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

ICD-9: 250.00-250.93, 648.00-648.04 and CPT: 99201-99215 (office/outpatient visit) (office/outpatient visit); 99341-99350 (home visit);
99304-99310 (nursing facility); 99324-99337 (domiciliary); 97802-97804 and G0270-G0271 (nutrition therapy)
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Most recent LDL-C < 100 mg/dL (3048F)
Most recent LDL-C 100-129 mg/dL (3049F)
Most recent LDL-C ≥ 130 mg/dL (3050F)
LDL-C level not performed during last 12 months reason not specified (3048F-8P)
3) High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus - Percentage of patients aged 18-75
years with diabetes (type 1 or type 2) who had most recent blood pressure in control (less than 140/80 mm Hg) -
This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.
The performance period for this measure is 12 months. It is anticipated that clinicians who provide services for the
primary management of diabetes mellitus will submit this measure.
ICD-9: 250.00-250.93, 648.00-648.04 and CPT: 99201-99215 (office/outpatient visit); 99341-99350 (home visit); 99304-99310 (nursing
facility); 99324-99337 (domiciliary); 97802-97804 and G0270-G0271 (nutrition therapy)
Systolic codes
_____ Most recent systolic blood pressure < 130 mm Hg (3074F)
_____ Most recent systolic blood pressure 130 to 139 mm Hg (3075F)
_____ Most recent systolic blood pressure > 140 mm Hg (3077F)
AND
Diastolic codes
_____ Most recent diastolic blood pressure < 80 mm Hg (3078F)
_____ Most recent diastolic blood pressure 80-89 mm Hg (3079F)
_____ Most recent diastolic blood pressure > 90 mm Hg (3080F)
OR
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Blood pressure measurement not performed, reason not specified (2000F-8P)
4) Screening for Future Fall Risk - Percentage of patients aged 65 years and older who were screened for
future fall risk (patients are considered at risk for future falls if they have had 2 or more falls in the past year or any
fall with injury in the past year) 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 all nonacute
settings (excludes emergency departments and acute care hospitals). It is anticipated that clinicians who
provide primary care for the patient will submit this measure.
ICD-9: None specified - CPT: 97001-97004 (PT eval); 99201-99215 (office/outpatient visit), 99304-99310 (nursing facility), 99324-99328
(domiciliary), 99334-99337 (domiciliary), 99341-99350 (home visits), 99387 and 99397 (preventive), 99401-99404 (preventive counseling),
Definition: A fall is defined as a sudden, unintentional change in position causing an individual to land at a lower
level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic
seizure, or overwhelming external force (Tinetti).
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Screening for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the
past year (1100F)
Screening for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the
past year (1101F)
Screening for future fall risk not performed for medical reasons (1100F-1P)
Screening for future fall risk not performed, reason not specified (1100F-8P)
5) Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor
Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) - Percentage of patients aged
18 years and older with a diagnosis of heart failure and left ventricular systolic dysfunction (LVSD) who were
prescribed ACE inhibitor or ARB therapy - This measure is to be reported a minimum of once per reporting period
for all heart failure patients seen during the reporting period. The left ventricular systolic dysfunction may be
*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.
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