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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.
Definition: Characterization includes, but is not limited to, (frequency, volume, timing, type of symptoms, how bothersome) _____ _____ Urinary incontinence characterized (1091F) Urinary incontinence not characterized reason not specified (1091F-8P) 50) Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older - Percentage of female patients aged 65 years and older with a diagnosis of urinary incontinence with a documented plan of care for urinary incontinence 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) Definition: Plan of care may include behavioral interventions (e.g., bladder training, pelvic floor muscle training, prompted voiding), referral to specialist, surgical treatment, reassess at follow-up visit, lifestyle interventions, addressing co-morbid factors, modification or discontinuation of medications contributing to urinary incontinence, or pharmacologic therapy. _____ _____ Urinary incontinence plan of care documented (0509F) Plan of care for urinary incontinence not documented reason not specified (0509F-8P) 51) Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation - Percentage of patients aged 18 years and older with a diagnosis of COPD who had spirometry evaluation results documented - This measure is to be reported a minimum of once per reporting period using the most recent spirometry results in the patient record for patients seen during the reporting period. It is anticipated that clinicians who provide primary care services for the patient will submit this measure. ICD-9: 491.0, 491.1, 491.20-491.22, 491.8, 491.9, 492.0, 492.8, 496 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99385-99387, 99395-99397 (preventive), 99401-99404 (preventive counseling) Instructions: Look for most recent documentation of spirometry evaluation results in the medical record; do not limit the search to the reporting period. _____ _____ _____ _____ _____ Spirometry results documented and reviewed (3023F) Spirometry results not documented medical reason(s) (3023F-1P) Spirometry results not documented for patient reasons (3023F-2P) Spirometry results not documented for system reasons (3023F-3P) Spirometry results not documented, reason not specified (3023F-8P) 52) Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy - Percentage of patients aged 18 years and older with a diagnosis of COPD and who have an FEV1/FVC less than 70% and have symptoms who were prescribed an inhaled bronchodilator - This measure is to be reported a minimum of once per reporting period for all COPD patients seen during the reporting period. It is anticipated that clinicians who provide primary care services for the patient will submit this measure. ICD-9: 491.0, 491.1, 491.20-491.22, 491.8, 491.9, 492.0, 492.8, 496 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99385-99387, 99395-99397 (preventive), 99401-99404 (preventive counseling) _____ _____ _____ Inhaled bronchodilator prescribed and spirometry test results demonstrate FEV 1 /FVC < 70% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) (4025F and 3025F) Documentation of medical reason(s) for not prescribing an inhaled bronchodilator and spirometry test results demonstrate FEV 1 /FVC < 70% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) (4025F-1P and 3025F) Documentation of patient reason(s) for not prescribing an inhaled bronchodilator and spirometry test results demonstrate FEV 1 /FVC < 70% with COPD symptoms (e.g., dyspnea, cough/sputum, wheezing) (4025F-2P and 3025F) 5-11 *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.
Page 1 and 2: PQRI MEASURE CODING AND REPORTING P
Page 3 and 4: ! The line item charge should be $0
Page 5 and 6: ICD-9: 250.00-250.93, 648.00-648.04
Page 7 and 8: _____ _____ _____ _____ _____ Beta-
Page 9: Definition: Pharmacologic Therapy:
Page 13 and 14: eport the proper CPT II Category II
Page 15 and 16: • Physicians and qualified nonphy
Page 17 and 18: preoperative medical evaluation (if
Page 19 and 20: The excision of malignant lesion co
Page 21 and 22: complex repairs (CPT codes 13100-13
Page 23 and 24: HEMORRHOIDECTOMY BY SIMPLE LIGATURE
Page 25 and 26: Medicare “Incident to Clarificati
Page 27 and 28: service or other face-to-face servi
Page 29 and 30: HOSPITAL OBSERVATION SERVICES - CPT
Page 31 and 32: If the physicians are each responsi
Page 33 and 34: documented. If the time is not docu
Page 35 and 36: Follow-Up Consultation Service Effe
Page 37 and 38: A physician (primary care or specia
Page 39 and 40: typical severity of the problem(s)
Page 41 and 42: Medicare Part B payment policy does
Page 43 and 44: HOME SERVICES - CPT CODES 99341-993
Page 45 and 46: the medical records must clearly do

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