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PQRS Cheat SheetOccupational Therapy Reporting- Individual MeasuresMedicare requires that practitioners meet certain quality reporting thresholdsand collect enough data to assess trends and performance. Only practitionerswho have reported quality data on at least 80% of appropriate patients areconsequently eligible for the PQRS incentive payment.*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 for Occupational Threapy, 2-PQRS.aspx and www.cms.gov*American Occupational Therapy Association, Copyright, February 2011. -2010.aspx
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 #173 - UNHEALTHY ALCOHOL USE - SCREENINGCPT Codes: 97003, 97004; Frequency: minimum once per reporting periodDid you screen the patient for unhealthy alcohol use?Yes3016FPatient was screened forunhealthy alcohol useNo3016F - 8PScreening was notperformed with modifier 8P(not performed, reason notspeicified)OR3016F - 1PScreening was notperformed with modifier 1P(not performed due tomedical reason)
Copyright 2013PQRS MEASURESMEASURE #181 - ELDER MALTREATMENT SCREEN AND FOLLOW UP PLANCPT Codes: 97003; Frequency: minimum once per reporting periodFor patient’s aged 65 and older:Was the patient screened for elderly maltreatment?NoG8535Patient not eligibleORG8536Reason not givenYesWas it positive for eldermaltreatment?NoG8734FScreen documented as negative, nofollow-up requiredYesWas a follow-up plandocumented?YesNoG8735Screen documented aspositive, follow-up plannot documented,reason not specifiedG8733Screen documented as positive anddocumented follow-up planORG8941Screen documented,patient not eligible forfollow-up
Copyright 2013PQRS MEASURESMEASURE #226 - TOBACCO USE - SCREENING AND CESSATION INTERVENTIONCPT Codes: 97003, 97004; Frequency: minimum once per reporting periodWas the patient screened for tobacco use?No4004F- 8PTobacco screening not performedwith modifier 8P (not performed,reason not speicified)ORYesWere they identifiedas a tobacco user?4004F- 1PTobacco screening not performedwith modifier 1P (not performed dueto medical reason)NoYes4004FPatient screened for tobacco use andreceived tobacco cessation intervention(counseling, pharmacotherpay, or both), ifidentified as a tobacco user1036FPatient screenfor tobacco useand identified asa non-user
MEASURE #128 - BODY MASS INDEX (BMI) & FOLLOW UP Did you perform a BMI assessment? Was the patient’s BMI normal* (between 18.5-25)? Was the BMI higher than 25? Was a follow-up plan created for the patient? CPT Codes: 97001, 97003; Frequency: minimum once per reporting period G
