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2014 Physician Quality Reporting System(PQRS)Measures Groups Specifications Manual01/23/2014This manual contains specific guidance for reporting 2014 Physician Quality Reporting System (PQRS) MeasuresGroups. Measures Groups are a subset of four or more PQRS measures that have a particular clinical condition orfocus in common. Only those measures groups defined in this document can be utilized when reporting themeasures group options. All other individual measures that are included in PQRS but not defined in this manual asincluded in a measures group cannot be grouped together to define a measures group.Version 7.101/23/14CPT only copyright 2013 American Medical Association. All rights reserved.Page 1 of 341

Twenty-five (25) measures groups have been established for 2014 PQRS: Diabetes, Chronic Kidney Disease (CKD),Preventive Care, Coronary Artery Bypass Graft (CABG), Rheumatoid Arthritis (RA), Perioperative Care, Back Pain,Hepatitis C, Heart Failure (HF), Coronary Artery Disease (CAD), Ischemic Vascular Disease (IVD), HIV/AIDS,Asthma, Chronic Obstructive Pulmonary Disease (COPD), Inflammatory Bowel Disease (IBD), Sleep Apnea,Dementia, Parkinson’s Disease, Hypertension, Cardiovascular Prevention, Cataracts, Oncology, Total KneeReplacement (TKR), General Surgery, and Optimizing Patient Exposure to Ionizing Radiation (OPEIR). As requiredby applicable statutes, through formal notice-and-comment rulemaking in 2013, these 25 measures groups consist ofindividual measures established for use in the 2014 PQRS. An eligible professional may choose to report one ormore measures groups through registry-based submission. Note that denominator coding has been modified fromthe original individual measures specified by the measure developer to allow for implementation in PQRS as ameasures group. An overview for each measures group is included in this manual followed by specific reportinginstructions for each measure within the group.There are two reporting periods available for eligible professionals to report 2014 PQRS measures groups: a) 12month reporting period from January 1 through December 31, 2014 OR b) a 6-month reporting period from July 1through December 31, 2014. Measures groups containing a measure with a 0% performance rate will not be countedas satisfactorily reporting the measures group. Those eligible professionals who satisfactorily report quality-dataunder the measures groups reporting option may earn an incentive payment equal to 0.5% of their total estimatedallowed charges for Medicare Part B Physician Fee Schedule (PFS) covered professional services furnished duringthe applicable reporting period.Please note, eligible professionals may choose to pursue more than one 2014 PQRS option. However, an eligibleprofessional who satisfactorily reports under more than one reporting option will earn a maximum of one incentivepayment equal to 0.5% of their total estimated allowed charges for Medicare Part B PFS covered professionalservices furnished during the longest reporting period for which he or she satisfied reporting requirements. Thismanual describes how to implement 2014 reporting of PQRS measures groups to facilitate satisfactory reporting ofquality-data by eligible professionals who wish to participate under this reporting alternative. Additional informationdescribing how to implement 2014 measures groups can be found in the 2014 Physician Quality Reporting System(PQRS) Getting Started with Measures Groups and Physician Quality Reporting Made Simple - Reporting thePreventive Care Measures Group at: tient-AssessmentInstruments/PQRS.Note: This document applies to PQRS for incentive payment eligibility only. Those who report satisfactorilyfor the 2014 program year may avoid the 2016 payment adjustment. Additional information on how to avoidfuture PQRS payment adjustments can be found through supporting documentation available on the CMSwebsite at tient-Assessment-Instruments/PQRS.Version 7.101/23/14CPT only copyright 2013 American Medical Association. All rights reserved.Page 2 of 342

Measures Groups Reporting Method:There is one reporting method for submission of measures groups:20 Patient Sample Method via Registry – 12-month or 6-month reporting period:o A participating eligible professional must report on all applicable measures within the selected measuresgroup for a minimum sample of 20 unique patients, a majority of which must be Medicare Part B FFSpatients, who meet patient sample criteria for the measures group. If the eligible professional does not haveat least 11 unique Medicare Part B FFS patients who meet patient sample criteria for the measures group,the eligible professional will need to choose another measures group or choose another reporting option.Please refer to the 2014 Physician Quality Reporting System (PQRS) Implementation Guide to determinethe proper reporting option.For registry-based 12-month reporting option submissions, all applicable measures within the group must be reportedduring the reporting period (January 1 through December 31, 2014), according to each measures group’s reportinginstructions contained within each group’s overview section.For registry-based 6-month reporting option submissions, all applicable measures within the group must be reportedduring the reporting period (July 1 through December 31, 2014), according to each measures group’s reportinginstructions contained within each group’s overview section.Measures groups containing a measure with a 0% performance rate will not be counted as satisfactorily reporting themeasures group.The patient sample for the 20 Patient Sample Method is determined by diagnosis and/or specific encounterparameters common to all measures within a selected measures group. All applicable measures within a group mustbe reported for each patient within the sample that meets the criteria (e.g., age or gender) required in accordancewith this manual. For example, if an eligible professional is reporting on the Preventive Care Measures Group, theScreening or Therapy for Osteoporosis measure would only need to be reported on women within the eligibleprofessional’s patient sample.Version 7.101/23/14CPT only copyright 2013 American Medical Association. All rights reserved.Page 3 of 342

sion 7.1Measure TitlePageDiabetes Measures GroupDiabetes: Hemoglobin A1c Poor ControlDiabetes: Low Density Lipoprotein (LDL-C) Control ( 100 mg/dL)Diabetes: Eye ExamDiabetes: Medical Attention for NephropathyDiabetes: Foot ExamChronic Kidney Disease (CKD) Measures GroupPreventive Care and Screening: Influenza ImmunizationAdult Kidney Disease: Laboratory Testing (Lipid Profile)Adult Kidney Disease: Blood Pressure ManagementAdult Kidney Disease: Patients On Erythropoiesis-Stimulating Agent (ESA) Hemoglobin Level 12.0 g/dLPreventive Care Measures GroupScreening or Therapy for Osteoporosis for Women Aged 65 Years and OlderUrinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence inWomen Aged 65 Years and OlderPreventive Care and Screening: Influenza ImmunizationPneumonia Vaccination Status for Older AdultsBreast Cancer ScreeningColorectal Cancer ScreeningPreventive Care and Screening: Body Mass Index (BMI) Screening and Follow-UpPreventive Care and Screening: Unhealthy Alcohol Use - ScreeningPreventive Care and Screening: Tobacco Use: Screening and Cessation InterventionCoronary Artery Bypass Graft (CABG) Measures GroupCoronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) inPatients with Isolated CABG SurgeryCoronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients withIsolated CABG Surgery911121314152022232425Coronary Artery Bypass Graft (CABG): Prolonged Intubation52Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection RateCoronary Artery Bypass Graft (CABG): StrokeCoronary Artery Bypass Graft (CABG): Postoperative Renal FailureCoronary Artery Bypass Graft (CABG): Surgical Re-ExplorationCoronary Artery Bypass Graft (CABG): Antiplatelet Medications at DischargeCoronary Artery Bypass Graft (CABG): Beta-Blockers Administered at DischargeCoronary Artery Bypass Graft (CABG): Anti-Lipid Treatment at DischargeRheumatoid Arthritis (RA) Measures GroupRheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD)TherapyRheumatoid Arthritis (RA): Tuberculosis ScreeningRheumatoid Arthritis (RA): Periodic Assessment of Disease ActivityRheumatoid Arthritis (RA): Functional Status AssessmentRheumatoid Arthritis (RA): Assessment and Classification of Disease PrognosisRheumatoid Arthritis (RA): Glucocorticoid Management535455565758596466676869707101/23/14CPT only copyright 2013 American Medical Association. All rights reserved.Page 4 of 34229323334353637384041485051

ersion 7.1Measure TitlePagePerioperative Care Measures GroupPerioperative Care: Timing of Prophylactic Parenteral Antibiotic – Ordering PhysicianPerioperative Care: Selection of Prophylactic Antibiotic – First OR Second GenerationCephalosporinPerioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (Non-CardiacProcedures)Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated inALL Patients)Back Pain Measures GroupBack Pain: Initial VisitBack Pain: Physical ExamBack Pain: Advice for Normal ActivitiesBack Pain: Advice Against Bed RestHepatitis C Measures GroupHepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating TreatmentHepatitis C: HCV Genotype Testing Prior to TreatmentHepatitis C: Hepatitis C Virus (HCV) Ribonucleic Acid (RNA) Testing Between 4-12Weeks After Initiation of TreatmentHepatitis C: Hepatitis A Vaccination in Patients with Hepatitis C Virus (HCV)Heart Failure (HF) Measures GroupHeart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or AngiotensinReceptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction(LVSD)Heart Failure: Left Ventricular Ejection Fraction (LVEF) AssessmentPreventive Care and Screening: Tobacco Use: Screening and Cessation InterventionCoronary Artery Disease (CAD) Measures GroupCoronary Artery Disease (CAD): Antiplatelet TherapyCoronary Artery Disease (CAD): Lipid ControlPreventive Care and Screening: Tobacco Use: Screening and Cessation InterventionCoronary Artery Disease (CAD): Symptom ManagementIschemic Vascular Disease (IVD) Measures Group767879Ischemic Vascular Disease (IVD): Use of Aspirin or Another AntithromboticPreventive Care and Screening: Tobacco Use: Screening and Cessation InterventionControlling High Blood PressureIschemic Vascular Disease (IVD): Complete Lipid Profile and LDL-C Control( 100 mg/dL)HIV/AIDS Measures GroupHIV/AIDS: CD4 Cell Count or CD4 Percentage PerformedHIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) ProphylaxisHIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, andSyphilisHIV Viral Load SuppressionPrescription of HIV Antiretroviral TherapyHIV Medical Visit FrequencyGap in HIV Medical Visits01/23/14CPT only copyright 2013 American Medical Association. All rights reserved.Page 5 of 7119120125126128129130135137138139140141142143