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determined by quantitative or qualitative assessment. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of left ventricular systolic dysfunction or 2) that uses descriptive terms such as moderately or severely depressed left ventricular dysfunction. It is anticipated that clinicians who provide primary management of patients with heart failure will submit this measure. ICD-9: 402.01, 402.11, 402.91; 404.01, 404.03, 404.11, 404.13, 404.91, 404.93; 428.0, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43, 428.9 and CPT: 99201-99215 (office/outpatient visit), 99238, 99239 (discharge), 99241-99245 (office/outpatient consult), 99304-99310 (nursing facility), 99324-99337 (domiciliary), 99341-99350 (home visit) _____ OR _____ _____ _____ AND _____ _____ _____ ACE inhibitor or ARB therapy prescribed and left ventricular ejection fraction (LVEF)
_____ _____ _____ _____ _____ Beta-blocker therapy prescribed (4006F) Documentation of medical reason(s) for not prescribing beta-blocker therapy (4006F-1P) Documentation of patient reason(s) for not prescribing beta-blocker therapy (4006F-2P) Documentation of system reason(s) for not prescribing beta-blocker therapy (4006F-3P) Beta-blocker therapy not prescribed, reason not specified (4006F-8P) 8) Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic Dysfunction - Percentage of patients aged 18 years and older with a diagnosis of heart failure who also have left ventricular systolic dysfunction (LVSD) and who were prescribed beta-blocker 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 determined by quantitative or qualitative assessment. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of left ventricular systolic dysfunction or 2) that uses descriptive terms such as moderately or severely depressed left ventricular dysfunction. It is anticipated that clinicians who provide primary management of patients with heart failure will submit this measure. ICD-9: 402.01, 402.11, 402.91; 404.01, 404.03, 404.11, 404.13, 404.91, 404.93; 428.0, 428.1, 428.20-428.23, 428.30-428.33, 428.40-428.43, 428.9 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99341-99350 (home visit), 99304-99310 (nursing facility), 99324-99337 (domiciliary) _____ Beta blocker therapy prescribed and left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (4006F and 3021F) OR _____ _____ _____ Documentation of medical reason(s) for not prescribing beta-blocker therapy (4006F-1P) Documentation of patient reason(s) for not prescribing beta-blocker therapy (4006F-2P) Documentation of system reason(s) for not prescribing beta-blocker therapy (4006F-3P) AND _____ _____ _____ Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (3021F) Left ventricular ejection fraction (LVEF) ≥ 40% or documentation as normal or mildly depressed left ventricular systolic function (3022F) Left ventricular ejection fraction (LVEF) was not performed or documented, reason not otherwise specified (3021F-8P) OR _____ Beta-blocker therapy was not prescribed, reason not otherwise specified and left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (4006F-8P and 3021F) 9) Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression - Percentage of patients aged 18 years and older diagnosed with new episode of major depressive disorder (MDD) and documented as treated with antidepressant medication during the entire 84-day (12 week) acute treatment phase - This measure is to be reported for each occurrence of MDD during the reporting period. It is anticipated that clinicians who provide the primary management of patients with major depressive disorder (MDD) will submit this measure. ICD-9: 296.20-296.24, 296.30-296.34, 298.0, 300.4, 309.1, 311 and CPT: 99201-99215 (office/outpatient visit); 90801, 90802, 90804-90809, 90862 (psychiatry) Definition: A “new episode” is defined as a patient with major depression who has not been seen or treated for major depression by any practitioner in the prior 4 months. A new episode can either be a recurrence for a patient with prior major depression or a patient with a new onset of major depression. *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. 5-7
Page 1 and 2: PQRI MEASURE CODING AND REPORTING P
Page 3 and 4: ! The line item charge should be $0
Page 5: ICD-9: 250.00-250.93, 648.00-648.04
Page 9 and 10: Definition: Pharmacologic Therapy:
Page 11 and 12: Definition: Characterization includ
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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