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

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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)
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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
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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
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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
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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.
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