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

More documents

Recommendations

Info

Report G8126: 1) For all patients with a diagnosis of Major Depression, New Episode who were prescribed a full 12 week course of antidepressant medication OR 2) At the completion of a 12 week course of antidepressant medication. _____ _____ _____ Patient with new episode of MDD documented as being treated with antidepressant medication during the entire 12 week acute treatment phase (G8126) Patient with new episode of MDD not documented as being treated with antidepressant medication during the entire 12 week acute treatment phase (G8127) Clinician documented that patient with a new episode of MDD was not an eligible candidate for antidepressant medication treatment or patient did not have a new episode of MDD (G8128) 39) Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older - Percentage of female patients aged 65 years and older who have a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed at least once since age 60 or pharmacologic therapy prescribed within 12 months - This measure is to be reported a minimum of once during the reporting period for patients seen during the reporting period. Female patients aged 65 years and older should have a central DXA measurement ordered or performed at least once since the time they turned 60 years or have pharmacologic therapy prescribed to prevent or treat osteoporosis. It is anticipated that clinicians who provide primary care or care for treatment of fracture or osteoporosis will submit this measure. ICD-9: No specific diagnosis codes and CPT: 99201-99215 (office/outpatient visit), 99387 and 99397 (preventive), 99401-99404 (preventive counseling) Definition: Pharmacologic Therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical order: bisphosphonates (alendronate, ibandronate, and risedronate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modules or SERMs (raloxifene). _____ _____ _____ _____ _____ _____ _____ Central Dual-energy X-Ray Absorptiometry (DXA) ordered (3096F) Central Dual-energy X-Ray Absorptiometry (DXA) results documented (3095F) Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (4005F) Documentation of medical reason(s) for not ordering or performing a central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-1P) Documentation of patient reason(s) for not ordering or performing central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-2P) Documentation of system reason(s) for not ordering or performing central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-3P) Central dual energy X-ray absorptiometry (DXA) measurement was not ordered or performed and a pharmacologic therapy for osteoporosis was not prescribed reason not otherwise specified (3096F-8P) 40) Osteoporosis: Management Following Fracture - Percentage of patients aged 50 years and older with fracture of the hip, spine, or distal radius who had a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed or pharmacologic therapy prescribed - This measure is to be reported after each occurrence of a fracture during the reporting period. Patients with a fracture of the hip, spine, or distal radius should have a central DXA measurement ordered or performed or pharmacologic therapy prescribed. The management (DXA ordered or performed or pharmacologic therapy prescribed) should occur within three months of the initial visit with the reporting clinician following the fracture. Patients with documentation of prior central DXA measurement or already receiving pharmacologic therapy would automatically meet the intent of this measure. It is anticipated that clinicians who manage the primary or ongoing care for osteoporosis or osteoporosis related fracture(s) will submit this measure. ICD-9: 733.12-733.14, 805.00-805.08, 805.10-805.18, 805.2, 805.4, 805.6, 805.8, 813.40-813.42, 813.44, 813.45, 813.50-813.52, 813.54, 820.00-820.03, 820.09-820.11, 820.20-820.22, 820.13. 820.8, 820.9 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office consult) *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. 5-8
Definition: Pharmacologic Therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical order: bisphosphonates (alendronate, ibandronate, and risedronate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modules or SERMs (raloxifene). _____ _____ _____ _____ _____ _____ _____ Central dual energy X-ray absorptiometry (DXA) ordered (3096F) Central dual energy X-ray absorptiometry (DXA) results documented (3095F) Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (4005F) Documentation of medical reason(s) for not ordering or performing a central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-1P) Documentation of patient reason(s) for not ordering or performing a central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-2P) Documentation of system reason(s) for not ordering or performing a central dual energy X-ray absorptiometry (DXA) measurement or not prescribing pharmacologic therapy for osteoporosis (3096F-3P) Central dual energy X-ray absorptiometry (DXA) measurement was not ordered or performed and a pharmacologic therapy for osteoporosis was not prescribed reason not otherwise specified (3096F-8P) 41) Osteoporosis: Pharmacologic Therapy - Percentage of patients aged 50 years and older with a diagnosis of osteoporosis who were prescribed pharmacologic therapy within 12 months - This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. Patients with a diagnosis of osteoporosis should be prescribed pharmacologic therapy to treat osteoporosis. It is anticipated that clinicians who provide services for patients with the diagnosis of osteoporosis will submit this measure. ICD-9: 733.00-733.03, 733.09 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99386-99387 and 99396- 99397 (preventive), 99401-99404 (preventive counseling) Definition: Pharmacologic Therapy: U.S. Food and Drug Administration approved pharmacologic options for osteoporosis prevention and/or treatment of postmenopausal osteoporosis include, in alphabetical order: bisphosphonates (alendronate, ibandronate, and risedronate), calcitonin, estrogens (estrogens and/or hormone therapy), parathyroid hormone [PTH (1-34), teriparatide], and selective estrogen receptor modules or SERMs (raloxifene). _____ _____ 1P) _____ _____ _____ Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed (4005F) Documentation of medical reason(s) for not prescribing pharmacologic therapy for osteoporosis (4005F- Documentation of patient reason(s) for not prescribing pharmacologic therapy for osteoporosis (4005F-2P) Documentation of system reason for not prescribing pharmacologic therapy for osteoporosis (4005F-3P) Pharmacologic therapy for osteoporosis was not prescribed reason not otherwise specified (4005F-8P) 42) Osteoporosis: Counseling for Vitamin D, Calcium Intake, and Exercise - Percentage of patients, regardless of age, with a diagnosis of osteoporosis who are either receiving both calcium and vitamin D or have been counseled regarding both calcium and vitamin D intake, and exercise 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. Patients with a diagnosis of osteoporosis should be receiving both calcium and vitamin D or had counseling regarding their use and counseled on exercise. It is anticipated that clinicians who provide services for patients with the diagnosis of osteoporosis will submit this measure. ICD-9: 733.00-733.03, 733.09 and CPT: 99201-99215 (office/outpatient visit), 99241-99245 (office/outpatient consult), 99385-99387 and 99395-99397 (preventive), 99401-99404 (preventive counseling) _____ _____ _____ Documentation of receipt of counseling on exercise AND either both calcium and vitamin D use or counseling regarding both calcium and vitamin D use (4019F) Documentation of medical reason(s) for patient not receiving both calcium and vitamin D or and not needing counseling regarding both calcium and vitamin D intake, and exercise (e.g., patient has dementia and is unable to receive counseling) (4019F-1P) Receipt of counseling on exercise AND either both calcium and vitamin D use or counseling regarding both calcium and vitamin D use was not documented reason not otherwise specified (4019F-8P) *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. 5-9
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: _____ _____ _____ _____ _____ Beta-
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

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?