Transcription
Medicare requires that practioners meet certain quality reporting thresholds andcollect data to assess trends and performance. If you are participating as aRehab PQRS statistical reporter, the following cheat sheets are below to assist youfor the PQRS Measures within your industry. Each measure is assigned a uniquenumber. The cheat sheets explain the possible G-Code Submission requirement perPQRS MeasureBeginning in 2015, the program will apply a negative payment adjustment to individual EPsand PQRS group practices who did not satisfactorily report data on quality measures forMedicare Part B Physician Fee Schedule (MPFS) covered professional services in 2013.Those who report satisfactorily for the 2015 program year will avoid the 2017PQRS negative payment adjustment.Cross-Cutting MeasuresNew for 2015, cross-cutting measures are now required for the purpose of having PQRSreporting used to assess quality performance under the VM [value-based modifier].If you’re an eligible professional who sees at least one Medicare patient in a billed visitduring 2015, then you must report on at least one cross-cutting measure to meetsatisfactory reporting requirements.CMS website: atient-Assessment-Instruments/PQRS/
PQRS MeasuresMEASURE #128 - BODY MASS INDEX (BMI) & FOLLOW UP (PT/OT)NEW 2015 this measure now counts as a Cross-cut measureCPT Codes: 97001, 97003; Frequency: minimum once per reporting periodDid you perform a BMI assessment?NoG8422G8421Patient is not eligible OR BMI was not calculated at visit*Normal BMI for age65 is 23 and 30;Age 18-64 is 18.5 and 25YesWas the patient’s BMI normal* (between 18.5-25)?YesG8420BMI calculated as normaland documented in EMRG8419BMI calculated outside ofnormal parameter, no follow-upORG8938BMI calculated, but patientis not eligible for follow-upNoWas a follow-up plancreated for the patient?YesNoYesWas the BMIhigher than 25?NoG8417Calculated a higher BMI,a follow-up plan wasdocumented in EMRG8418Calculated a lower BMI,a follow-up plan wasdocumented in EMR
PQRS MeasuresMEASURE #130 - MEDICATIONS (PT/OT/SLP)NEW 2015 this measure now counts as a Cross-cut measureCPT Codes: 92626, 97001, 97002, 97003, 97004, 97532, 92526, 92508, 92507; Frequency: each visitDid you document the patient’s current medications?NoG8430Patient is not eligibleORYesG8427Documented patient’s medications,including drug name, dosage,frequency and routeG8428Reason not given
PQRS MeasuresMEASURE #131 - PAIN ASSESSMENT AND FOLLOW UP (PT/OT/SLP/CHIRO)NEW 2015 this measure now counts as a Cross-cut measureCPT Codes: 92507, 92508, 92526, 97532, 97001, 97002, 97003, 97004; 98940, 98941, 98942; Frequency: each visitDid you complete a pain assessment?NoG8442Patient is not eligibleORG8732Reason not givenYesDoes the patient have pain?YesNoWas a follow-updocumented?YesG8731Pain is negative, no follow up requiredNoG8509Pain is positive, nodocumentation of follow-up,reason not specified.ORG8730Pain is positive, a follow-up plan was documented in EMRG8939Pain assessment documented,follow-up plan not documented,patient is not eligible
PQRS MeasuresMEASURE #134 - PREVENTIVE CARE AND SCREENINGFOR CLINICAL DEPRESSION (OT)NEW 2015 this measure now counts as a Cross-cut measureCPT Codes: 97003; Frequency: once per reporting periodWas the screening documented?G8433Screening not documented, patient not eligibleORG8432Screening not documented, reason not givenYesWas the screening positive or negative?PositiveNoNegative G8510Screening documented negative, follow up not requiredG8431Screening documented positive, follow up plan documentedORG8940Screening documented positive, follow up not documented, patient not eligibleORG8511Screening documented positive, follow up not documented, reason not given
PQRS MeasuresMEASURE #154 - FALLS - RISK ASSESSMENT (PT/OT)(this is a two part measure which is paired with Measure #155)CPT Codes: 97001, 97002, 97003, 97004; Frequency: once per reporting periodDoes the patient have more than 2 falls or anyfalls within the injury period in the last year?No1101FPatient is not eligible but screened forfuture falls (Measure #155 is not required for reporting)OR1101F - 8PPatient is not eligible, no documented fallswith modifier 8P not performed, reason notspecified (Measure #155 is not required for reporting)Yes1100FPatient screened for futurefalls, documentedRECORD & CONTINUENoWas a fall assessmentcompleted?1100F is paired with 3288FAND if 1100f is reported,Measure #155 is requiredsee next pageYes3288F - 8PFall documented with modifier8P, not performed, reason notspecified; MAY CONTINUE WITHFALLS - PLAN OF CAREOR3288F - 1PFall documented withmodifier 1P, not performed dueto medical reason3288FFall documented; MAY CONTINUE WITH FALLS - PLAN OF CARE
PQRS MeasuresMEASURE #155 - FALLS - PLAN OF CARE (PT/OT)(this is a two part measure which is paired with Measure #154)CPT Codes: 97001, 97002, 97003, 97004; Frequency: once per reporting periodDid you complete a plan of care for the patient?Yes0518FPlan of care is documented in EMRNo0518F - 8PPlan of care is not documented withmodifier 8P, not performed, reasonnot speicifiedOR0518F - 1PPlan of care is not documentedwith modifier 1P, not performeddue to medical reason
PQRS MeasuresMEASURE #181 - ELDER MALTREATMENT SCREEN AND FOLLOW UP PLAN (OT)CPT Codes: 97003; Frequency: once per reporting periodWas the patient screen documented?NoG8535Screen not documented, patient not eligibleORYesIs screen positive or negative?G8536Screen not documented, reason not givenNegative G8734Screen documented negative, follow up not requiredPositiveG8733Screen documented positive, follow up plan documentedORG8941Screen documented positive, follow up plan not documented, patient not eligibleORG8735Screen documented positive, follow up plan not documented, reason not given
PQRS MeasuresMEASURE #182 - FUNCTIONAL OUTCOME ASSESSMENT (PT/OT/CHIRO)NEW 2015 this measure now counts as a Cross-cut measureCPT Codes: 97001, 97002, 97003, 97004, 98940, 98941, 98942; Frequency: each visitDid you complete a functional outcome asssessment?NoG8540Patient is not eligibleORG8541Reason not givenYesWere there any deficiencies?NoG8542Documented no deficiences, plan of care not requiredNoYesDOCUMENT DEFICIENCIESWas a plan of care created?YesG9227G8543Functional outcomeDocumentedassessment, but no OR assessmentdocumented, care plandocumentation ofnot documented,plan of care,patient is not eligiblereason not specifiedG8539Documented assessment andthe plan of care based on theidentified deficienciesORG8942Documented assessmentand the plan of care withinprevious 30 days
PQRS MeasuresMEASURE #226 - TOBACCO USE - SCREENING AND CESSATION INTERVENTION(OT)CPT Codes: 97003, 97004; Frequency: once per reporting periodWas the patient screened for tobacco use?NoORYesWere they identified as a tobacco user?Yes4004FPatient screened for tobacco use andreceived tobacco cessation intervention(counseling, pharmacotherpay, or both),if identified as a tobacco user4004F- 8PTobacco screening not performed with modifier8P, not performed, reason not speicifiedNo1036FPatient screen fortobacco use andidentified as anon-user4004F- 1PTobacco screening not performed with modifier1P, not performed due to medical reason
PQRS MeasuresNEW 2015 this measure has been removed.MEASURE #245 - Chronic Wound Care: Use of Wound SurfaceCulture Technique in Patients with Chronic Skin Ulcers (Overuse Measure)CPT Codes: 97001, 97002; Frequency: each visitWas wound surface culture technique used?Yes4260FWound surface culture technique usedOR4260F with 1PDocumentation of medical reason(s) forusing a wound surface culture techniqueNo4261FTechnique other than surface cultureof the wound exudate used or woundsurface culture technique not used
PQRS MeasuresMEASURE #317 - PREVENTITIVE CARE AND SCREENING: SCREENING FOR HIGHBLOOD PRESSURE AND FOLLOW-UP DOCUMENTEDCPT Codes: 97532 Frequency: once per reporting periodWas the patient screened for high blood pressure?NoG8784BP reading not documented,patient not eligibleORG8785BP reading not documented,reason not givenYesIs BP reading documented?NoG8951Pre-Hypertensive or hypertensive BP reading documented,follow up not documented, patient not eligibleORYesG8783Normal BP reading documented,follow up not requiredG8952Pre-Hypertensive or hypertensive BP reading documented,follow up not documented, reason not givenORG8950Pre-Hypertensive or hypertensive BP readingdocumented, follow up documented
MEASURE #226 - TOBACCO USE - SCREENING AND CESSATION INTERVENTION (OT) CPT Codes: 97003, 97004; Frequency: once per reporting period Was the patient screened for tobacco use? Yes Yes No Were they identified as a to
