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The Importance of Proper Documentation and Coding with the HEDIS SPC Measure
Medical Mutual of Ohio·OH · Cardiology, Internal Medicine, Family Medicine +1 more·Coding
We identified it
Jun 20, 2026
Summary
Medical Mutual of Ohio has issued updated guidance on proper documentation and coding for the HEDIS SPC (Statin Therapy for Patients with Cardiovascular Disease) measure. The policy provides specific ICD-10 and SNOMED codes for excluding patients with statin intolerance or adverse reactions, and outlines criteria for measuring statin therapy adherence in ASCVD patients.
Action Required
Immediately: Billing team should review current ASCVD patient documentation to ensure proper coding of statin exclusions using the specified ICD-10 codes (G72.0, G72.2, G72.9, M60.9, M62.82, M79.10, M79.18). Contact Medical Mutual's Supplemental Data team (Richard Hein: richard.hein@medmutual.com, Nadia Dumevi: nadia.dumevi@medmutual.com) to incorporate SNOMED codes into supplemental data files. Update EMR templates to prompt providers to document statin therapy prescriptions and patient adherence for HEDIS reporting.