511000, 313234004, 406117000, 736687002
    • History of hepatitis B illness ICD-10-CM: B16.0, B16.1, B16.2, B16.9, B17.0, B18.0, B18.1, B19.10, B19.11
    • Anaphylaxis due to the hepatitis B vaccine SNOMED CT code 428321000124101