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

eport the proper CPT II Category II code with modifier indicated in the numerator coding indicating this is not the
initial evaluation. It is anticipated that clinicians who provide care for patients with GERD will submit this measure.
ICD-9: 530.81, 530.10-530.12, 530.19 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult)
Definition: Alarm symptoms for GERD include involuntary weight loss, dysphagia, and GI bleeding.
_____ Upper gastrointestinal endoscopy performed (3130F)
_____ Documentation of referral for upper gastrointestinal endoscopy (3132F and 1071F)
_____ Patient does not have alarm symptoms (1070F)
_____ Initial evaluation of GERD occurred prior to the reporting period (1071F-8P)
_____ Upper endoscopy not performed or patient not referred for upper endoscopy for medical reasons (e.g.,
patient has already had the procedure) (3130F-1P and 1071F)
_____ Upper endoscopy not performed or patient not referred for upper endoscopy for patient reasons (3130F-2P
and 1071F)
_____ Upper endoscopy not performed or patient not referred for upper endoscopy for system reasons (3130F-3P
and 1071F)
_____ Upper endoscopy not performed or patient not referred for upper endoscopy, reason not specified (3130F-
8P and 1071F)
(Joy’s Comment: For successful reporting of this measure, physicians will have to report on this measure and
measure #60 at least one time for every Medicare patient with GERD.)
63) Gastroesophageal Reflux Disease (GERD): Barium Swallow- Inappropriate Use - Percentage of
patients aged 18 years and older with a diagnosis of GERD, seen for an initial evaluation, who did not have a
Barium swallow test ordered - This measure is to be reported once for all GERD patients seen during the reporting
period. Patients being seen for an initial evaluation of GERD should not receive a barium swallow test. If the initial
evaluation of GERD occurred prior to the reporting period, report the proper CPT Category II with modifier
indicated in the numerator coding indicating this is not the initial evaluation. It is anticipated that clinicians who
provide care for patients with GERD will submit this measure.
ICD-9: 530.81, 530.10-530.12, 530.19 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult)
Definitions: This is an overuse measure. For performance, the numerator will be calculated as the difference
between patients in the denominator and patients for whom a CPT Category II code was reported for barium
swallow test ordered. A higher score indicates appropriate treatment of patients with GERD (i.e., the proportion for
whom a barium swallow test was not ordered).
_____
_____
_____
_____
Barium swallow test ordered (3142F)
Patient does not meet denominator inclusion because the initial evaluation of GERD occurred prior to the
reporting period (3200F-8P)
Barium swallow test ordered for medical reasons (3142F-1P)
Barium swallow test not ordered (3200F)
(Joy’s Comment: For successful reporting of this measure, physicians will have to report on this measure and
measure #60 at least one time for every Medicare patient with GERD.)
64) Asthma Assessment - Percentage of patients aged 5 to 40 years with a diagnosis of asthma who were
evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal
asthma symptoms - This measure is to be reported a minimum of once per reporting period for patients seen during
the reporting period. It is anticipated that clinicians who provide primary care services for the patient with a
diagnosis of asthma will submit this measure.
ICD-9: 493.00-493.02, 493.10-493.12, 493.20-493.22, 493.81, 493.82, 493.90, 493.92 and CPT: 99201-99215 (office/outpatient visit), 99241-
99245 (office/outpatient consult), 99383-99386, 99393-99396 (preventive), 99401-99404 (preventive counseling)
Definitions: To be counted in calculations of this measure, symptom frequency must be numerically quantified.
Measure may also be met by clinician documentation or patient completion of an asthma assessment
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*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.