pqri measure coding and reporting principles - Indiana Academy of ...

46) Medication Reconciliation - Percentage of patients aged 65 years and older discharged from any inpatient
facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 60 days following discharge
in the office by the physician providing on-going care who had a reconciliation of the discharge medications with
the current medication list in the medical record documented - This measure is to be reported at an office visit
occurring within 60 days of each inpatient facility discharge during the reporting period. This measure is appropriate
for use in the ambulatory setting only. It is anticipated that clinicians who provide primary on-going care will submit
this measure when a patient is seen in the office within 60 days following discharge from any inpatient facility. If a
patient has not been discharged within the 60-day timeframe from an inpatient facility, there are no reporting
requirements for this measure.
ICD-9: No specific diagnosis code and CPT: 99201-99215 (office/outpatient visit), 99387 and 99397 (preventive), 99401-99404 (preventive
counseling)
_____
_____
Patient discharged from an inpatient facility within the last 60 days and discharge medications reconciled
with the current medication list in outpatient medical record (1110F and 1111F)
Patient discharged from an inpatient facility within the last 60 days and discharge medication not
reconciled with current medication list in the medical record, reason not specified (1110F and 1111F-8P)
47) Advance Care Plan - Percentage of patients aged 65 years and older with documentation of a surrogate
decision-maker or advance care plan in the medical record - This measure is to be reported a minimum of once per
reporting period for patients seen during the reporting period. This measure is appropriate for use in all healthcare
settings. It is anticipated that clinicians who provide primary care services for the patient will submit this measure.
ICD-9: No specific diagnosis codes and CPT: 99201-99215 (office/outpatient visit), 99218-99220 (observation services), 99221-99223 (initial
inpatient), 99231-99233 (subsequent inpatient), 99234-99236 (admit and discharge on the same day), 99281-99285 (ED services), 99291
(critical care), 99304-99310 (nursing facility), 99324-99337 (domiciliary/rest home), 99341-99350 (home visits), 99387 and 99397
(preventive services), 99401-99404 (preventive counseling)
_____
_____
_____
Surrogate decision maker or advance care plan documented in the medical record (1080F)
Surrogate decision maker or advance directive not documented for patient reasons (1080F-2P)
Surrogate decision maker or advance directive not documented, reason not specified (1080F-8P)
(Joy’s Comment: For successful reporting of this measure, primary care physicians will have to report on this
measure at least one time for every Medicare patient.)
48) Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and
Older - Percentage of female patients aged 65 years and older who were assessed for the presence or absence of
urinary incontinence within 12 months - This measure is to be reported a minimum of once per reporting period for
patients seen during the reporting period. This measure is appropriate for use in the ambulatory setting only. It is
anticipated that clinicians who provide primary care for the patient will submit this measure.
ICD-9: No specific codes and CPT: 99201-99215 (office/outpatient visit), 99387 and 99397 (preventive), 99401-99404 (preventive
counseling)
Definition: Urinary incontinence is defined as any involuntary leakage of urine.
_____
_____
_____
Presence or absence of urinary incontinence assessed (1090F)
Presence or absence of urinary incontinence not assessed for medical reasons (1090F-1P)
Presence or absence of urinary incontinence not assessed reason not specified (1090F-8P)
49) Characterization of Urinary Incontinence in Women Aged 65 Years and Older - Percentage of
female patients aged 65 years and older with a diagnosis of urinary incontinence whose urinary incontinence was
characterized at least once within 12 months - This measure is to be reported a minimum of once per reporting
period for patients seen during the reporting period. This measure is appropriate for use in the ambulatory setting
only. It is anticipated that clinicians who provide services for patients with the diagnosis of urinary incontinence will
submit this measure.
ICD-9: 307.6, 625.6, 788.30-788.39 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99387 and 99397
(preventive), 99401-99404 (preventive counseling)
5-10
*All CPT Codes, Descriptions, and Two-Digit Modifiers
Only Are Copyright 2006 American Medical Association. GEN 2007 REV 07-01
Copyright 2007 Newby Consulting, Inc.