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PQRS Cheat SheetPhysical Therapy Reporting- Individual MeasuresAccording to APTA, to participate in PQRS using individual measures, you mustreport on a minimum of 3 measures for 50% of all Medicare patients seenduring the reporting period, if reporting via claims, or on a minimum of 3measures for 80% of all Medicare patients seen during the reporting period, ifreporting via registry.*Important Note: This cheat sheet was designed to help you report the mostpossible G-code and CPT code by the PQRS measure. For more information onPQRS and G-codes for Physical Therapy, n Physical Therapy Association, Copyright, March 2013. http://www.apta.org/pqrs/individualmeasures/
Copyright 2013PQRS MEASURESMEASURE #126 - DIABETES - NEUROLOGICAL EVALUATIONCPT Codes: 97001, 97002, 97597, 97598; Frequency: minimum once per reporting periodDid you perform a lower extremity neurological exam?NoYesG8404Exam performedG8405Exam not performedORG8406Patient is not eligible
Copyright 2013PQRS MEASURESMEASURE #127 - DIABETES - FOOTWEAR EVALUATIONCPT Codes: 97001, 97002, 97597, 97598; Frequency: minimum once per reporting periodDid you perform a footwear evaluation?NoG8415Exam not performedORG8416Patient is not eligibleYesG8410Exam performed and documented
Copyright 2013PQRS MEASURESMEASURE #128 - BODY MASS INDEX (BMI) & FOLLOW UPCPT Codes: 97001, 97003; Frequency: minimum once per reporting periodDid you perform a BMI assessment?NoG8422Patient is not eligibleORG8421BMI was not calculatedat visitYesWas the patient’s BMInormal* (between 18.5-25)?*Normal BMI for age 65 is 23 and 30; Age18-64 is 18.5 and 25YesNoG8420BMI calculated asnormal anddocumented in EMRWas a follow-up plancreated for the patient?NoG8419BMI calculated outside ofnormal parameter, no follow-upYesORG8938BMI calculated, but patient is not eligible for follow-upYesG8417Calculated a higherBMI, a follow-up planwas documentedin EMRWas the BMIhigher than 25?NoG8418Calculated a lower BMI,a follow-up plan wasdocumented in EMR
Copyright 2013PQRS MEASURESMEASURE #130 - MEDICATIONSCPT Codes: 97001, 97002, 97003, 97004; Frequency: each visitDid you document the patient’s current medications?NoG8430Patient is not eligibleORYesG8427Documented patient’s medications, includingdrug name, dosage, frequency and route.G8428Reason not given
Copyright 2013PQRS MEASURESMEASURE #131 - PAIN ASSESSMENT AND FOLLOW UPCPT Codes: 97001, 97003;97003 Frequency: each visitDid you complete a pain assessment?NoG8442Patient is not eligibleORG8732Reason not givenYesDoes the patienthave pain?YesNoWas a follow-updocumented?YesG8731Pain is negative, nofollow up requiredNoG8509Pain is positive, noORdocumentation offollow-up, reason notspecified.G8730Pain is positive, a follow-up planwas documented in EMRG8939Pain assessmentdocumented, follow-upplan not documented,patient is not eligible
Copyright 2013PQRS MEASURESMEASURE #154 - FALLS - RISK ASSESSMENTCPT Codes: 97001, 97002, 97003, 97004; Frequency: minimum onceper reporting periodDoes the patient have more than 2 falls or any falls withinthe injury period in the last year?1101FPatient is not eligible butscreened for future fallsNoYes1100FPatient screened forfuture falls, documentedRECORD & CONTINUEWas a fall assessmentcompleted?No3288F - 8PFall documented with modifier8P (not performed, reason notspecified); MAY CONTINUEWITH FALLS - PLAN OF CAREYesOR1101F - 8PPatient is not eligible, nodocumented falls withmodifier 8P (not performed,reason not specified)3288F - 1PFall documented withOR modifier 1P (notperformed due tomedical reason)3288FFall documented; MAY CONTINUEWITH FALLS - PLAN OF CARE
Copyright 2013PQRS MEASURESMEASURE #155 - FALLS - PLAN OF CARECPT Codes: 97001, 97002, 97003, 97004; Frequency: minimum once per reporting periodDid you complete a plan of care for the patient?Yes0518FPlan of care isdocumented in EMRNo0518F - 8PPlan of care is notdocumented with modifier8P (not performed, reasonnot speicified)OR0518F - 1PPlan of care is notdocumented with modifier1P (not performed due tomedical reason)
Copyright 2013PQRS MEASURESMEASURE #182 - FUNCTIONAL OUTCOME ASSESSMENTCPT Codes: 97001, 97002; Frequency: each visitNoDid you complete a functional outcome asssessment?G8540Patient is not eligibleORG8541Reason not givenYesWere there anydeficiencies?NoG8542Documented no deficiences, plan of care not requiredYesDOCUMENTDEFICIENCIESWas a plan ofcare created?NoG8543Documented assessment, butno documentation of plan ofcare, reason not specifiedYesG8539Documented assessment andthe plan of care based on theidentified deficienciesORG8942Documented assessment andthe plan of care within previous30 days
Copyright 2013 MEASURE #154 - FALLS - RISK ASSESSMENT Does the patient have more than 2 falls or any falls within the injury period in the last year?
