Home > Clinical & Pharmacy
Web Content Viewer
Web Content Viewer
Work with your patient to control asthma
June 6, 2023

This article is for primary care providers, allergists, and pulmonologists caring for our members

While asthma affects almost 25 million people in the United States, disparities lie heavily in Black and Hispanic communities. You play a crucial role in supporting your patients with asthma by making sure they understand their condition and treatment plan.

Tips for HEDIS®'' Improvement

  • Save time during HEDIS record collection by coding for appropriate exclusions (see table below).
  • Prescribe a long-term controller medication and provide patient reminders for refills.
  • Limit the number of refills on reliever medications to no more than two. If a member requests additional refills, call to ensure they’re taking their controller as prescribed, and that it's working for them.
  • Advise patients to add controller medication to daily routine, for example, taking medication before brushing teeth.

The Asthma Action Plan saves lives

As you know, the asthma action plan helps your patient understand their triggers and the appropriate medication to take. When creating this plan be sure to:

  • Share resources that are culturally appropriate and in the patient's preferred language.
  • Practice shared decision making to better understand patient preferences and concerns while building a stronger patient-provider relationship.
  • Carefully explain the difference between controller and reliever medication and discuss why controller adherence is important.

When patients should be excluded

While the asthma medication ratio HEDIS measure looks at members with persistent asthma, certain comorbid conditions such as emphysema, COPD, and obstructive chronic bronchitis can exclude them from the measure. 

Common exclusion codes


ICD-10-CM code

Acute respiratory failure 

J96.00-J96.02, J96.20-J96.22

Chronic obstructive pulmonary disease (COPD)

J44.0, J44.1, J44.9

Chronic respiratory conditions due to fumes or vapors


Cystic fibrosis 

E84.0, E84.11, E84.19, E84.8, E84.9


J43.0-J43.2, J43.8, J43.9, J98.2, J98.3  

Obstructive chronic bronchitis 

491.20-491.22 (ICD-9-CM)

Other emphysema 


Note that the list above is not exhaustive, but a sample of diagnosis codes that may be used.

Coding HEDIS exclusions for comorbid conditions, when applicable, improves performance rates by excluding these members. This can also eliminate the need to submit patient medical records during HEDIS record collection, saving your staff time and resources.