168
PQRS Clinical Quality Measures Session 2
PQRS
Clinical Quality
Measures
Session 2
Clinical Quality Measures
Meaningful Use Stages 1 &2 and PQRS Aprima PRM 2015 and Patch 1
© 2016 Aprima Medical Software, Inc. All rights reserved. Confidential and Proprietary. Aprima is a registered trademark of Aprima Medical Software.
All other trademarks are the property of their respective holders.
Reference Number: 1117.18
2 Ref: 1117.18
ONC Certified HIT
Aprima PRM 2015 EHR (electronic health record) and PM (practice management), version 15.0.1, has received Meaningful Use Stages 1 and 2 certification as a Complete EHR for use in ambulatory care settings from InfoGard (www.infogard.com), an accredited ONC-ACB certification body. This Complete EHR is 2014 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services or guarantee receipt of incentive payments.
The application’s original certification was received on August 5, 2013, and the original InfoGuard certification number was IG-2999-13-0024. The application’s most recent certification was received on December 1, 2015. Current certification information is shown in the table below.
Vendor Name: Aprima Medical Software, Inc.
Certified EHR Name: Aprima PRM 2015
Certified EHR Version: 15.0.1
InfoGard Certification #: IG-2999-15-0061
CMS EHR Certification ID 1314E01RBJXGEAT
[for use on the Medicare and Medicaid EHR Incentive Program website]
Certification Date: 12/01/2015
Classification: Complete
Practice Setting: Ambulatory
Requirements Edition: 2014
Clinical Quality Measures: CMS2 v3, CMS22 v2, CMS50 v2, CMS52 v2, CMS56 v2, CMS61 v3, CMS62 v2, CMS64 v3, CMS65 v3, CMS66 v2, CMS68 v3, CMS69 v2, CMS74 v3, CMS75 v2, CMS77 v2, CMS82 v1, CMS90 v3, CMS117 v2, CMS122 v2, CMS123 v2, CMS124 v2, CMS125 v2, CMS126 v2, CMS127 v2, CMS128 v2, CMS129 v3, CMS130 v2, CMS131 v2, CMS132 v2, CMS133 v2, CMS134 v2, CMS135 v2, CMS136 v3, CMS137 v2, CMS138v2, CMS139 v2, CMS142 v2, CMS143 v2, CMS144 v2, CMS145 v2, CMS146 v2, CMS147 v2, CMS148 v2, CMS149 v2, CMS153 v2, CMS154 v2, CMS155 v2, CMS156 v2, CMS158 v2, CMS159 v2, CMS160 v2, CMS161 v2, CMS163 v2, CMS164 v2, CMS165 v2, CMS166 v2, CMS167 v2, CMS169 v2, CMS177 v2, CMS182 v3
Additional SW Required: Microsoft Excel
Ref: 1117.18 3
Contents
Introduction ................................................................................................. 7
Using This Guide ....................................................................................... 7
Measures to Report ......................................................................................... 7
Measure Numbering Systems ......................................................................... 8
CMS Recommended Measures for Adults ............................................................ 8
Office of the National Coordinator for Health Information Technology Recommended Core Measures for Adults and Pediatric .................................................................. 9
Certified Measures by Domain ....................................................................... 10
Information on Clinical Codes Used for CQMs ..................................................... 15
Submission of Data ........................................................................................ 17
PQRS .................................................................................................... 17
Meaningful Use ........................................................................................ 18
Comprehensive Primary Care Initiative ............................................................ 19
Use of Aprima PRM for Only Part of the Year ..................................................... 19
Registration and Attestation ............................................................................. 20
Meaningful Use Registration ......................................................................... 20
PQRS Registration for EHR-Based Reporting ....................................................... 20
QualityNet PQRS Portal .............................................................................. 21
Reporting Configuration .................................................................................. 21
Enter Practice, Provider, and Patient Information ............................................... 22
Identify the Payer Typology for All Insurance Payers ............................................ 23
Verify Procedure Code Definitions .................................................................. 24
Create Negation Reasons............................................................................. 28
Associate LOINC Codes with Lab Tests Used for Measures ...................................... 28
Associate CVX Codes with Types of Vaccine Used for Measures ................................ 30
Associate SNOMED Codes with Items ............................................................... 30
Create a History Group for Procedures ............................................................ 39
Configure Observation Charting ..................................................................... 40
Configure Education Forms .......................................................................... 42
Verify Race and Ethnicity Definitions .............................................................. 45
Configure Attachment Types ........................................................................ 46
Configure Drug Screening for the Practice ........................................................ 46
4 Ref: 1117.18
Clinical Quality Measure Details ......................................................................... 47
Measure Denominators and Numerators ........................................................... 48
Entering Data for Exclusions and Exceptions ...................................................... 49
CMS Measure Definitions ............................................................................. 50
CMS 2; NQF 0418; PQRS 134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan ..................................................................... 50
CMS 22 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented .......................................................................................... 53
CMS 50; NQF NA; PQRS 374 Closing the Referral Loop: Receipt of Specialist Report ....... 57
CMS 52; NQF 0405; PQRS 160 HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis ............................................................................................ 58
CMS 56; NQF NA; PQRS 376 Functional Status Assessment for Hip Replacement ............ 60
CMS 61; NQF NA; PQRS 316 Preventive Care and Screening: Cholesterol — Fasting Low Density Lipoprotein (LDL-C) Test Performed ..................................................... 62
CMS 62; NQF 0403, PQRS 368 HIV/AIDS: Medical Visit ........................................... 66
CMS 64; NQF NA; PQRS 316 Preventive Care and Screening: Risk- Stratified Cholesterol — Fasting Low Density Lipoprotein (LDL-C) ......................................................... 67
CMS 65; NQF NA; PQRS 373 Hypertension: Improvement in Blood Pressure .................. 71
CMS 66; NQF NA; PQRS 375 Functional Status Assessment for Knee Replacement .......... 73
CMS 68; NQF 0419; PQRS 130 Documentation of Current Medications in the Medical Record .......................................................................................................... 75
CMS 69; NQF 0421; PQRS 128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up ............................................................................ 76
CMS 74; NQF NA; PQRS 379 Primary Caries Prevention Intervention as Offered by Primary Care Providers, Including Dentists ................................................................. 78
CMS 75; NQF NA; PQRS 378 Children Who Have Dental Decay or Cavities .................... 79
CMS 77; NQF NA; PQRS 381 HIV/AIDS: RNA Control for Patients with HIV .................... 80
CMS 82; NQF 1401; PQRS 372 Maternal Depression Screening .................................. 81
CMS 90; NQF NA; PQRS 377 Functional Status Assessment for Complex Chronic Conditions .......................................................................................................... 82
CMS 117; NQF 0038; PQRS 240 Childhood Immunization Status ................................ 83
CMS 122; NQF 0059; PQRS 1 Diabetes: Hemoglobin A1c Poor Control ......................... 85
CMS 123; NQF 0056; PQRS 163 Diabetes Foot Exam .............................................. 86
CMS 124; NQF 0032; PQRS 309 Cervical Cancer Screening ...................................... 88
CMS 125; NQF NA; PQRS 112 Breast Cancer Screening ........................................... 89
CMS 126; NQF 0036; PQRS 311 Use of Appropriate Medications for Asthma .................. 90
CMS 127; NQF 0043; PQRS 111 Pneumonia Vaccination Status for Older Adults ............. 91
Ref: 1117.18 5
CMS 128; PQRS 0105; PQRS 9 Anti-Depressant Medication Management ...................... 92
CMS 129; NQF 0389; PQRS 102 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients ....................................................... 94
CMS 130; NQF 0034; PQRS 113 Colorectal Cancer Screening ................................... 96
CMS 131; NQF 0055; PQRS 117 Diabetes: Eye Exam .............................................. 97
CMS 132; NQF 0564; PQRS 192 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures ............................................... 99
CMS 133; NQF 0565; PQRS 191 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery ....................................................................... 101
CMS 134; NQF 0062; PQRS 119 Diabetes: Urine Protein Screening ............................102
CMS 135; NQF 0081; PQRS 5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) ................................................................................. 105
CMS 136; NQF 0108; PQRS 366 Follow-Up Care for Children Prescribed Attention- Deficit/Hyperactivity Disorder (ADHD) Medication ............................................ 107
CMS 137; NQF 0004; PQRS 305 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment ........................................................................... 108
CMS 138; NQF 0028; PQRS 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention ............................................................................. 111
CMS 139; NQF 0101; PQRS 318 Screening for Future Fall Risk .................................113
CMS 140; NQF 0387; PQRS 71 Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer .......................... 114
CMS 141; NQF 0385; PQRS 72 Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients .............................................................................................. 114
CMS 142; NQF 0089; PQRS 19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care ................................................................ 114
CMS 143; NQF 0086; PQRS 12 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation ........................................................................................... 116
CMS 144; NQF 0083; PQRS 8 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) ....................................................................... 117
CMS 145; NQF 0070; PQRS 7 Coronary Artery Disease (CAD): Beta-Blocker Therapy- Prior Myocardial infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) ......... 119
CMS 146; NQF 0002; PQRS 66 Appropriate Testing for Children with Pharyngitis ........... 121
CMS 147; NQF 0041; PQRS 110 Preventative Care and Screening: Influenza Immunization .........................................................................................................123
CMS 148; NQF 0060; PQRS 365 Hemoglobin A1c Test for Pediatric Patients ................. 124
CMS 149; NQF NA; PQRS 281 Dementia: Cognitive Assessment ................................ 126
CMS 153; NQF 0033; PQRS 310 Chlamydia Screening for Women .............................127
CMS 154; NQF 0069; PQRS 65 Appropriate Treatment for Children with Upper Respiratory Infection (URI) ...................................................................................... 129
6 Ref: 1117.18
CMS 155; NQF 0024; PQRS 239 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents ................................................ 130
CMS 156; NQF 0022; PQRS 238 Use of High-Risk Medications in the Elderly .................131
CMS 157; NQF 0384; PQRS 143 Oncology: Medical and Radiation – Pain Intensity Quantified .........................................................................................................131
CMS 158; NQF 0608; PQRS 369 Pregnant Women that had HBsAg testing ....................132
CMS 159; NQF 0710; PQRS 370 Depression Remission at Twelve Months ..................... 135
CMS 160; NQF 0712; PQRS 371 Depression Utilization of the PHQ-9 Tool ....................137
CMS 161; NQF 0104; PQRS 107 Major Depressive Disorder (MDD): Suicide Risk Assessment .........................................................................................................139
CMS 163; NQF 0064; PQRS 2 Diabetes: Low Density Lipoprotein (LDL) Management ....... 140
CMS 164; NQF 0068; PQRS 204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic ..................................................................................... 141
CMS 165; NQF 0018; PQRS 236 Controlling High Blood Pressure ............................... 144
CMS 166; NQF 0052; PQRS 312 Use of Imaging Studies for Low Back Pain ................... 145
CMS 167; NQF 0088; PQRS 18 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy ..................................... 147
CMS 169; NQF 0110; PQRS 367 Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use ....................................................................... 149
CMS 177; NQF 1365; PQRS 382 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment .................................................................................... 151
CMS 179; NQF NA; PQRS 380 ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range ................................................................................................ 152
CMS 182; NQF 0075; PQRS 241 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control .......................................................................................... 152
Clinical Quality Reports .................................................................................156
CQM 2015 .............................................................................................. 156
Ref: 1117.18 7
Introduction
The Centers for Medicare and Medicaid Services’ (CMS) uses clinical quality measures for several quality programs. Clinical quality measures are used for the Health Information Technology for Economic and Clinical Health (HITECH) Act initiative, which is commonly referred to as Meaningful Use, and for the Physician Quality Reporting System (PQRS) program.
Although both Meaningful Use and PQRS use the clinical quality measures, the programs have different requirements. These requirements are summarized in the following table.
Please note that Aprima PRM is not certified for all the clinical quality measures. You must select measures for which the application is certified.
Requirement Meaningful Use PQRS
Reporting Period for first year of participation
90 days, aligned with a calendar quarter
Full year
Reporting period for any subsequent year of participation
Full year (CMS has proposed reducing this period, but this has not been enacted.)
Full year
Patient Population All patients Medicare patients only
Using This Guide
This document:
Explains the features and functions that you can use to meet the requirements for the quality control measures.
Gives general information about the quality control measures, and what you must do to meet the measures’ requirements.
Describes the reports you use for quality control measure monitoring and reporting.
Measures to Report
PQRS measure reporting requirements have been aligned with Meaning Use requirements. For both Meaningful Use and PQRS, each provider must perform nine of the available clinical quality measures. You must select clinical quality measures from at least three of the six key health care policy domains defined by the Department of Health and Human Services’ National Quality Strategy.
8 Ref: 1117.18
The six key health care policy domains are:
Care Coordination
Clinical Process/Effectiveness
Efficient Use of Healthcare Resources
Patient and Family Engagement
Patient Safety
Population/Public Health
Please note that for PQRS reporting, if you do not have patient data for at least nine measures from three domains, then you must report on measures for which you do have Medicare patient data. You must report on at least one measure for which you have Medicare patient data.
Unlike Meaningful Use measures, clinical quality measures do not have goals; that is, you do not have to perform the measure’s procedure on a certain percentage of patients. You only have to report your percentage for each measure.
Measure Numbering Systems
Three different numbering systems are used to identify clinical quality measures. The CMS numbering system begins with CMS and is followed by a one to three digit number. The National Quality Forum numbering system begins with NQF and is followed by a four-digit number. The PQRS numbering system begins with PQRS and is followed by a one to three digit number. All clinical quality measures have a CMS and a PQRS number. Some clinical quality measures also have an NQF number.
The Meaningful Use program uses clinical quality measures identified by the CMS numbering system. The PQRS program uses only those clinical quality measures identified by the PQRS numbering system.
This document lists the clinical quality measures with all three numbers. Measures are listed in numerical order by CMS number.
CMS Recommended Measures for Adults
CMS recommends the following measures for adults because these measures align with high priority health care improvement goals. If any of these measures are not relevant for your practice, then choose another, more relevant measure.
CMS 2 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up
Plan
CMS 50 Closing the Referral Loop: Receipt of Specialist Report
CMS 68 Documentation of Current Medications in the Medical Record
Ref: 1117.18 9
CMS 69 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
CMS 90: Functional Status Assessment for Complex Chronic Conditions
CMS 138 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS 156 Use of High-Risk Medications in the Elderly
CMS 165 Controlling High Blood Pressure
CMS 166 Use of Imaging Studies for Low Back Pain
Office of the National Coordinator for Health Information Technology Recommended Core Measures for Adults and Pediatric
CMS 2 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
CMS 50 Closing the referral loop: receipt of specialist report
CMS 68 Documentation of Current Medications in the Medical Record
CMS 69 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
CMS 75 Children who have dental decay or cavities
CMS 90 Functional status assessment for complex chronic conditions
CMS 117 Childhood Immunization Status
CMS 126 Use of Appropriate Medications for Asthma
CMS 136 ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
CMS 138 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
CMS 146 Appropriate Testing for Children with Pharyngitis
CMS 153 Chlamydia Screening for Women
CMS 154 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
CMS 155 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
CMS 156 Use of High-Risk Medications in the Elderly
CMS 165 Controlling High Blood Pressure
CMS 166 Use of Imaging Studies for Low Back Pain
10 Ref: 1117.18
Certified Measures by Domain
The following tables list the measures by key health care policy domain, as defined by the Department of Health and Human Services’ National Quality Strategy. Measures are list in numerical order by CMS number. NQF and PQRS numbers are also shown. Not all measures have an NQF number.
The tables also show the Aprima status of each measure. The statuses are:
Certified: Aprima PRM is certified for this measure.
Not Certified: Aprima is not seeking certification for this measure. It cannot be used.
You must report on nine measures from at least three of the six domains. You must select measures that are certified in the version of the application you will use when reporting.
Care Coordination Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
50 NA 374 Closing the Referral Loop: Receipt of Specialist Report
Certified
Clinical Process/Effectiveness Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
52 0405 160 HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis
Certified
61 NA 316 Preventive Care and Screening: Cholesterol — Fasting Low Density Lipoprotein (LDL-C) Test Performed
Certified
62 0403 368 HIV/AIDS: Medical Visit Certified
64 NA 316 Preventive Care and Screening: Risk- Stratified Cholesterol — Fasting Low Density Lipoprotein (LDL-C)
Certified
65 NA 373 Hypertension: Improvement in Blood Pressure
Certified
74 NA 379 Primary Caries Prevention Intervention as Offered by Primary Care Providers, Including Dentists
Certified
Ref: 1117.18 11
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
75 NA 378 Children Who Have Dental Decay or Cavities Certified
77 NA 381 HIV/AIDS: RNA Control for Patients with HIV Certified
122 0059 1 Diabetes: Hemoglobin A1c Poor Control Certified
123 0056 163 Diabetes Foot Exam Certified
124 0032 309 Cervical Cancer Screening Certified
125 NA 112 Breast Cancer Screening Certified
126 0036 311 Use of Appropriate Medications for Asthma Certified
127 0043 111 Pneumonia Vaccination Status for Older Adults
Certified
128 0105 9 Anti-Depressant Medication Management Certified
130 0034 113 Colorectal Cancer Screening Certified
131 0055 117 Diabetes: Eye Exam Certified
133 0565 191 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
Certified
134 0062 119 Diabetes: Urine Protein Screening Certified
135 0081 5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Certified
136 0108 366 Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Certified
137 0004 305 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Certified
140 0387 71 Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Not Certified
141 0385 72 Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients
Not Certified
12 Ref: 1117.18
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
142 0089 19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Certified
143 0086 12 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Certified
144 0083 8 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Certified
145 0070 7 Coronary Artery Disease (CAD): Beta-Blocker Therapy- Prior Myocardial infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Certified
148 0060 365 Hemoglobin A1c Test for Pediatric Patients Certified
149 NA 281 Dementia: Cognitive Assessment Certified
158 0608 369 Pregnant Women that had HBsAg testing Certified
159 0710 370 Depression Remission at Twelve Months Certified
160 0712 371 Depression Utilization of the PHQ-9 Tool Certified
161 0104 107 Major Depressive Disorder (MDD): Suicide Risk Assessment
Certified
163 0064 2 Diabetes: Low Density Lipoprotein (LDL) Management
Certified
164 0068 204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Certified
165 0018 236 Controlling High Blood Pressure Certified
167 0088 18 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Certified
169 0110 367 Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use
Certified
182 0075 241 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Certified
Ref: 1117.18 13
Efficient Use of Healthcare Resources Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
129 0389 102 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Certified
146 0002 66 Appropriate Testing for Children with Pharyngitis
Certified
154 0069 65 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Certified
166 0052 312 Use of Imaging Studies for Low Back Pain Certified
Patient and Family Engagement Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
56 NA 376 Functional Status Assessment for Hip Replacement
Certified
66 NA 375 Functional Status Assessment for Knee Replacement
Certified
90 NA 377 Functional Status Assessment for Complex Chronic Conditions
Certified
157 0384 143 Oncology: Medical and Radiation – Pain Intensity Quantified
Not Certified
Patient Safety Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
68 0419 130 Documentation of Current Medications in the Medical Record
Certified
132 0564 192 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
Certified
139 0101 318 Screening for Future Fall Risk Certified
156 0022 238 Use of High-Risk Medications in the Elderly Certified
14 Ref: 1117.18
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
177 1365 382 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment
Certified
179 NA 380 ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range
Not Certified
Population/Public Health Domain
CMS No.
NQF No.
PQRS No.
Measure Name Aprima Status
2 0418 134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Certified
22 NA 317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
Certified
69 0421 128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Certified
82 1401 372 Maternal Depression Screening Certified
117 0038 240 Childhood Immunization Status Certified
138 0028 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Certified
147 0041 110 Preventative Care and Screening: Influenza Immunization
Certified
153 0033 310 Chlamydia Screening for Women Certified
155 0024 239 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Certified
Ref: 1117.18 15
Information on Clinical Codes Used for CQMs
Clinical codes, such as diagnosis codes, procedure codes, SNOMED codes, etc., that you chart in visit notes are used to identify the patients or visits to be included in a clinical quality measure’s initial patient population, denominator population, and numerator population. Each measure has its own set of codes that qualify for the measure. If the measure has exclusions, then the measure also has codes that qualify for the exclusions. You may download the complete official code set from the NIH Value Set Authority Center website.
You can also access tables of the valid clinical codes for the clinical quality measures from the online Help within the application. Code tables are provided for those items that are frequently used or that may be problematic when troubleshooting numerator and denominator numbers. Code tables are not included for items with extremely large inclusive code sets.
Use the following process to access the code tables in the online Help.
1. Help menu → Clinical Codes for CQMs
16 Ref: 1117.18
2. In the Help window, select the hyperlink for the desired CQM.
3. The window then displays the measure description. Select the hyperlink for the desired code set.
Ref: 1117.18 17
4. Review the list of codes. You can use CTRL+F to access the Find function to search for a code or other text string.
Submission of Data
There are two ways that you can report on clinical quality measures. You can either:
Attest to CQMs through the EHR Registration & Attestation System, or
eReport CQMs through Physician Quality Reporting System (PQRS) Portal.
Aprima recommends attestation through the EHR Registration & Attestation System because this enables you to enter the actual values into the attestation application with less risk of file rejections.
More information is available from the CMS website at http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/ReportingCQMsin2015.html
PQRS
PQRS data may be submitted for individual providers or for a group of providers submitting under a single tax ID number (TIN). To submit as a group, you must register to take part in PQRS GPRO. Once you have registered, then group submission is the only submission mechanism that CMS will analyze to determine subjectivity to payment adjustment for the group and all associated NPIs who bill Medicare under the group's TIN.
When you register for PQRS GPRO, you must identify the submission method you will use. The only submission method supported by Aprima PRM for GPRO is the direct electronic health record (EHR) using certified EHR technology (CEHRT) method. Please see the Submission Methods section below for more information
18 Ref: 1117.18
Submission Methods
Eligible providers who are participating in the PQRS program may report by any of the following methods.
Medicare Part B claims
Qualified registry
Direct electronic health record (EHR) using certified EHR technology (CEHRT) (This is the QualityNet Portal.)
CEHRT via Data Submission Vendor
Qualified Clinical Data Registry
Some of these reporting methods require you to select from a subset of clinical quality measures. This document only contains information about the subset of measures that may be report using the direct electronic health record (EHR) using certified EHR technology (CEHRT) method.
More Information on PQRS
More information about the PQRS program is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/pqrs/index.html
More information about the payment reduction associated with PQRS participation is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/Payment-Adjustment-Information.html
Meaningful Use
Meaningful Use allows you to attest to your clinical quality measure results when attesting for the Meaningful Use measures. Aprima recommends the attestation reporting option.
Because the clinical quality measures for Meaningful Use and PQRS are now aligned, your data submission and reporting options for Meaningful Use may be aligned with your PQRS data submission.
If you submit your PQRS data using the QualityNet Portal for the direct electronic health record (EHR) using certified EHR technology submission method, then you may use this same method for Meaningful Use. Your PQRS data can be submitted for Meaningful Use as well, or you may make a separate submission for Meaningful Use. For example, if you are reporting for Meaningful Use for the first time, you may submit your 90 days of Meaningful Use data before the end of the calendar year, and then after the end of the year, submit your PQRS data.
If you submit your PQRS data using any of the other methods, then you may simply attest to your clinical quality measure results when attesting for the Meaningful Use measures. Your PQRS data submission then supports your Meaningful Use attestation.
Ref: 1117.18 19
More Information on Meaningful Use
More information about Meaningful Use reporting using a Stage 2 certified EHR is available from the CMS website at http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
For instructions on using Aprima PRM for Meaningful Use measures, please refer to the Aprima PRM Meaningful Use Guide for 2015.
Comprehensive Primary Care Initiative
The Comprehensive Primary Care (CPC) Initiative uses the same clinical quality measures as Meaningful Use and PQRS. CPC data is submitted as a group. However, the QRDA file structure used for CPC data submission is different than the file structure used for PQRS.
More Information on CPC
More information about the CPC Initiative is available from the CMS website at http://innovation.cms.gov/initiatives/comprehensive-primary-care-initiative/.
Use of Aprima PRM for Only Part of the Year
If you were using another EHR application and you started using Aprima PRM sometime during the 2015 calendar year, then you can only generate reporting information from the application for the portion of the year during which you used the application. For example, if you started using Aprima PRM on April 13, 2015, then you can only generate reports for the period of April 13 to December 31, 2015.
Please contact QualityNet for specifics and requirements if you are only reporting for part of the year from Aprima PRM. QualityNet has special registration and instructions for this situation.
20 Ref: 1117.18
Registration and Attestation Meaningful Use Registration
Please refer to the Aprima PRM Meaningful Use Guide for 2015 for information and instructions on registration and attestation for Meaningful Use.
PQRS Registration for EHR-Based Reporting
In order to submit your PQRS reporting data using EHR-based reporting, you need at least two IDs with different roles in the CMS EIDM system. The first ID must have the Security Official role. The additional IDs must have either the Individual Practitioner role or the Individual Practitioner Representative role. A solo practitioner is a single eligible professional, as identified by NPI number, who bills under an individual tax identification number (TIN). You need one Security Official role ID and an Individual Practitioner role or the Individual Practitioner Representative role for each provider in your practice.
If you are reporting on PQRS for the first time, you must register with EIDM and obtain your IDs and passwords. You should do this as early in the year as possible. The process for obtaining these IDs can take several weeks to complete.
If you have reported on PQRS in the past, then you had IDs for the now retired IACS system. You must convert your IACS Security Officer and EHR Submitter IDs to the new EIDM system. You should do this as early in the year as possible in case there are any issues that must be resolved.
You must change the passwords for the EIDM IDs every 90 days. (You should receive an email notifying you that the password is expiring.) If the user associated with either of these IDs leaves your practice, then you must register a new user and obtain a new ID.
Obtain and Setup EIDM IDs
You must obtain or convert your EIDM IDs and set them up with the ‘Physician Quality and Value Programs’ role. CMS and Aprima urge you to do this as soon as possible. Please note that Aprima cannot assist you with this process or perform it for you. The person who will perform the EIDM role must do this.
The action you need to take depends upon whether you had an active IACS account.
If you do not have an IACS or EIDM account, then follow the instructions provided here to sign up for an EIDM account with the correct role.
If you have an IACS account that you previously used to access QRURs, then follow the instructions provided here to sign up for an EIDM account. You will be allowed to perform the same tasks using your EIDM account that you were able to perform with your IACS account.
If you already have an EIDM account, then follow the instructions provided here to sign up for the correct role in EIDM.
Ref: 1117.18 21
EIDM and QualityNet Questions
For questions about setting up an EIDM account, please contact the QualityNet Help Desk. They are available Monday through Friday, from 7:00 a.m. to 7:00 p.m. CT
Phone: 1 (866) 288-8912 (TTY 1-877-715-6222)
Fax: (888) 329-7377
Email: [email protected]
To avoid security violations, do not include personal identifying information, such as Social Security Number or TIN, in email inquiries to the QualityNet Help Desk.
QualityNet PQRS Portal
The QualityNet PQRS portal is the website established by CMS to which you will upload your PQRS reporting files. Use your EIDM ID to log into the QualityNet PQRS portal.
To access the PQRS portal, browse to:
www.qualitynet.org/portal/server.pt/community/pqri_home/212
You will access this same website to upload your PQRS patient reporting files during the file submission period following the conclusion of the reporting period.
QualityNet Guides
From the following website, you may download the QualityNet PQRS portal user guide, submission user guide, and other guides. The links to the guides are in the menu at the left under the User Guides heading.
https://www.qualitynet.org/portal/server.pt/community/pqri_home/212
Reporting Configuration
There are a number of tasks that you must perform in the application to configure it for clinical quality measure reporting for Meaningful Use and PQRS. Several of the tasks you must perform are to associate an item, such as a procedure or diagnosis code, with a code from another code system, such as SNOMED. These codes are used by the application and by CMS to determine patients and visits that meet measure requirements.
Use the instructions below to configure the items in your database. You can use the CQM Reporting Codes report to help you identify SNOMED, LOINC, or other codes you need to associate to procedures, diagnoses, tests, or other items.
Please note that all screen shots are from Aprima PRM 2015. The instructions are applicable to both Aprima PRM 2014 Patch A and 2015 unless noted otherwise.
22 Ref: 1117.18
Enter Practice, Provider, and Patient Information
The following information is required to calculate, monitor, and report on PQRS measure compliance whether using EHR-based or claims-based reporting.
Practice Information
Practice information is entered in the Configure Practice Settings window. You must enter the following:
Practice name
Practice address, including state and ZIP code
Service site addresses, including state and ZIP code
Provider Information
Provider information is entered in the Provider window. The following information must be entered in the provider record for each provider participating in the PQRS program. The provider’s employer tax identification number (ETIN) and NPI numbers must be correctly entered in the Provider window’s ID Values tab. The ETIN and NPI numbers must be entered through the system-defined claim format value types. If these IDs are entered through user- defined claim format value types, then the ID numbers will not report on the PQRS EHR Report.
First and last name
Specialty
Primary phone number
NPI number
ETIN number
Patient Information
Patient information is entered in the Patient and Account windows. The following information is required for each qualifying patient.
First and last name
Date of birth
Gender
Race
Ethnicity
Patient Social Security number
Insurance payer (Medicare must be primary)
Plan group ID
Subscriber Medicare ID
Ref: 1117.18 23
Patient Status for Test Patient
The application includes a system-defined patient status for Test Patient. Use this patient status to identify patient records that are used for application testing or training, and are not actual patients. By default, patient records with this status are not included in PQRS reporting. You may choose to include test patients when generating PQRS reports if needed.
Identify the Payer Typology for All Insurance Payers
The insurance payer typology code identifies the source of the payment. The payer typology is required for all Medicare insurance payers participating in the PQRS program, and it is recommended for all insurance payers for Meaningful Use reporting.
Medicare Part B fee-for-service (FFS) payers (including Railroad Retirement Board and Medicare Secondary) are eligible for PQRS, and must be associated with the Medicare payer typology code. Medicare replacement (Medicare Part C and Medicare Advantage Plan) are not eligible for PQRS. These payers will have a different payer typology code.
1. List Editor icon ) → Demographics → Insurance Payer
2. Search for and select the desired payer, and select the Modify button.
3. Select the Settings tab.
4. In the PQRS Insurance Carrier field, select the payer typology code appropriate for the insurance payer.
Make sure that all Medicare Part B fee-for-service (FFS) payers are associated with the Medicare payer typology code.
24 Ref: 1117.18
Verify Procedure Code Definitions
HCPCS Procedure Codes
Some measures may be charted using HCPCS or CPT codes. HCPCS codes must be properly defined as the HCPCS code type, rather than as CPT code type.
1. List Editor ) → Clinical → Lab Template
2. Search for and select the desired procedure code, and select the Modify button.
3. In the Code Type field, select HCPCS.
Procedure Codes for Orders
Procedure codes for laboratory and radiology orders must have the procedure code type of Lab or Radiology. These procedure codes must also be defined to generate an order.
If you have access to an external PACS (picture archiving and communication system) that enables you to access images from a hospital or imaging center, then you may identify this on the procedure code for radiology procedures.
1. List Editor ) → Clinical → Procedure Code
2. Search for and select the desired procedure code, and select the Modify button.
Ref: 1117.18 25
3. In the Code Type field, select either ‘Lab’ or ‘Radiology’ as appropriate.
4. Select the Generate Order checkbox.
5. If this a radiology order and you have access to this type of image through an external PACS, then select the Image Results Directly Accessible checkbox.
6. Select the OK button to save the procedure code.
7. If you selected the Image Results Directly Accessible checkbox, then the application will display a popup message reminding you that you are attesting that you have a direct link to the image results.
Select the OK button if you do have access to the PACS.
Select Cancel if you do not have direct access to image results.
26 Ref: 1117.18
Create Custom Procedure Codes
For some measures, you may need custom procedures codes associated with SNOMED or LOINC codes. The custom procedure code enables the provider to include in a visit note a SNOMED or LOINC code required by the measure that cannot otherwise be entered.
1. List Editor icon ) → Clinical → Procedure
2. Select New from the List Editor window to display the Add Procedure Codes window.
3. Select the Add Custom Code radio button, and select OK.
4. Enter an ID, if desired.
5. Enter the new Code. This may be a combination of alpha and numeric characters.
6. Select the procedure Code Type, such as CPT or HCPCS
7. Enter a Short Description and a Long Description. These may be the same.
8. Select a Procedure Group to be used for reporting, if desired
9. Select the By Default Don’t Claim checkbox if you will not charge for and make a claim for the procedure.
10. Enter Notes explaining the code, if desired.
Ref: 1117.18 27
11. Select the NDC/SNOMED tab.
12. In the SNOMED Concept ID field, select the appropriate SNOMED code. You can associate
two SNOMED codes if needed.
13. In the LOINC Code field, select the appropriate LOINC code. The LOINC code identifies a specific lab test that the procedure code represents or that is associated with the procedure.
28 Ref: 1117.18
Create Negation Reasons
Negation reasons identify why a procedure was not performed. When charting a patient visit note, a provider may select a procedure code and apply a negation reason to it. This identifies that the procedure was not performed, and why not.
Negation reasons are associated with SNOMED codes. The SNOMED is included in the patient visit note when the negation reason is used, and then included in the reporting for Meaningful Use or other quality program.
The application includes several common negation reasons. You may create additional negation reasons if desired. Remember that the negation reason must be associated with a valid SNOMED code that qualifies for a given measure.
1. List Editor icon ) → Clinical → Negation Reason
2. Select the New button.
3. In the Negation Reason window, enter a Name for the reason.
4. Enter a SNOMED Concept ID.
5. Enter an ID and Notes, if desired.
Associate LOINC Codes with Lab Tests Used for Measures
The clinical quality measures involving lab tests for which quantifiable results must be entered require that an appropriate LOINC code for the lab test be entered in the lab template used to record the test results. You may add the LOINC code to the lab template after the results are received, but it is critical that you add the LOINC code prior to reporting for PQRS or Meaningful Use.
You must enter an appropriate LOINC code in every lab template that may be used to record results for the test, whether the results are recorded manually or through a laboratory interface. If there are duplicate test items in a lab template, then you must enter an appropriate LOINC code for each of the test items.
Ref: 1117.18 29
Please keep in mind that CMS makes changes to the PQRS measures and measure requirements each year, and that Meaningful Use measures are also subject to change. You should regularly verify that your lab templates contain the correct LOINC codes for current PQRS and Meaningful Use measures.
Use the following procedure to add a LOINC code to a test item in a lab template.
Please note that you cannot associate a SNOMED code to a test item from the Lab Template window. However, once you have added the test item to a lab template, you can then access that test item through the Observation Item window. In the Observation Item window, you can associate a SNOMED code to the test item. Please see the Configure Observation Charting section of this document for instructions.
1. List Editor ) → Clinical → Lab Template
2. Search for and select the desired lab template, and select the Modify button.
3. Highlight the desired test entry in the list of test items.
4. In the Test Item area at the bottom of the window:
a. Enter the LOINC Code for the selected test item.
b. Select the Update button to update the selected test item.
5. Repeat step 4 for each test item used for a PQRS or Meaningful Use measure.
6. Select the OK button.
7. Repeat steps 2 through 6 for each lab template contain test items used for a PQRS or Meaningful Use measure.
30 Ref: 1117.18
Associate CVX Codes with Types of Vaccine Used for Measures
Measures related to vaccinations require a CVX code associated with the type of vaccine. The CVX code is required for reporting and for submitting immunization records to registries.
1. List Editor ) → Vaccines →Types of Vaccine
2. Search for and select the desired type of vaccine, and select the Modify button.
3. Select the CVX Code used to submit immunization records to registries.
Associate SNOMED Codes with Items
SNOMED (Systematized Nomenclature of Medicine) codes are used to report on Meaningful Use measures and other government and non-government quality reporting programs. You may associate SNOMED codes with a number of different items in the database. Then, when providers chart diagnoses, procedures, and other items in patient visit notes, the associated SNOMED code is also recorded in the patient chart. The SNOMED code is then available for reporting on various programs.
Some items also enable you to enter LOINC or HL7 codes. These codes may also be needed for Meaningful Use or other quality program reporting.
SNOMED Code for Discontinue Reason
Discontinue reasons identify why a prescription has been discontinued for a patient. A discontinue reason must be associated with a valid SNOMED code that qualifies for a given measure.
1. List Editor ) → Clinical → Discontinue Reason
2. Search for and select the desired entry, and select the Modify button.
3. In the SNOMED Concept ID field, select the appropriate SNOMED code.
Ref: 1117.18 31
SNOMED Code for an ICD-9 Diagnosis Code
1. List Editor ) → Clinical → Diagnosis Code
2. Search for and select the desired entry, and select the Modify button.
3. In the SNOMED Concept ID field, select the appropriate SNOMED code.
SNOMED Codes for Medical Problem
1. List Editor ) → Clinical → Problem
2. Search for and select the desired entry, and select the Modify button.
3. In the SNOMED Concept ID field, select the appropriate SNOMED code.
4. In the Family History SNOMED field, select the appropriate SNOMED code for the problem for a member of the patient’s family.
32 Ref: 1117.18
SNOMED and LOINC Codes for Observation Items
1. List Editor ) → Clinical → Observation Item
2. Search for and select the desired entry, and select the Modify button.
3. In the LOINC code field, select the appropriate LOINC code.
4. In the SNOMED Concept ID field, select the appropriate SNOMED code.
Ref: 1117.18 33
SNOMED and LOINC Codes for Procedure Codes
When associating a SNOMED code with a procedure, it is important to remember that some SNOMED codes identify the procedure, but that other SNOMED codes negate the procedure. When the SNOMED code negates a procedure, it identifies the reason that you did not perform the procedure.
You can associate two SNOMED codes with a procedure code. A second code may be needed if a procedure code is used for two different quality measures or for measures in different quality programs.
1. List Editor ) → Clinical → Procedure Code
2. Search for and select the desired entry, and select the Modify button.
3. Select the NDC/SNOMED/LOINC tab.
4. In the SNOMED Concept ID field, select the appropriate SNOMED code. You can associate two SNOMED codes if needed.
5. In the LOINC Code field, select the appropriate LOINC code.
34 Ref: 1117.18
SNOMED, HL7, and LOINC Codes for Questions
You can associate SNOMED, HL7, and LOINC codes with history questions in the knowledge database. Any of these types of codes may be needed for a Meaningful Use or other quality program measure.
1. List Editor ) → KDB → History Questions/Answers
2. Select the desired History Group.
3. Search for and select the desired Question entry, and select the Modify button.
4. In the SNOMED Concept ID field, select the appropriate SNOMED code.
5. Enter the appropriate HL7 Code if desired.
6. Enter the appropriate LOINC Code if desired.
Ref: 1117.18 35
SNOMED and LOINC Codes for KDB Answers
You can associate SNOMED and LOINC codes with history answers in the knowledge database.
1. List Editor ) → KDB → Problem
2. Select the desired History Group.
3. Search for and select the desired Question entry.
4. Search for and select the desired Answer entry, and select the Modify button.
5. In the SNOMED Concept ID field, select the appropriate SNOMED code.
6. Enter the appropriate LOINC Code if desired.
36 Ref: 1117.18
SNOMED Code for CC Symptom
If you are using Measure 64: Assessment of Asthma Control, then you must create the CC symptoms needed chart in the HPI tab of Full Note Composer. You must associate a SNOMED code with each symptom.
1. List Editor ) → KDB → CC and HPI Designer
2. In the Criteria slider:
a. Select the radio button for the level (global, care team, or provider) at which you want to make the addition.
b. Select the desired Care Team or Provider, if appropriate.
3. In the System panel, highlight the Respiratory system.
4. In the Symptom panel, select the New button.
5. In the Find CC/ROS Symptom window, select the New button.
6. In the CC Symptom window:
a. In the Name field, enter the symptom description.
b. Select the SNOMED Concept ID code.
SNOMED Code Description
170631002 Asthma disturbing sleep
Ref: 1117.18 37
SNOMED Code Description
170632009 Asthma causing night waking
170633004 Asthma disturbs sleep weekly
170634005 Asthma disturbs sleep frequently
395022009 Asthma night-time symptoms
370204008 Asthma causes daytime symptoms most days
373899003 Asthma daytime symptoms
170635006 Asthma not disturbing sleep
170636007 Asthma never disturbs sleep
370205009 Asthma causes night symptoms 1 to 2 times per month
370202007 Asthma causes daytime symptoms 1 to 2 times per month
370203002 Asthma causes daytime symptoms 1 to 2 times per week
370208006 Asthma never causes daytime symptoms
SNOMED Code for Physical Exam Finding
If you are using CMS 133 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery, then you can create a physical exam finding for the visual acuity results. The finding must be associated with the qualifying SNOMED code.
1. List Editor ) → KDB → PE Designer
2. In the Criteria slider:
a. Select the radio button for the level (global, care team, or provider) at which you want to make the addition.
b. Select the desired Care Team or Provider, if appropriate.
3. In the exam Type panel, highlight the exam you want to edit.
4. In the Parent System panel, highlight the Eyes parent system.
5. In the Finding panel, select the New button.
6. In the Find PE Description window, select the New button.
38 Ref: 1117.18
7. In the PE Finding window:
a. In the ID field, enter the SNOMED code.
b. In the Name field, enter the finding description.
Ref: 1117.18 39
Create a History Group for Procedures
Some measures require that a procedure be performed and results entered. For these measures, you may either perform the procedure in your practice, order the procedure to be performed by another provider or medical services provider (such as a laboratory), or receive results for the procedure that performed or ordered by another provider (such as a specialist or a referring provider).
If you did not order the test, you may enter the procedure into the patient’s history. To do this, you must create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window.
Use the process below to create a history category for procedures.
1. List Editor ) → KDB → History Designer
2. Select the Criteria slider to define the provider or care team to which any modifications apply.
a. Select the appropriate radio button. Changes can be made for all users (Global) or for a particular care team or provider.
b. If appropriate, select the Care Team or Provider to which the modifications apply.
c. If desired, select the Include Inactive Items checkbox and/or the Include Hidden Items checkbox.
3. In the Patient History panel, select the New button to create a new history group.
4. In the History Group window, enter the Name for the group.
5. Enter an ID and Notes, if desired.
6. In the Question Header field, enter ‘Procedure’. This defines how the question column is displayed in Full Note Composer.
7. In the Answer Header field, enter ‘Time Frame’. This defines how the question column is displayed in Full Note Composer.
8. Select the Procedure Group checkbox.
9. Do not make any other entries or changes.
10. Select the OK button to save the history group, and return to the List Editor – History Designer window.
11. Select the Save button to save the history group.
40 Ref: 1117.18
Configure Observation Charting
Observation charting is needed for clinical quality measure CMS 90: Functional Status Assessment for Complex Chronic Conditions. You must configure the needed items for observation charting if your providers will be reporting on this measure.
The Observation tab for clinical note type windows enables providers and other clinical users to enter and view observation findings in patient visit note using a simple flowsheet view. In the Observation tab, you can select one or more observation templates containing the observation items that you are monitoring for the patient.
Observations included in an observation template and charted in a patient visit note through the Observation tab are displayed in the Patient Results window like lab test results and other observation results.
Please refer to the Administrative User’s Guide for more information about these items.
Configuration Steps
To use the Observation tab, you or your administrative super user must:
1. Create the observation items needed.
2. Create one or more observation templates that include the desired observation items.
3. Create or modify a clinical note type that includes the Observation tab. The Observation tab is not part of any system-defined clinical note type.
Create an Observation Item
You must create an observation item for the assessment score of each functional status assessment that your providers perform. The observation item for the assessment score must be associated to the appropriate LOINC code for the functional status assessment.
1. List Editor ) → Clinical → Observation Item
2. Select the New button.
3. Enter an ID if desired.
4. Enter a Name for the item.
5. Enter any Notes if desired.
6. In the Data Type are, select the type of data being observed. Observation items that are to be graphed must be defined with the data type ‘metric’.
7. Select the LOINC Code associated with the observation item. The LOINC code must be included for the observation item to be used for clinical quality measure reporting.
8. In the Control Type field, select the desired method for entering method. This may be a generic entry, such as number or text. If you chose the data type ‘metric’ in step 6, then you must choose ‘Generic Number’ as the control type.
Ref: 1117.18 41
Create an Observation Template
1. List Editor ) → Clinical → Observation Template
2. Enter a Name for the template.
3. Enter an ID and Notes, if desired.
4. Add an observation item to the template.
a. Select the New button.
b. In the Find Observation window, search for and select the desired item.
c. Select the OK button to add the item and return to the Observation Template window.
5. Repeat step 4 to add all desired items.
6. Use the up and down arrows to move the items into the desired order.
Include the Observation Tab in a Clinical Note Type
The Observation tab is not included in any system-defined clinical note type. In order for providers to use Observation tab, you must add it to a custom clinical note type. Then you must add that clinical note type to the user settings definition used by the provider.
1. List Editor ) → Integration → Clinical Note Type
2. Search for and select the desired clinical note type, and select the Modify button.
3. Select the Tabs tab.
4. Select the New button to add a tab to the clinical note type.
5. In the Find Form Layout window, select the Observation entry and select the OK button.
6. To change the order in which the tabs will display in the clinical note type window:
a. Highlight the tab you want to move.
b. Select the up or down arrow icon to move the selected tab.
7. Make any other additions or changes needed to the clinical note type.
42 Ref: 1117.18
Configure Education Forms
You can associate education forms with age, gender, chief complaint, diagnosis, procedure, and/or observation item and results. Then when the specified conditions are met in a patient visit note, the application adds the associated education form to the Education Form slider so that the provider can easily give it to the patient.
Measures that require educating or counseling the patient are fulfilled by a procedure code or a SNOMED code associated with a procedure code. If the provider typically gives the patient an education form when performing this counseling, then you can associate a procedure code to the education form. Then when the provider selects the education form from the Education Form slider, the application adds the associated procedure code to the SP tab of the patient visit note.
Associate Education Forms Required for Measures
1. List Editor ) → Clinical → Education Form Association
2. Select the New button.
3. Enter a Name for the set of education form associations.
4. Enter an ID or Notes if desired.
5. In the Patient Education Form field, search for and select the desired form.
6. Define the Demographic Factors for the education form.
a. Define the age range by entering From and To ages and select the Units for the age (days, years, etc.).
b. Select the Gender or genders.
7. If desired, enter the Recurrence period in which you want the form to be automatically available in the Education Form Slider. For example, Every 1 Years, or Every 6 Months.
Ref: 1117.18 43
8. Search for and select the item or items to which you want to associate the education form. You may associate the form with one or more:
CC Symptom
Diagnosis
Procedure
9. In the Other Factors section, select the checkboxes for the additional factors related to the form.
Smoker: If identified as a smoker in the patient history.
Overweight: For patients between the ages of 18 and 65, Medicare defines overweight as having a BMI over 25.
Underweight: For patients between the ages of 18 and 65, Medicare defines underweight as having a BMI under 18.5.
10. Define the Observation Items that the education form is associated with.
a. Select the desired Observation Item.
b. Select the operator for the Result.
c. Enter the result Value.
d. If an additional observation item is desired, select the radio button for ‘And’ or ‘Or’ and then repeat substeps a through c for the next observation item.
11. Repeat steps 5 through 10 for each education form.
Define the Patient Communication Type and Procedure Code for Education Forms
Measures that require educating or counseling the patient are fulfilled by a procedure code or a SNOMED code associated with a procedure code. If the provider typically gives the patient an education form when performing this counseling, then you can associate a procedure code to the education form. Then when the provider selects the education form from the Education Form slider, the application adds the associated procedure code to the SP tab of the patient visit note.
The education forms must also have a patient communication type that associates the form with the education subject matter of the measure. Please note that only one patient communication type can be associated with an education form. If the provider uses an education form on a general topic, such as nutrition, for more than one condition, such as underweight and overweight, then you must have a copy of the education form for each condition, and each copy must be associated with the appropriate patient communication type. You may copy an education form using the File menu’s Save As option.
Please note that if you are using the education forms provided by Alere™, then you must configure both the English and the Spanish versions of the form.
44 Ref: 1117.18
1. List Editor ) → Clinical → Education Form
2. Search for and select the desired education form, and select the Modify button.
3. Ignore the Related PQRI Measure field. This is no longer used.
4. In the Patient Communication Type, select the type that is appropriate for the Meaningful Use measure education need addressed by this form. The patient communication types used for Meaningful Use measures are:
Nutrition
Overweight
Physical Activity
Underweight
Smoking Cessation
5. Select the Procedure code for which this education form is used.
Ref: 1117.18 45
Verify Race and Ethnicity Definitions
The Department of Health and Human Services’ (HHS) requires that a Medicare or Medicaid patient’s race and ethnicity be identified and reported as part of the HITECH and ARRA Meaningful Use requirements for EHR adoption. Therefore, the application includes the Centers for Disease Control and Prevention’s (CDC) full set of race and ethnicity names and ANSI codes.
HHS has defined a subset of race and ethnicity identifiers that are most frequently used, including a Not Provided identifier that is acceptable for Meaningful Use purposes. The race and ethnicity identifiers in this subset are defined as active. All other race and ethnicity codes are inactive by default. All race and ethnicity identifiers that include a valid ANSI code are valid for Meaningful Use purposes. If you need a race or ethnicity identifier that is not active, simply search for inactive items, find the desired item, and activate it by unselecting the Inactive checkbox.
If you have created and used user-define race or ethnicity options, you must associated them with a valid ANSI code.
Race
1. List Editor ) → Demographics → Race
2. Search for and select the desired race, and select the Modify button.
3. Enter a valid ANSI Code.
Ethnicity
1. List Editor ) → Demographics → Ethnicity
2. Search for and select the desired ethnicity, and select the Modify button.
3. Enter a valid ANSI Code.
Drug screening is required for Meaningfule Use measures and for clinical quality measures. Ensure that the necessary screening is configured for both the practice and for each provider.
46 Ref: 1117.18
Configure Attachment Types
User-defined attachment types that are used for CMS 50 must have SNOMED code 371530004 in the ID field.
1. List Editor ) → System → Attachment Type
2. Search for and select the desired attachment type, and select the Modify button.
3. In the ID field, enter appropriate SNOMED code.
Configure Drug Screening for the Practice
1. Tools → Configure Practice Settings → Drug Screening tab
Ref: 1117.18 47
2. Select the Drug To Drug Interaction checkbox.
3. Select the desired Drug-To-Drug Severity level.
4. Select the Allergies Precautions checkbox.
5. Select the desired Allergy Match items.
6. Select the Geriatric Precautions checkbox. This is needed only if you see patients who are 65 years old or older.
7. In the Minimum Geriatric Age field, select 65. This is needed only if you see patients who are 65 years old or older.
8. Select other screening items as desired.
Configure Drug Screening for a Provider
1. List Editor → System → Provider
2. Search for and select the desired provider, and select the Modify button.
3. Select the Drug Screening tab.
4. Either:
Select the Use Practice Setting checkbox if drug screening is correctly set for the practice and if the provider does not need any modification to the practice settings. If selected, this task is complete.
Deselect the Use Practice Setting checkbox if the provider needs settings that are different from the practice settings. You must complete the remaining steps of this task.
5. Select the Drug To Drug Interaction checkbox.
6. Select the desired Drug-To-Drug Severity level.
7. Select the Allergies Precautions checkbox.
8. Select the desired Allergy Match items.
9. Select the Geriatric Precautions checkbox. This is needed only if you see patients who are 65 years old or older.
10. In the Minimum Geriatric Age field, select 65. This is needed only if you see patients who are 65 years old or older.
11. Select other screening items as desired.
Clinical Quality Measure Details
This document assumes that providers, clinical staff members, and other staff who chart patient visit notes, enter lab results, and enter other patient information know how to use the application and the various features needed for Meaningful Use and PQRS reporting. Please refer to the online help or the EHR User’s Guide and General User’s Guide for instructions on using the application if needed.
48 Ref: 1117.18
This document also assumes that a provider’s standard charting practices for visit notes, lab results, patient history, and other clinical information will generally properly identify patients for measure denominators and numerators, when the database is properly configured with the needed SNOMED, LOINC, and other clinical codes.
Therefore, the measure details include general charting instructions that clarify the requirements of a measure. But, the details do not include instructions for every single item of information that may be used to determine whether a patient qualifies for a measure denominator, qualifies for the numerator, or is excluded from the measures.
For example, most measures have an age requirement, and many measures are applicable to particular gender. The measure details specify the age requirement, but do not remind you that you must have entered the patient’s date of birth in the patient’s record.
Measure Denominators and Numerators
All clinical quality measures have a denominator and a numerator patient population. The denominator is the total qualifying patient population for the measure. The numerator is the patient population for whom you have provided the service specified for the measure. For Meaningful Use, the qualifying patient population is all patients; for PQRS, the qualifying patient population is Medicare patients. Therefore, your denominator and numerator populations for a measure will be different when reporting for Meaningful Use and for PQRS.
Some measures have additional specific populations for the denominator. For example, some measures divide general denominator population into two or three subpopulations.
In general, the qualifying population for clinical quality reporting is patients in a defined age range at the beginning of the reporting period and who have an encounter with the eligible provider during the reporting period. Please note that when two or more office visits are required, all the visits must all be performed by the reporting provider in order to qualify.
It is important to understand that each measure has defined qualifying visit or encounter codes. The qualifying visit or encounter codes for each measure are not listed in the measure details in this document. However, the qualifying visit or encounter codes for each measure are listed in the Meaningful Use section of the Online Help.
Individual measures may have additional qualifying and excluding characteristics for the denominator and/or numerator population, including age and number of visits, and such things as a diagnosis, gender, allergies, or procedures previously performed. Some of the additional characteristics used to define the denominator and numerator patient populations are given in the measure descriptions below. For complete information on qualifying and excluding characteristics for individual measures, please refer to CMS.
Ref: 1117.18 49
Entering Data for Exclusions and Exceptions
Some measures have exclusions or exceptions that eliminate a patient from the initial patient population or from the denominator. A measure’s exclusions or exceptions may be a prior diagnosis, a procedure performed in the past, or test results that do not meet or that exceed a specified threshold. A measure’s exclusions or exceptions may also be a patient, medical, situation, or system reason for not performing a procedure or prescribing a medication otherwise required to include the patient in the measure numerator.
Measure details include the exclusion and exception descriptions defined by CMS, but the details do not include instructions for charting the information that identifies a patient is excluded. If the exclusion is a particular diagnosis or procedure, then the applicable diagnosis or procedure code must be in the patient’s history. These diagnosis and procedure codes are not listed in the measure details. Please refer to the CMS measure definitions to review the diagnosis and procedure codes for exclusions and exceptions.
Likewise, the measure details do not include instructions for entering lab tests, other screenings, or assessments and their results that may exclude a patient from a given measures. You enter lab tests and screening or results that exclude a patient in the same way that you enter lab tests and results that include a patient in a measure.
When a measure allows a patient to be excluded based on a patient, medical, or other reason for not performing a procedure otherwise required, then you must chart that procedure on the SP tab of a patient visit note, and then enter a negation reason for that procedure. The negation reason identifies that the procedure was not actually performed and why. The negation reason must be associated with a valid SNOMED code, and the SNOMED code must qualify as a negation reason for the measure. Please refer to the CMS measure definitions to review the SNOMED codes that qualify as a negation reason for the measure.
Similarly, when a measure allows a patient to be excluded based a patient, medical, or other reasons for not prescribing a medication otherwise required, then you must enter a prescription for the medication in the SIG Writer window. Then you must discontinue the prescription, and include a discontinue reason that is associated with a valid SNOMED code that qualifies as a discontinue reason for the measure. You may discontinue the prescription at a later time, for example, because the patient starting taking the medication but had an allergic reaction to it, or you may discontinue the prescription at the time you write it, for example, because the patient states they will not take the medication or the medication is contraindicated for some reason. To discontinue the medication at the time, select the Send
Prescriptions ) icon to prescribe the item. (You do not, however, have to actually send the prescription electronically or print it.) Then discontinue the medication and enter the reason. Please refer to the CMS measure definitions to review the SNOMED codes that qualify as a discontinue reason for the measure.
50 Ref: 1117.18
CMS Measure Definitions
You can obtain the definition of each measure and the list of valid clinical codes (CPT, ICD-9, SNOMED, LOINC, etc.) for each measure from the CMS website at the following link.
https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_eCQM_EligibleProfessional_ July2014.zip
This enables you to download a zipped file of information for all CQM measures. The zipped file contains a zipped file for each individual measure. The zipped file for each measure includes an HTML file that contains the measure description, denominator and numerator descriptions, exclusion descriptions, and the very specific logic required for the measure.
You can use the CQM Reporting Codes report within Aprima PRM 2014 to verify the clinical codes used for each measure. Be aware that any given code may be used to include a patient in the initial population, denominator, or numerator or it may be used to exclude the patient. In order to determine how a given code is used for a measure, you must check the specific logic for the measure in the HTML file from CMS.
CMS 2; NQF 0418; PQRS 134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
Domain
Population/Public Health
Measure
Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.
Exclusions or Exceptions
Patient Reason(s): Patient refuses to participate.
OR
Medical Reason(s): Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status.
OR
Situations where the patient’s functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tools. For example: certain court appointed cases or cases of delirium.
Ref: 1117.18 51
Entering Denominator Data
The patient must be 12 years and older at the beginning of the measurement period. The patient must have at least one eligible visit during the measurement period.
Entering Numerator Data
This measure requires that you perform an appropriate depression screening. When the screening result is positive, you must chart the appropriate diagnosis.
To chart the screening, you must enter a procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window. The procedure code you use must be associated with:
A LOINC code identifying the screening (adult or adolescent) and
A SNOMED code indicating whether the screening results were positive or negative.
The LOINC code for the screening indicates whether the screening was for an adult or an adolescent. Since a procedure code may only be associated with one LOINC code, then you must use different procedure codes for adult and adolescent screenings. If you use the same procedure for both adults and adolescents, then you must create a custom procedure code record for one of the age groups.
Because the results of the screening are indicated by the SNOMED code associated with the procedure code, you must have two procedure code records for the CPT or HCPCS code used for the screening. One must be associated with the SNOMED code for positive results, and one must be associated with the SNOMED code for negative results. Therefore, you must create a custom procedure code record for one of the results.
Important: A procedure code may be associated with two SNOMED codes. However, you cannot associate both the SNOMED code for positive results and the SNOMED code for negative results to the same procedure code. If you do, the application will not be able to correctly identify the results for a given patient.
Because you may need to have one or more custom procedure codes in order to correctly identify the screening and its results, it is recommended that you include the procedures in your charge ticket.
LOINC: 73831-0 or 73832-8
SNOMED Positive Result: 428181000124104
SNOMED Negative Result: 428171000124102
When the screening result is positive, you must chart the diagnosis with a qualifying ICD-9 or ICD-10 code or a diagnosis code associated with a qualifying SNOMED code for depression in the Dx tab of Full Note Composer or other clinical note type window.
52 Ref: 1117.18
SNOMED: 162004, 832007, 1196001, 1499003, 2506003, 2618002, 3109008, 3530005, 4441000, 5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14183003, 14495005, 15193003, 15639000, 16295005, 16506000, 17782008, 18818009, 19300006, 19527009, 19694002, 20250007, 20960007, 21900002, 22121000, 22407005, 25922000, 26203008, 26530004, 28475009, 28663008, 28884001, 29929003, 30520009, 30687003, 30935000, 31446002, 33078009, 33380008, 34315001, 35481005, 35489007, 35846004, 36170009, 36474008, 36583000, 36923009, 38368003, 38451003, 38694004, 39809009, 40379007, 40568001, 40926005, 41552001, 41832009, 41836007, 42925002, 43568002, 43769008, 45479006, 46229002, 48589009, 48937005, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 63778009, 64731001, 65042007, 66344007, 66631006, 67711008, 68569003, 69392006, 70546001, 71294008, 71336009, 71984005, 73471000, 73867007, 74686005, 75084000, 75360000, 75752004, 75837004, 76441001, 77486005, 77911002, 78269000, 78640000, 78667006, 79298009, 79584002, 81319007, 81319007, 82998009, 83176005, 83225003, 84760002, 85080004, 85248005, 86058007, 87203005, 87512008, 87950005, 111485001, 191610000, 191611001, 191613003, 191616006, 191618007, 191620005, 191621009, 191623007, 191625000, 191627008, 191629006, 191630001, 191632009, 191634005, 191636007, 191638008, 191639000, 191641004, 191643001, 191659001, 192080009, 192362008, 231444002, 231504006, 231542000, 268621008, 319768000, 320751009, 370143000, 371596008, 371599001, 371600003, 371604007, 430852001, 442057004
ICD-9: 290.13, 290.21, 290.43, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.31,
296.32, 296.33, 296.34, 296.36, 296.82, 298.0, 300.4, 301.12, 309.0, 309.1, 309.28, 311
ICD-10: F31.11, F31.12, F31.13, F31.2, F31.73, F31.74, F31.9, F01.51, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.42, F33.9, F34.1, F43.21, F43.23
Then you must establish a follow up plan that includes one of the following:
Medication,
Additional screening, or
Referral to another qualifying medical services provider.
To use medication as the follow-up plan, you must prescribe a qualifying medication as the follow up plan. Write the prescription through the SIG Writer window, and then either print it or submit it electronically.
To chart the additional screening, you must enter a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
SNOMED for Suicide Risk Assessment: 225337009
SNOMED codes for the follow up plan: 5694008, 5694008, 88848003, 88848003, 91310009,
91310009, 372067001, 372067001, 385721005, 385721005, 385724002, 385724002, 385725001, 385725001, 385726000, 385726000, 385727009, 385727009, 385887004, 385887004, 385889001, 385889001, 385890005, 385890005, 401277000, 401277000, 410223002, 410223002, 410224008, 410224008, 410225009, 410225009, 410226005,
Ref: 1117.18 53
410226005, 410227001, 410227001, 410228006, 410228006, 410229003, 410229003, 410230008, 410230008, 410231007, 410231007, 410232000, 410232000, 410233005, 410233005, 410234004, 410234004, 425604002, 425604002, 439141002, 439141002
To use a referral as the follow-up plan, you must order the referral by entering a procedure code that is associated with a qualifying SNOMED code.
SNOMED codes for depression referral: 183524004, 183583007, 183851006, 183866009,
305922005, 306136006, 306137002, 306226009, 306227000, 306252003, 306291008, 306294000, 308459004, 308477009, 309627007, 390866009, 401174001, 429387009, 61801003, 14129001, 183524004, 183528001, 183583007, 183866009, 305922005, 306136006, 306137002, 306138007, 306204008, 306226009, 306227000, 306252003, 306294000, 308459004, 308477009, 390866009, 401174001, 408293001, 429387009, 61801003
CMS 22 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
Domain
Population/Public Health
Measure
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated.
Exclusions or Exceptions
Patient Reason(s): Patient refuses to participate.
OR
Medical Reason(s): Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated.
Entering Denominator Data
Patients must be 18 years old or older before the start of the measurement period. Patients do not already have an active diagnosis of hypertension.
54 Ref: 1117.18
Entering Numerator Data
Patients who were screened for high blood pressure AND a recommended follow-up plan is documented as indicated if the blood pressure is pre-hypertensive or hypertensive.
To report on this measure, you must enter the patient’s blood pressure (both systolic and diastolic values) in the Vitals tab of Full Note Composer or other clinical note type window. Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.
The blood pressure measurement from the most recent visit is used to report on this measure. When that visit contains more than one blood pressure measurement, then the measurement with the lowest systolic and diastolic blood pressure is used.
This measure looks at both the systolic and diastolic pressures to determine the follow-up needed for the patient. So, if either the patient’s systolic pressure or diastolic pressure are equal to or greater than the criteria, then you must perform the specified follow-up actions. This is also true when the blood pressure from the prior year is considered. The blood pressure was high in the prior year if either the systolic pressure was 140 or higher or the diastolic pressure was 90 or higher. It is not necessary for both the systolic and the diastolic pressure to be higher than the target.
If the patient’s blood pressure is between 120/80 and 140/90, then within one day of the visit, you must either:
Order referral to another provider, or
Document a plan to retest the blood pressure within a year and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.
If the patient’s blood pressure is 140/90 or greater, but has not been high (or was not taken) in the year prior to this visit, then within one day of the visit, you must either:
Order referral to another provider, or
Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption.
If the patient’s blood pressure is 140/90 or greater, and has been high in the year prior to this visit, then within one day of the visit, you must either:
Order referral to another provider, or
Document a plan to retest the blood pressure within four weeks and document lifestyle change recommendations that may include diet, exercise, weight loss, and alcohol consumption, and either
Write a prescription for medication, or
Order a screening or test, such as a comprehensive metabolic panel or an electrocardiogram.
Ref: 1117.18 55
To chart a referral to another provider, you must order the referral by entering a procedure code that is associated with a qualifying SNOMED code. The system-defined Referral Order procedure code is associated with SNOMED code 306253008. You may associate other procedure codes with more specific qualifying SNOMED codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.
SNOMED: 134403003, 183516009, 183561008, 183856001, 306206005, 306253008, or
308470006
You may also create the referral from Patient/Provider Tracking. When you create the referral in this way, you must create the referral within one day of the visit date and associate it with the visit.
To chart that you plan to retest the blood pressure, you must have one or more custom procedure codes and associate them with a qualifying SNOMED code that indicates the timeframe for the follow up test. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Please note that simply entering the referral in Referral Tracking or Patient Provider Tracking will not count for this measure.
SNOMED codes for retest within 4 weeks: 183617005, 183618000, 183619008, 183620002,
183621003, 183622005, 183623000
SNOMED codes for retest within 1 year: 61342007, 183617005, 183618000, 183619008,
183620002, 183621003, 183622005, 183623000, 183624006, 183625007, 183626008, 183627004, 183628009, 300042001
For diet, exercise, weight loss, or alcohol consumption recommendations, counseling, or education, you must chart an appropriate procedure. Select the desired procedure code in the SP or SO tab of Full Note Composer or other clinical note type window. If the procedure code is associated with an education form, such as for counseling, then selecting the education form from the Education Form slider will add the procedure code to the SP tab.
Alcohol
SNOMED: 24165007, 38670004, 390857005, 408947007, 413473000, 417096006, 419822006,
431260004
Diet
HCPCS: G8417, S9452, S9470
SNOMED: 11816003, 14044002, 31002004, 40546006, 54123004, 61310001, 103699006,
169411000, 182922004, 182954008, 182955009, 182956005, 182960008, 183061003, 183065007, 183070000, 183071001, 226164007, 281085002, 284071006, 284352003, 304491008, 305849009, 306163007, 361231003, 370847001, 386464006, 386619000, 386620006, 410114009, 410171007, 410177006, 410270001, 413315001, 418995006, 424753004, 443288003
56 Ref: 1117.18
Exercise
HCPCS: S9451
SNOMED: 281090004, 304507003, 304549008, 386291006, 386292004, 386373004, 386463000,
410289001
Lifestyle
SNOMED: 313204009, 364706004, 39155009, 415510005, 443402002, 60134006
Weight Loss
HCPCS: S9449
SNOMED: 170795002, 266724001, 268523001, 275919002, 401003006, 408289007, 410200000
To use medication as part of the follow-up plan, you must prescribe a qualifying medication as the follow up plan. Write the prescription through the SIG Writer window, and then either print it or submit it electronically.
To chart a screening or test, you must enter a procedure code that is associated with a qualifying SNOMED code. You may enter the in either the SP or the SO tab of Full Note Composer or other clinical note type window.
CPT: 80047, 80048, 80050, 80053, or 80069
SNOMED: 2278000, 5540006, 8879006, 15373003, 18207002, 20501000, 27171005, 27260001, 28317006, 36793009, 59573005, 60218003, 68994006, 70901006, 71878006, 73668004, 82912006, 88480006, 102811001, 105362001, 113075003, 127800008, 164846002, 167181009, 167182002, 167183007, 167222005, 167470001, 251838003, 259295006, 271000000, 271075006, 271236005, 271240001, 290127004, 301119002, 301120008, 304048005, 312468003, 312472004, 313502007, 313936008, 365616005, 365618006, 365756002, 365757006, 365760004, 390963002, 390964008, 420155008, 444164000, 444275009, 444336003
Troubleshooting
This measure looks at both the systolic and diastolic pressures. Either the patient’s systolic pressure or diastolic pressure must be equal to or greater than the criteria to move to the next level.
Ref: 1117.18 57
CMS 50; NQF NA; PQRS 374 Closing the Referral Loop: Receipt of Specialist Report
Domain
Care Coordination
Measure
Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.
Exclusions or Exceptions
None.
Entering Denominator Data
The patient must have at least one visit during the measurement period.
You must order the referral. This can be done in either of the following ways.
In the visit note, enter a procedure code that is associated with a qualifying SNOMED code.
Create the referral from Patient/Provider Tracking. When you create the referral in this way, you must associate the referral with the visit.
The system-defined Referral Order procedure code is associated with SNOMED code 306253008. You may associate other procedure codes with more specific qualifying SNOMED codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.
SNOMED codes for the referral: 54395008, 103697008, 103699006, 183515008, 183517000,
183528001, 183529009, 183530004, 183541002, 183555005, 183557002, 183561008, 183567007, 183569005, 183591003, 183878008, 183879000, 183880002, 183881003, 183882005, 183884006, 183885007, 183886008, 183887004, 183888009, 183889001, 183890005, 183891009, 183892002, 183893007, 183894001, 183895000, 183896004, 183897008, 183899006, 183900001, 183901002, 183902009, 183903004, 183904005, 183905006, 183906007, 183907003, 183908008, 183909000, 183910005, 183911009, 183913007, 183914001, 183915000, 183916004, 266747000, 274410002, 306160005, 306161009, 306162002, 306253008, 306254002, 306255001, 306256000, 306257009, 306258004, 306259007, 306260002, 306261003, 306262005, 306263000, 306264006, 306265007, 306266008, 306267004, 306268009, 306269001, 306270000, 306271001, 306272008, 306273003, 306274009, 306275005, 306276006, 306277002, 306278007, 306279004, 306280001, 306281002, 306282009, 306284005, 306285006, 306286007, 306287003, 306288008, 306289000, 306290009, 306291008, 306293006, 306294000, 306295004, 306296003, 306297007, 306298002, 306299005, 306300002, 306301003, 306302005, 306303000, 306304006, 306305007, 306306008, 306307004, 306308009,
58 Ref: 1117.18
306309001, 306310006, 306311005, 306312003, 306313008, 306314002, 306315001, 306316000, 306317009, 306318004, 306320001, 306338003, 306351008, 306352001, 306353006, 306354000, 306355004, 306356003, 306357007, 306358002, 306359005, 306360000, 306361001, 306736002, 307063001, 307777008, 308447003, 308449000, 308450000, 308451001, 308452008, 308453003, 308465004, 308469005, 308470006, 308471005, 308472003, 308473008, 308474002, 308475001, 308476000, 308477009, 308478004, 308479007, 308480005, 308481009, 308482002, 308483007, 308484001, 308485000, 309046007, 309627007, 309629005, 310515004, 312487009, 312488004, 390807002, 406158007, 406159004, 408285001, 415277000, 416116000, 425971006, 429365000, 428441000124100, 428451000124103, 428461000124101, 428471000124108, 428481000124106, 428491000124109, 428541000124104
Entering Numerator Data
When you receive the consultation report from the referred to physician or medical service provider, you must attach the consultation report to the referral record using Document Linking. You must use the attachment type Consultation Report when attaching the report to the referral. The Consultation Report attachment type has the SNOMED code 371530004 in the ID field.
Please note that referral entries with a status of Historical Reference or of Relationship are not included.
CMS 52; NQF 0405; PQRS 160 HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis
Exclusions or Exceptions
Numerator 1: Patient did not receive PCP prophylaxis because there was a CD4 count above 200 cells/mm3 during the three months after a CD4 count below 200 cells/mm3
Numerator 2: Patient did not receive PCP prophylaxis because there was a CD4 count above 500 cells/mm3 or CD4 percentage above 15% during the three months after a CD4 count below 500 cells/mm3 or CD4 percentage below 15%
Numerator 3: None
Ref: 1117.18 59
Entering Denominator Data
Denominator 1: All patients aged 6 years and older with a diagnosis of HIV/AIDS and a CD4 count below 200 cells/mm3 who had at least two visits during the measurement year, with at least 90 days in between each visit. The test must be performed less than 9 months after the start of the measurement period.
Denominator 2: All patients aged 1-5 years of age with a diagnosis of HIV/AIDS and a CD4 count below 500 cells/mm3 or a CD4 percentage below 15% who had at least two visits during the measurement year, with at least 90 days in between each visit. The test must be performed less than 9 months after the start of the measurement period.
Denominator 3: All patients aged 6 weeks to 12 months with a diagnosis of HIV who had at least two visits during the measurement year, with at least 90 days in between each visit.
To include a patient in the denominator, you must enter a qualifying diagnosis code or a diagnosis code associated with a qualifying SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in either the Hx tab of Full Note Composer or the History window.
ICD-9: 042, V08
ICD-10: B20, Z21
SNOMED: 5810003, 40780007, 48794007, 52079000, 62246005, 62479008, 77070006, 79019005, 86406008, 87117006, 91947003, 111880001, 186706006, 186707002, 186708007, 186709004, 186717007, 186718002, 186719005, 186721000, 186723002, 186725009, 186726005, 230180003, 230201009, 230598008, 235009000, 235726002, 240103002, 276666007, 315019000, 359791000, 397763006, 398329009, 402915006, 402916007
To report on this measure, you must order or perform a CD4+Count or CD4+Percentage test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the CD4+Count or CD4+Percentagetest item on each lab template for both manually entered and electronic results.
CD4+Count LOINC: 24467-3, 32515-9, 32532-4, 40898-9, 63450-1
CD4+Percentage LOINC: 17822-8, 32516-7, 32533-2, 40623-1, 43970-3, 51300-2, 8123-2
60 Ref: 1117.18
Entering Numerator Data
Numerator 1: Patients who were prescribed pneumocystis jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 200 cells/mm3.
Numerator 2: Patients who were prescribed pneumocystic jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 500 cells/ mm3 or a CD4 percentage below 15%.
Numerator 3: Patients who were prescribed Pneumocystic jiroveci pneumonia (PCP) prophylaxis at the time of diagnosis of HIV.
To report on this measure, you must write a prescription for a Pneumocystic jiroveci pneumonia (PCP) prophylaxis medication through the SIG Writer window, and either print it or submit it electronically through the Surescripts pharmacy clearinghouse. The prescription counts for the rendering provider on the visit note, even if another provider enters and submits the prescription.
For numerators 1 and 2, you must write the prescription within 3 months of performing the CD4 test that had results qualifying for the numerator.
For numerator 3, you must enter the diagnosis of HIV and the prescription in the same visit note.
CMS 56; NQF NA; PQRS 376 Functional Status Assessment for Hip Replacement
Domain
Patient and Family Engagement
Measure
Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patient-reported) functional status assessments
Exclusions or Exceptions
Patients with multiple trauma at the time of the total hip arthroplasty or patients with severe cognitive impairment.
Entering Denominator Data
Adults aged 18 and older with a primary total hip arthroplasty (THA) and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after THA procedure. The outpatient encounter is restricted to office visit and outpatient consultation procedure codes.
Ref: 1117.18 61
You must enter a qualifying procedure code or a procedure code associated with a qualifying SNOMED code for the hip replacement in the surgical history category in the Hx tab of Full Note Composer or the Patient History window.
HCPCS: S2118
CPT: 27130
SNOMED: 15163009, 19954002, 33788003, 52734007, 53081006, 55423004, 57589001, 76915002, 179294005, 179304004, 179305003, 265157000, 265160007, 314489006, 314491003, 425443008, 426618001, 426904006, 427728006, 429156003, 443435007
Please note that the system-defined hip surgery question in the surgical history does not count for this measure. This is because that entry may be for any hip surgery; it is not specifically total hip arthroplasty.
Entering Numerator Data
Patients with patient reported functional status assessment results (e.g., VR-12, VR-36, PROMIS-10,-Global Health, PROMIS-29, HOOS) not more than 180 days prior to the primary THA procedure, and at least 60 days and not more than 180 days after the THA procedure.
To report on this measure, you must have set up an observation item for the score of each assessment that you use, and put these observation items in an observation template. The observation item for each assessment’s score must include the appropriate LOINC code for the functional status assessment. You may use the system-defined PROMIS-10 observation template for this measure.
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the functional status assessment in the observation template on the Observation tab.
Please note that entries in the Cognitive and Functional Assessment history categories do not count for this measure.
Activities of Daily Living LOINC Code: 72095-3
HOOS LOINC Codes: 72094-6, 72095-3, 72096-1
PROMIS-10 LOINC Codes: 71969-0, 71970-8, 71971-6, 71972-4
PROMIS-29 LOINC Codes: 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9, 71961-7, 71962-5, 71963-3, 71964-1, 71965-8, 71966-6, 71967-4, 71968-2, 71970-8
62 Ref: 1117.18
VR12 LOINC Codes: 72009-4, 72010-2, 72011-0, 72012-8, 72013-6, 72014-4, 72015-1, 72016-9, 72017-7, 72018-5, 72019-3, 72020-1, 72021-9, 72022-7, 72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4
VR-36 LOINC Codes: 71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3, 71983-1, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2, 71993-0, 71994-8, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9, 72003-7, 72004-5, 72005-2, 72006-0, 72007-8, 72008-6
CMS 61; NQF NA; PQRS 316 Preventive Care and Screening: Cholesterol — Fasting Low Density Lipoprotein (LDL-C) Test Performed
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed.
Exclusions or Exceptions
Patient Reason(s): Patient Request
OR
Patient Refusal: Entering Denominator Data
Entering Denominator Data
The patient must have at least one E&M visit during the reporting period. Please note that E&M code 99211 does not qualify for this measure.
Denominator 1: (High Risk) All patients aged 20 through 79 years who have CHD or CHD Risk Equivalent OR 10-Year Framingham Risk > 20%.
Denominator 2 : (Moderate Risk) All patients aged 20 through 79 years who have 2 or more Major CHD Risk Factors OR 10-Year Framingham Risk 10-20%.
Denominator 3 : (Low Risk) All patients aged 20 through 79 years who have 0 or 1 Major CHD Risk Factors OR 10-Year Framingham Risk <10%.
** For Denominator 2 and Denominator 3, fasting HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above. (This is a negative risk factor.)
Ref: 1117.18 63
Enter a CHD or CHD risk equivalent diagnosis or hypertension diagnosis for the patient with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
CHD or CHD risk equivalent ICD-9: V45.81, V45.82, 093.0, 250.00, 250.01, 250.02, 250.03,
250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 411.0, 411.1, 411.81, 411.89, 413.1, 413.9, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.8, 414.9, 433.11, 433.31, 441.3, 441.4, 443.0, 443.1, 443.21, 443.22, 443.23, 443.24, 443.29, 443.81, 443.82, 443.89, 443.9, 648.00, 648.01, 648.02, 648.03, 648.04
CHD or CHD risk equivalent ICD-10: A52.01, E08.36, E08.42, E09.36, E09.42, E10.10, E10.11, E10.21, E10.29, E10.311, E10.319, E10.36, E10.39, E10.40, E10.42, E10.51, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.29, E11.311, E11.319, E11.329, E11.339, E11.349, E11.359, E11.36, E11.39, E11.40, E11.42, E11.51, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.36, E13.42, I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I25.10, I25.5, I25.810, I25.811, I25.812, I25.89, I25.9, I63.139, I63.239, I63.59, I65.29, I65.8, I71.3, I71.4, I73.00, I73.1, I73.81, I73.89, I73.9, I77.71, I77.72, I77.73, I77.74, I77.79, I79.8
CHD or CHD risk equivalent SNOMED: 2751001, 3546002, 5368009, 5969009, 8801005, 9859006, 10326007, 10365005, 11530004, 14336007, 15023006, 15256002, 23045005, 25907005, 26298008, 28032008, 28248000, 29899005, 30670000, 33559001, 34140002, 38542009, 39058009, 39181008, 39202005, 39724006, 42954008, 44054006, 46635009, 48431000, 50570003, 50620007, 51002006, 53741008, 54181000, 57886004, 59079001, 62207008, 63739005, 64586002, 67682002, 70694009, 73211009, 74218008, 74371005, 74627003, 75398000, 75524006, 75682002, 75878002, 76751001, 81266008, 81531005, 81830002, 82247006, 87343002, 90205004, 91352004, 92517006, 93396008, 111552007, 111558006, 119564002, 119565001, 123641001, 123642008, 123763000, 127013003, 127014009, 175041000, 175045009, 175047001, 175048006, 175367001, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 190406000, 190407009, 190410002, 190411003, 190412005, 193184006, 194843003, 195268001, 197605007, 198609003, 199223000, 199227004, 199229001, 199230006, 199231005, 201250006, 201251005, 201252003, 230572002, 230577008, 232717009, 232719007, 232720001, 233296007, 233297003, 233298008, 233817007, 233964008, 233970002, 233984007, 233985008, 237599002, 237600004, 237601000, 237604008, 237613005, 237618001, 237619009, 237627000, 266254007, 276951007, 290002008, 309426007, 309814006, 310387003, 310505005, 311366001, 312912001, 313435000, 313436004, 314186008, 314537004, 314771006, 314772004, 314893005, 314902007, 314903002, 315295003, 359597003, 359601003, 359611005, 359642000, 360546002, 361131008, 371087003, 371803003, 371804009, 371805005, 395204000, 398274000, 400047006, 405326004, 405408003, 405409006, 405411002, 405412009, 408539000, 408540003, 408546009, 413183008, 414088005, 414890007, 414906009, 420006002, 420270002, 420414003, 420422005, 420662003, 420756003, 421165007, 421327009, 421750000,
64 Ref: 1117.18
421847006, 421895002, 422088007, 422183001, 422228004, 422275004, 423263001, 424736006, 424989000, 425159004, 425442003, 425771001, 426651005, 426705001, 426875007, 427089005, 427919004, 428896009, 441656006, 444569004
Hypertension ICD-9: 401.1, 401.9, 402.01, 402.11, 402.91, 403.01, 403.11, 403.91, 404.01, 404.02, 404.03, 404.11, 404.12, 404.13, 404.91, 404.92, 404.93, 405.01, 405.11, 405.19, 405.91, 405.99
Hypertension ICD-10: H35.039, I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I67.4
Hypertension SNOMED: 1201005, 4210003, 8762007, 10725009, 10964002, 14973001,
19769006, 23130000, 26174007, 28119000, 31992008, 34742003, 38341003, 39018007, 44772007, 46481004, 46764007, 48146000, 48194001, 52698002, 56218007, 57684003, 59621000, 59720008, 59997006, 65518004, 68267002, 70272006, 73410007, 74451002, 78975002, 81626002, 84094009, 89242004, 102932008, 123799005, 123800009, 160273004, 170577003, 170578008, 170579000, 170586008, 185264001, 185716009, 185717000, 194783001, 194785008, 194788005, 194791005, 233815004, 233941006, 233942004, 233943009, 233944003, 233945002, 233946001, 234072000, 234073005, 234075003, 237279007, 270440008, 275944005, 276789009, 288250001, 302192008, 371125006, 371622005, 390925005, 395050009, 397748008, 398254007, 401117004, 401118009, 402832006, 412779008, 423674003, 428575007, 429198000, 429457004
To report the patient’s smoking risk factor, enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a qualifying SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes.
Current every day smoker (SNOMED code 449868002)
Current some day smoker (SNOMED code 428041000124106)
Former smoker (SNOMED code 8517006)
Smoker, current status unknown (SNOMED code 77176002)
Heavy tobacco smoker (SNOMED code 428071000124103)
Light tobacco smoker (SNOMED code 428061000124105)
It is strongly recommended that you use the system-defined tobacco history answers. If you have charted tobacco use using custom history answers, you may merge your custom-defined answers with the appropriate system-defined answer.
To report the patient’s HDL-C risk factor, you must order or perform an HDL test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
Ref: 1117.18 65
You must associate a LOINC code to the HDL test item on each lab template for both manually entered and electronic results.
HDL LOINC codes: 14646-4, 18263-4, 2085-9
To report on the family history of premature CHD, you must enter a relationship and a problem in the family history category in the Hx tab of Full Note Composer or the Patient History window. The problem must be associated with SNOMED code 134439009.
Please note that in Aprima PRM 2014 GA, a problem may only be associated with one SNOMED code. If a problem is associated with a SNOMED code that indicates the patient has CHD, then you will need to create a second problem to associate with the SNOMED code for family history of CHD. In Aprima PRM Patch A, you may enter both SNOMED codes on the same problem record.
The application calculates the patient’s Framingham risk percentage based on information entered for the patient, and includes the correct SNOMED for reporting when applicable. The Framingham risk percentage is not displayed in the visit note or patient chart.
Entering Numerator Data
Numerator 1 (High Risk): Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period.
Numerator 2 (Moderate Risk): Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period.
Numerator 3 (Low Risk): Patients who had a fasting LDL-C test performed or a calculated LDL- C during the measurement period or up to four years prior to the current measurement period.
To report on this measure, you must order or perform a lab test that includes LDL-C, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
You must associate a LOINC code to all of the above named tests in all lab templates. The LOINC codes for each type of test are listed below.
LOINC: 12773-8, 13457-7, 18261-8, 18262-6, 2089-1, 22748-8, 39469-2, 49132-4, 55440-2
The test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the LDL-C value. Results stored in the database as text notes or as an image file cannot be used for reporting.
66 Ref: 1117.18
CMS 62; NQF 0403, PQRS 368 HIV/AIDS: Medical Visit
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visit.
Exclusions or Exceptions
None
Entering Denominator Data
All patients, regardless of age, with a diagnosis of HIV/AIDS seen within a 12 month period.
To include a patient in the denominator, you must enter a qualifying diagnosis code or a diagnosis code associated with a qualifying SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in either the Hx tab of Full Note Composer or the History window.
ICD-9: 042, V08
ICD-10: B20, Z21
SNOMED: 5810003, 5810003, 40780007, 48794007, 52079000, 62246005, 62479008, 77070006, 79019005, 86406008, 87117006, 91947003, 111880001, 186706006, 186707002, 186708007, 186709004, 186717007, 186718002, 186719005, 186721000, 186723002, 186725009, 186726005, 230180003, 230201009, 230598008, 235009000, 235726002, 240103002, 276666007, 315019000, 359791000, 397763006, 398329009, 402915006, 402916007
Entering Numerator Data
Patients with at least two medical visits during the measurement year with a minimum of 90 days between each visit.
Ref: 1117.18 67
CMS 64; NQF NA; PQRS 316 Preventive Care and Screening: Risk- Stratified Cholesterol — Fasting Low Density Lipoprotein (LDL-C)
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.
Exclusions or Exceptions
Patients who have an active diagnosis of pregnancy.
OR
Patients who are receiving palliative care.
OR
Denominator Exceptions (1, 2, and 3): (Exceptions only applied if the fasting LDL-C test is not performed during the measurement period): When a fasting LDL-C test is not performed during the measurement period for a valid patient reason, the appropriate test that should have been performed should be submitted along with a negation code to indicate the reason the appropriate test was not performed.
Entering Denominator Data
Denominator 1 (High Risk): All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD risk equivalent .
OR
Have Multiple Risk Factors (2+) of the following: cigarette smoking, hypertension, low high density lipoprotein (HDL-C), family history of premature CHD, or age (men >= 45; women >= 55) AND a 10-year Framingham risk >20%.
HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)
68 Ref: 1117.18
Denominator 2 (Moderate Risk): All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have Multiple Risk Factors (2+) of the following: cigarette smoking, hypertension, low high density lipoprotein (HDL-C), family history of premature CHD, or age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20%.
HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)
Denominator 3 (Low Risk): All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 of the following risk factors: cigarette smoking, hypertension, low high density Lipoprotein (HDL), family history of premature CHD, or age (men >= 45; women >= 55) AND a 10-year Framingham risk <=20%.
HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor).
To report the patient’s LDL-C risk factor, you must order or perform an LDL test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the LDL test item on each lab template for both manually entered and electronic results.
LDL LOINC codes: 12773-8, 12773-8, 13457-7, 13457-7, 18261-8, 18261-8, 18262-6, 18262-6,
2089-1, 2089-1, 22748-8, 22748-8, 39469-2, 39469-2, 49132-4, 49132-4, 55440-2, 55440-2
Enter a CHD or CHD risk equivalent diagnosis or hypertension diagnosis for the patient with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
CHD or CHD risk equivalent ICD-9: V45.81, V45.82, 093.0, 250.00, 250.01, 250.02, 250.03,
250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 411.0, 411.1, 411.81, 411.89, 413.1, 413.9, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.8, 414.9, 433.11, 433.31, 441.3, 441.4, 443.0, 443.1, 443.21, 443.22, 443.23, 443.24, 443.29, 443.81, 443.82, 443.89, 443.9, 648.00, 648.01, 648.02, 648.03, 648.04
CHD or CHD risk equivalent ICD-10: A52.01, E08.36, E08.42, E09.36, E09.42, E10.10, E10.11, E10.21, E10.29, E10.311, E10.319, E10.36, E10.39, E10.40, E10.42, E10.51, E10.618,
Ref: 1117.18 69
E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.29, E11.311, E11.319, E11.329, E11.339, E11.349, E11.359, E11.36, E11.39, E11.40, E11.42, E11.51, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13.36, E13.42, H35.039, I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I25.10, I25.5, I25.810, I25.811, I25.812, I25.89, I25.9, I63.139, I63.239, I63.59, I65.29, I65.8, I67.4, I71.3, I71.4, I73.00, I73.1, I73.81, I73.89, I73.9, I77.71, I77.72, I77.73, I77.74, I77.79, I79.8
CHD or CHD risk equivalent SNOMED: 2751001, 3546002, 5368009, 5969009, 8801005, 9859006,
10326007, 10365005, 11530004, 14336007, 15023006, 15256002, 23045005, 25907005, 26298008, 28032008, 28248000, 29899005, 30670000, 33559001, 34140002, 38542009, 39058009, 39181008, 39202005, 39724006, 42954008, 44054006, 46635009, 48431000, 50570003, 50620007, 51002006, 53741008, 54181000, 57886004, 59079001, 62207008, 63739005, 64586002, 67682002, 70694009, 73211009, 74218008, 74371005, 74627003, 75398000, 75524006, 75682002, 75878002, 76751001, 81266008, 81531005, 81830002, 82247006, 87343002, 90205004, 91352004, 92517006, 93396008, 111552007, 111558006, 119564002, 119565001, 123641001, 123642008, 123763000, 127013003, 127014009, 175041000, 175045009, 175047001, 175048006, 175367001, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 190406000, 190407009, 190410002, 190411003, 190412005, 193184006, 194843003, 195268001, 197605007, 198609003, 199223000, 199227004, 199229001, 199230006, 199231005, 201250006, 201251005, 201252003, 230572002, 230577008, 232717009, 232719007, 232720001, 233296007, 233297003, 233298008, 233817007, 233964008, 233970002, 233984007, 233985008, 237599002, 237600004, 237601000, 237604008, 237613005, 237618001, 237619009, 237627000, 266254007, 276951007, 290002008, 309426007, 309814006, 310387003, 310505005, 311366001, 312912001, 313435000, 313436004, 314186008, 314537004, 314771006, 314772004, 314893005, 314902007, 314903002, 315295003, 359597003, 359601003, 359611005, 359642000, 360546002, 361131008, 371087003, 371803003, 371804009, 371805005, 395204000, 398274000, 400047006, 405326004, 405408003, 405409006, 405411002, 405412009, 408539000, 408540003, 408546009, 413183008, 414088005, 414890007, 414906009, 420006002, 420270002, 420414003, 420422005, 420662003, 420756003, 421165007, 421327009, 421750000, 421847006, 421895002, 422088007, 422183001, 422228004, 422275004, 423263001, 424736006, 424989000, 425159004, 425442003, 425771001, 426651005, 426705001, 426875007, 427089005, 427919004, 428896009, 441656006, 444569004
Hypertension ICD-9: 401.1, 401.9, 402.01, 402.11, 402.91, 403.01, 403.11, 403.91, 404.02,
404.03, 404.1, 404.11, 404.12, 404.13, 404.91, 404.92, 404.93, 405.01, 405.11, 405.19, 405.91, 405.99
Hypertension SNOMED: 1201005, 4210003, 8762007, 10725009, 10964002, 14973001, 19769006, 23130000, 26174007, 28119000, 31992008, 34742003, 38341003, 39018007, 44772007, 46481004, 46764007, 48146000, 48194001, 52698002, 56218007, 57684003, 59621000, 59720008, 59997006, 65518004, 68267002, 70272006, 73410007, 74451002, 78975002, 81626002, 84094009, 89242004, 102932008, 123799005, 123800009, 160273004, 170577003, 170578008, 170579000, 170586008, 185264001, 185716009, 185717000, 194783001, 194785008, 194788005, 194791005, 233815004, 233941006, 233942004, 233943009, 233944003, 233945002, 233946001, 234072000, 234073005, 234075003, 237279007, 270440008, 275944005, 276789009, 288250001, 302192008,
70 Ref: 1117.18
371125006, 371622005, 390925005, 395050009, 397748008, 398254007, 401117004, 401118009, 402832006, 412779008, 423674003, 428575007, 429198000, 429457004
To report the patient’s smoking risk factor, enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a qualifying SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes.
Current every day smoker (SNOMED code 449868002)
Current some day smoker (SNOMED code 428041000124106)
Former smoker (SNOMED code 8517006)
Smoker, current status unknown (SNOMED code 77176002)
Heavy tobacco smoker (SNOMED code 428071000124103)
Light tobacco smoker (SNOMED code 428061000124105)
It is strongly recommended that you use the system-defined tobacco history answers. If you have charted tobacco use using custom history answers, you may merge your custom-defined answers with the appropriate system-defined answer.
To report the patient’s HDL-C risk factor, you must order or perform an HDL test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the HDL test item on each lab template for both manually entered and electronic results.
HDL LOINC codes: 14646-4, 18263-4, 2085-9
To report on the family history of premature CHD, you must enter a relationship and a problem in the family history category in the Hx tab of Full Note Composer or the Patient History window. The problem must be associated with SNOMED code 134439009.
Please note that in Aprima PRM 2014 GA, a problem may only be associated with one SNOMED code. If a problem is associated with a SNOMED code that indicates the patient has CHD, then you will need to create a second problem to associate with the SNOMED code for family history of CHD. In Aprima PRM Patch A, you may enter both SNOMED codes on the same problem record.
The application calculates the patient’s Framingham risk percentage based on information entered for the patient, and includes the correct SNOMED for reporting when applicable. The Framingham risk percentage is not displayed in the visit note or patient chart.
Ref: 1117.18 71
Entering Numerator Data
Numerator 1: Patients whose most recent fasting LDL-C test is <100 mg/dL
Numerator 2: Patients whose most recent fasting LDL-C test is <130 mg/dL
Numerator 3: Patients whose most recent fasting LDL-C test is <160 mg/dL within the measurement period or up to four years prior
To report on this measure, you must order or perform a lab test that includes LDL-C, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
You must associate a LOINC code to the tests used in all lab templates used for the test results. The LOINC codes for each type of test are listed below.
LDL LOINC codes: 12773-8, 13457-7, 18261-8, 18262-6, 2089-122748-8, 39469-2, 49132-4, 55440-2,
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the LDL-C value. Results stored in the database as text notes or as an image file cannot be used for reporting.
CMS 65; NQF NA; PQRS 373 Hypertension: Improvement in Blood Pressure
This measure requires a reporting period that is greater than six months. The numerator will be zero if your reporting period is less than six months.
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period.
Exclusions or Exceptions
Exclude from the denominator all patients with evidence of end-stage renal disease (ESRD) on or prior to December 31 of the measurement year. Documentation of dialysis or renal transplant also meets the criteria for evidence of ESRD.
Exclude from the denominator all patients with a diagnosis of pregnancy during the measurement year.
72 Ref: 1117.18
Entering Denominator Data
All patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of hypertension documented during that outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit.
Enter the hypertension diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 401.0, 401.1, 401.9
ICD-10: I10
SNOMED: 10725009, 1201005, 276789009, 371125006, 429457004, 46481004, 48146000, 56218007, 59621000, 59720008, 65518004, 78975002
To report on this measure, you must enter the patient’s blood pressure in the Vitals tab of Full Note Composer or other clinical note type window. You must enter both systolic and diastolic values, but this measure is only concerned with the systolic entry.
The blood pressure measurement from the most recent visit is used to report on this measure. When that visit contains more than one blood pressure measurement, then the measurement with the lowest systolic and diastolic blood pressure is used.
Please note that if the patient has a visit in the first six months of the reporting period and their blood pressure is not high at that time and they do not have a diagnosis or problem of hypertension, then the patient will not be counted for this measure even if the patient’s blood press is high in a visit in during the last six months of the year.
Entering Numerator Data
Patients whose follow-up systolic blood pressure is at least 10 mmHg less than their baseline blood pressure or is adequately controlled (systolic blood pressure is less than 140 mmHg).
If a follow-up blood pressure reading is not recorded during the measurement year, the patient’s blood pressure is assumed “not improved.”
To report on this measure, the patient must have a second visit that:
Is at least six months after the first visit,
Is within the reporting period,
Is with the same provider as the first visit, and
Includes a blood pressure reading.
Ref: 1117.18 73
Enter the patient’s blood pressure in the Vitals tab of Full Note Composer or other clinical note type window. You must enter both systolic and diastolic values, but this measure is only concerned with the systolic entry.
Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.
The blood pressure measurement from the most recent visit is used to report on this measure. When that visit contains more than one blood pressure measurement, then the measurement with the lowest systolic and diastolic blood pressure is used.
CMS 66; NQF NA; PQRS 375 Functional Status Assessment for Knee Replacement
Domain
Patient and Family Engagement
Measure
Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.
Exclusions or Exceptions
Patients with multiple traumas at the time of the total knee arthroplasty or patients with severe cognitive impairment.
Entering Denominator Data
Adults, aged 18 and older, with a primary total knee arthroplasty (TKA) procedure performed within the time period of 180 days before and 185 days after the start of the measurement period. The patient must also have had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after the TKA procedure. The outpatient encounter is restricted to office visit and outpatient consultation procedure codes.
You must enter a qualifying procedure code or a procedure code associated with a qualifying SNOMED code for the knee replacement in the surgical history category in the Hx tab of Full Note Composer or the Patient History window.
CPT: 27447
SNOMED: 179344006, 179345007, 179351002, 179352009, 265170009, 265172001, 392237008, 430698003, 443681002, 443682009
74 Ref: 1117.18
Entering Numerator Data
Patients with patient reported functional status assessment results (e.g., VR-12, VR-36, PROMIS-10, Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA procedure, and at least 60 days and not more than 180 days after the TKA procedure.
To report on this measure, you must have set up an observation item for the score of each assessment that you use, and put these observation items in an observation template. The observation item for each assessment’s score must include the appropriate LOINC code for the functional status assessment. You may use the system-defined PROMIS-10 observation template for this measure.
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the functional status assessment in the observation template on the Observation tab.
Please note that entries in the Cognitive and Functional Assessment history categories do not count for this measure.
Activities of Daily Living LOINC Code: 72100-1
KOOS LOINC Codes: 72102-7, 72099-5, 72101-9
PROMIS-10 LOINC Codes: 71969-0, 71970-8, 71971-6, 71972-4
PROMIS-29 LOINC Codes: 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9, 71961-7, 71962-5, 71963-3, 71964-1, 71965-8, 71966-6, 71967-4, 71968-2, 71970-8
VR12 LOINC Codes: 72009-4, 72010-2, 72011-0, 72012-8, 72013-6, 72014-4, 72015-1, 72016-9,
72017-7, 72018-5, 72019-3, 72020-1, 72021-9, 72022-7, 72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4
VR-36 LOINC Codes: 71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3, 71983-1, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2, 71993-0, 71994-8, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9, 72003-7, 72004-5, 72005-2, 72006-0, 72007-8, 72008-6
Ref: 1117.18 75
CMS 68; NQF 0419; PQRS 130 Documentation of Current Medications in the Medical Record
Domain
Patient Safety
Measure
Percentage of specified visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications to the best of his/her knowledge and ability. This list must include ALL prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.
Please note that the denominator and numerator counts for this measure are a count of distinct visits, not of distinct patients. Therefore, on the CQM 2015 report, the denominator and numerator counts on the summary page will not equal the count of patients in the patient list accessed through the hyperlink for the denominator and numerator.
Exclusions or Exceptions
None
Entering Denominator Data
The patient must be 18 years old or older at the beginning before the start of the measurement period.
Entering Numerator Data
To report on this measure, you must select the checkbox for the Medication History category in the Hx tab of Full Note Composer or other clinical note type to indicate that you have reviewed the medication list.
76 Ref: 1117.18
CMS 69; NQF 0421; PQRS 128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
Domain
Population/Public Health
Measure
Percentage of patients aged 18 years and older with an encounter during the reporting period with a documented calculated BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, follow-up is documented during the encounter or during the previous six months of the encounter with the BMI outside of normal parameters.
Normal parameters for patients age 65 years and older is a BMI between ≥23 and <30. Normal parameters for patients age 18 years to 64 years is a BMI between ≥18.5 and <25.
Denominator 1: All patients aged 18 through 64 years.
Denominator Inclusions: Population Stratification 1: (Patients aged 18-64)
Numerator 1: Patients with BMI calculated within the past six months or during the current visit and a follow-up plan documented if the BMI is outside of parameters.
Numerator Inclusions: Population Stratification 1: (BMI < 25 kg/m2 and 18.5 kg/m2)
Denominator 2: All patients aged 65 years and older
Numerator 2: Patients with BMI calculated within the past six months or during the current visit and a follow-up plan documented if the BMI is outside of parameters.
Numerator Inclusions: Population Stratification 2: (BMI < 30 kg/m2 and 23 kg/m2)
Exclusions or Exceptions
Patients who are pregnant.
Entering Denominator Data
For denominator 1, the patient must be between 18 and 64 years old before the beginning of the measurement period.
For denominator 2, the patient must be 65 years of age or older before the beginning of the measurement period. The patient must have at least one eligible encounter during the measurement period.
Ref: 1117.18 77
For both denominators, the patient must have at least one eligible encounter during the measurement period. Eligible encounters do not include encounters where the patient is receiving palliative care, refuses BMI measurement, the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.
Entering Numerator Data
To report on this measure, you must enter the patient’s height and weight in the Vitals tab of the patient visit note window. The BMI is calculated automatically from the height and weight entries, and then displayed on the Vitals tab and charted in the visit note. The application determines the appropriate LOINC code to associate with the BMI based on the patient’s age.
If there is a medical reason for not calculating the BMI, then you must enter one of the following HCPCS procedure codes and enter an appropriate negation reason on that procedure.
HCPCS for BMI: G8938, G8421, G8417, G8418, G8419, G8420, G8422, G8938
If the BMI is out of the established normal range, then you must establish a follow up plan, which may include medication, procedures, counseling, or a referral to another qualifying medical services provider.
To document the follow-up plan using a procedure, counseling, or referral, use a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure code in either the SP or the SO tab of Full Note Composer or other clinical note type window.
If the procedure code you want has been associated with an education form, such as for counseling, then selecting the education form from the Education Form slider will add the procedure code to the SP tab.
The education form assigned to the patient must be associated with a patient communication type of Overweight or Underweight. Please note that since only one patient communication type can be associated with an education form, you must have separate forms for these conditions. If you use an education form on a general topic, such as nutrition, for both underweight and overweight, then you must have two copies of education form in your database.
Above Normal Follow Up
CPT: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847,
43848, 97804, 98960, 99078
HCPCS: G8417, S9449, S9451, S9452, S9470
SNOMED: 304549008, 307818003, 361231003, 370847001, 386291006, 386292004, 386373004, 386463000, 386464006, 401003006, 410177006, 413315001, 418995006, 424753004, 443288003
78 Ref: 1117.18
Above Normal Referral
SNOMED: 103698003, 103699006, 183515008, 183524004, 183583007, 185359002, 305922005,
306136006, 306163007, 306164001, 306165000, 306166004, 306167008, 306168003, 306226009, 306227000, 306252003, 306344004, 306353006, 306354000, 308459004, 308470006, 308477009, 390864007, 390866009, 390893007, 408289007, 410160006, 416790000, 424203006, 91251008
Below Normal Follow Up
HCPCS: G8418, S9449, S9452, S9470
SNOMED: 386464006, 404923009, 410177006, 413315001, 418995006, 424753004, 429095004, 443288003
Below Normal Referral
SNOMED: 91251008, 103698003, 103699006, 183515008, 183524004, 183583007, 185359002,
305922005, 306136006, 306163007, 306164001, 306165000, 306166004, 306167008, 306168003, 306226009, 306227000, 306252003, 306344004, 306353006, 306354000, 308459004, 308470006, 308477009, 390866009, 390893007, 408289007, 410160006, 416790000, 424203006
To document the follow-up plan using a medication, write a prescription for an appropriate medication using the SIG Writer window. Then print or electronically submit the prescription.
CMS 74; NQF NA; PQRS 379 Primary Caries Prevention Intervention as Offered by Primary Care Providers, Including Dentists
Domain
Clinical Process/Effectiveness
Measure
Percentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period.
Exclusions or Exceptions
None.
Entering Denominator Data
Children, age 0-20 years, with a visit during the measurement period.
Ref: 1117.18 79
Entering Numerator Data
Children who receive a fluoride varnish application.
To report on this measure, you must enter a qualifying procedure code or a procedure code associated with a qualifying SNOMED code for a fluoride varnish application.
HCPCS: D1203, D1206
SNOMED: 35889000, 70468009, 234723000, 313042009
CMS 75; NQF NA; PQRS 378 Children Who Have Dental Decay or Cavities
Domain
Clinical Process/Effectiveness
Measure
Percentage of children, age 0 through 20 years, who have had tooth decay or cavities during the measurement period.
Exclusions or Exceptions
None
Entering Denominator Data
The patient must be 0 through 20 years old, and must have at least one visit during the measurement period.
Entering Numerator Data
To report on this measure, you must enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.
ICD-9 codes: 521.00, 521.01, 521.02, 521.03, 521.04, 521.05, 521.06, 521.07, 521.08, 521.09
ICD-10: K02.3, K02.51, K02.52, K02.53, K02.61, K02.62, K02.63, K02.7, K02.9
80 Ref: 1117.18
CMS 77; NQF NA; PQRS 381 HIV/AIDS: RNA Control for Patients with HIV
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 13 years and older with a diagnosis of HIV/AIDS, with at least two visits during the measurement year, with at least 90 days between each visit, whose most recent HIV RNA level is <200 copies/mL.
Exclusions or Exceptions
None.
Entering Denominator Data
All patients aged 13 years and older with a diagnosis of HIV/AIDS with at least two visits during the measurement year.
To include a patient in the denominator, you must enter a qualifying diagnosis code or a diagnosis code associated with a qualifying SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in either the Hx tab of Full Note Composer or the History window.
ICD-9: 042, V08
ICD-10: B20, Z21
SNOMED: 5810003, 40780007, 48794007, 52079000, 62246005, 62479008, 77070006, 79019005, 86406008, 87117006, 91947003, 111880001, 186706006, 186707002, 186708007, 186709004, 186717007, 186718002, 186719005, 186721000, 186723002, 186725009, 186726005, 230180003, 230201009, 230598008, 235009000, 235726002, 240103002, 276666007, 315019000, 359791000, 397763006, 398329009, 402915006, 402916007
Entering Numerator Data
Patients whose most recent HIV RNA level is <200 copies/mL.
To report on this measure, you must order or perform an HIV RNA test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Ref: 1117.18 81
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the HIV RNA test item on each lab template for both manually entered and electronic results.
LOINC codes: 10351-5, 20447-9, 21008-8, 21333-0, 23876-6, 41515-8, 48511-0, 59419-2,
62469-2, 70241-5
CMS 82; NQF 1401; PQRS 372 Maternal Depression Screening
Domain
Population/Public Health
Measure
The percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child’s first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life.
Exclusions or Exceptions
None
Entering Denominator Data
Children with a visit who turned 6 months of age in the measurement period.
Entering Numerator Data
Children with documentation of maternal screening or treatment for postpartum depression for the mother.
Enter the mother’s screening using a procedure code associated with the SNOMED code 428221000124108 in the SP tab of Full Note Composer or other clinical note type.
Enter the mother’s treatment using a procedure code associated with the SNOMED code 428231000124106 in the SP tab of Full Note Composer or other clinical note type.
If you use the same procedure when screening or treating patients, then you may need to associate the procedure with two different SNOMED codes, one that indicates patient screening or treatment and one that indicates maternal screening or treatment. Or you can create custom procedure codes for the maternal screening and treatment, and associate those custom procedure codes with the appropriate SNOMED codes.
82 Ref: 1117.18
CMS 90; NQF NA; PQRS 377 Functional Status Assessment for Complex Chronic Conditions
Domain
Patient and Family Engagement
Measure
Percentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessments.
Exclusions or Exceptions
Patients with severe cognitive impairment or patients with an active diagnosis of cancer.
Entering Denominator Data
The patient must be 65 years old or older. The patient must have an active diagnosis of heart failure.
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, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9
ICD-10: I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9
SNOMED: 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007, 43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003, 77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007, 92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005, 195112003, 195114002, 206586007, 233924009, 277639002, 314206003, 359617009, 359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001, 426263006, 426611007, 441481004, 441530006
This measure requires at least two patient visits and two assessments. The first visit must be within the first 185 days of the measurement period (January 1 through July 4). The second visit must be within the assessment period, and must be at least 30 days after and not more than 180 days after the first visit. The assessments must be done during or within two weeks prior to each of these two visits.
Because of the timing constraints on the first and second visit, this measure is not optimal if your reporting period is 90 days.
Ref: 1117.18 83
Entering Numerator Data
To report on this measure, you must enter the result of the assessment (e.g., VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29). To do this, you must have set up an observation item for the score of each assessment that you use, and put these observation items in an observation template. The observation item for each assessment’s score must include the appropriate LOINC code for the functional status assessment.
LOINC codes: 71938-5, 71940-1, 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9,
71961-7, 71962-5, 71963-3, 71964-1, 71965-8, 71966-6, 71967-4, 71968-2, 71969-0, 71970-8, 71971-6, 71972-4, 71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3, 71983-1, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2, 71993-0, 71994-8, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9, 72003-7, 72004-5, 72005-2, 72006-0, 72007-8, 72008-6, 72009-4, 72010-2, 72011-0, 72012-8, 72013-6, 72014-4, 72015-1, 72016-9, 72017-7, 72018-5, 72019-3, 72020-1, 72021-9, 72022-7, 72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4, 72188-6, 72189-4, 72190-2, 72191-0, 72192-8, 72193-6, 72194-4, 72195-1, 72196-9
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment for a complex chronic condition.
Enter the score of the functional status assessment in the observation template on the Observation tab.
Please note that entries in the Cognitive and Functional Assessment history categories do not count for this measure.
CMS 117; NQF 0038; PQRS 240 Childhood Immunization Status
Domain
Population/Public Health
Measure
Percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.
Denominator: All patients who turn two years of age during the measurement period.
84 Ref: 1117.18
Numerator: Patients who received all of the following vaccinations by their second birthday.
Number of Vaccination
4 Diphtheria, tetanus and acellular pertussis (DTaP)
3 Polio (IPV)
1 Measles, mumps, rubella (MMR)
3 H influenza type B (HIB)
3 Hepatitis B (Hep B);
1 Chicken pox (VZV);
4 Pneumococcal conjugate (PCV);
2 Hepatitis A (Hep A)
2 or 3 Rotavirus (RV);
2 Influenza (flu)
Exclusions or Exceptions
None.
Entering Denominator Data
The patient must turn 2 years old during the measurement period. The patient must have at least one visit during the measurement period.
Entering Numerator Data
To report on this measure, you must document the administration of the each of the required vaccines.
To document an immunization, enter the administration using the appropriate CPT code for that immunization and enter the vaccination details in the Vaccine Administration Record. This can be done in the patient visit note or in the Patient History, Immunization History category. The vaccine type for the vaccination must be associated with the appropriate CVX code.
All vaccinations must be given according to the recommended schedule for the vaccine.
Patient refusal is not considered valid reporting for this measure. These patients will be counted in the denominator.
Ref: 1117.18 85
CMS 122; NQF 0059; PQRS 1 Diabetes: Hemoglobin A1c Poor Control
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
Exclusions or Exceptions
Patients with a diagnosis of gestational diabetes during the measurement period.
Entering Denominator Data
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001, 81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
86 Ref: 1117.18
Entering Numerator Data
Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%. Patients who do not have an HbA1c level entered during the measurement period are also included in the numerator. Please note that for this measure, a low numerator is the desired outcome.
To report on this measure, you must order or perform an A1c test and then either enter the test results or receive them through an interface. You must associate the results with the order, and give them a status of Resulted or Approved.
The A1c test results must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value.
Results stored in the database as text notes or an image file cannot be used for reporting.
You must associate a LOINC code to the A1C test. There are two ways to do this. You can enter the LOINC on the test item on each lab template for both manually entered and electronic results. This is done in the Lab Template window. The second way is easy if you have several templates. You can enter the LOINC on the A1C test in the Observation Item window. This associates the LOINC to all A1C test items in all lab templates.
The LOINC codes for this result are 17855-8, 17856-6, 4548-4.
CMS 123; NQF 0056; PQRS 163 Diabetes Foot Exam
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.
Exclusions or Exceptions
Patients with a diagnosis of gestational diabetes during the measurement period.
Patients who have had both feet amputated.
Entering Denominator Data
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Ref: 1117.18 87
Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window. This diagnosis or problem must be active.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,
81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
Entering Numerator Data
Patients who received a foot exam during the measurement period. The foot exam must include a visual inspection, a sensory exam, and a pulse exam.
To report on this measure, you must order or perform all three of the required exams. You may chart the exams using procedure codes that are associated with the SNOMED codes for the exams.
Pulse exam: 91161007
Sensory exam: 134388005
Visual exam: 401191002
The procedure codes 2028-F and G9226 are associated with the proper SNOMED codes, and configured to report as a complete foot exam (visual, sensory, and pulse).
88 Ref: 1117.18
CMS 124; NQF 0032; PQRS 309 Cervical Cancer Screening
Domain
Clinical Process/Effectiveness
Measure
Percentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer. Please note that the denominator is patients 23-64 years of age, but the Pap test required for the numerator may be performed up to two years prior when the patient may be 21 or 22 years of age.
Exclusions or Exceptions
Women who had a hysterectomy with no residual cervix.
Entering Denominator Data
Women 23-64 years of age with a visit during the measurement period.
Entering Numerator Data
Women with one or more Pap tests during the measurement period or the two years prior to the measurement period.
To report on this measure, you must order or perform a Pap test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
To chart the Pap test, you must enter a procedure code that is associated with a qualifying LOINC code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
If you did not order the Pap test, you may enter the procedure into the patient’s history. To do this, you must create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window.
Whether the procedure was ordered or entered in the patient history, you must enter the result of the Pap test. The Pap test must be resulted within 24 months prior to the start of the measurement period or during the measurement period.
Pap test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
Ref: 1117.18 89
You must associate a LOINC code to the test item on each lab template for both manually entered and electronic results.
LOINC codes: 10524-7, 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0,
47527-7, 47528-5
CMS 125; NQF NA; PQRS 112 Breast Cancer Screening
Domain
Clinical Process/Effectiveness
Measure
Percentage of women 40–69 years of age who had a mammogram to screen for breast cancer. Please note that the denominator is patients 41-69 years of age, but the mammogram required for the numerator may be performed in the year prior when the patient may be 40 years of age.
Exclusions or Exceptions
Women who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies.
Entering Denominator Data
Women 41–69 years of age with a visit during the measurement period.
Entering Numerator Data
Women with one or more mammograms during the measurement period or the year prior to the measurement period.
To document the test, order the mammography test using one of the HCPCS codes below. If you did not order the mammography test, you may enter the procedure into the patient’s history. To do this, you must create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window.
Whether the procedure was ordered or entered in the patient history, you must enter and approve the mammography results in the Patient Results window, and give them a status of Resulted or Approved. The test must be resulted within 12 months prior to the start of the measurement period or during the measurement period.
HCPCS codes: G0202, G0204, G0206
LOINC codes: 24604-1, 24605-8, 24606-6, 24610-8, 26175-0, 26176-8, 26177-6, 26287-3, 26289-9, 26291-5, 26346-7, 26347-5, 26348-3, 26349-1, 26350-9, 26351-7, 36319-2,
90 Ref: 1117.18
36625-2, 36626-0, 36627-8, 36642-7, 36962-9, 37005-6, 37006-4, 37016-3, 37017-1, 37028-8, 37029-6, 37030-4, 37037-9, 37038-7, 37052-8, 37053-6, 37539-4, 37542-8, 37543-6, 37551-9, 37552-7, 37553-5, 37554-3, 37768-9, 37769-7, 37770-5, 37771-3, 37772-1, 37773-9, 37774-7, 37775-4, 38067-5, 38070-9, 38071-7, 38072-5, 38090-7, 38091-5, 38807-4, 38820-7, 38854-6, 38855-3, 39150-8, 39152-4, 39153-2, 39154-0, 42168-5, 42169-3, 42174-3, 42415-0, 42416-8, 46335-6, 46336-4, 46337-2, 46338-0, 46339-8, 46342-2, 46350-5, 46351-3, 46354-7, 46355-4, 46356-2, 46380-2, 48475-8, 48492-3, 69150-1, 69251-7, 69259-0
CMS 126; NQF 0036; PQRS 311 Use of Appropriate Medications for Asthma
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 5 through 64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.
Exclusions or Exceptions
Patients with emphysema, COPD, cystic fibrosis or acute respiratory failure during or prior to the measurement period.
Entering Denominator Data
The patient must be between 5 and 64 years old. The patient must have at least one visit during the measurement period.
You must identify patients with asthma with an appropriate ICD-10 code or with a SNOMED code associated with an ICD-9 code. The diagnosis may be entered in the Problem/Diagnosis category in the Patient History window or in Dx tab of Full Note Composer or other clinical note type window, but the diagnosis must be active.
ICD-10 Codes: J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52
SNOMED Codes: 426656000, 426979002, 427295004
Entering Numerator Data
To report on this measure, you must prescribe an asthma medication. To report the asthma medication, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
Ref: 1117.18 91
Troubleshooting
The diagnosis for persistent asthma cannot be made inactive or resolved prior to the start of the measurement period.
CMS 127; NQF 0043; PQRS 111 Pneumonia Vaccination Status for Older Adults
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.
Exclusions or Exceptions
None.
Entering Denominator Data
Patients 65 years of age and older with a visit during the measurement period.
Please note that the E&M codes 99211 and 99243 do not count for this measure.
Entering Numerator Data
Patients who have ever received a pneumococcal vaccination.
To report on this measure, you must document the administration of the pneumonia vaccine or document it in the patient’s history. The vaccination may have been given at any time prior to or during the measurement period.
To document the pneumonia immunization, enter the administration using a procedure code associated to an appropriate SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.
You may also document the pneumonia immunization by using a type of vaccine associated with the qualifying CVX code. Identify the type of vaccine when documenting the vaccine details in the vaccine administration record.
92 Ref: 1117.18
To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record.
CVX: 33
SNOMED for administering the vaccination: 12866006, 394678003
CMS 128; PQRS 0105; PQRS 9 Anti-Depressant Medication Management
This measure requires a reporting period that is greater than six months. Numerator two will be zero if your reporting period is less than six months.
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported.
a. Percentage of patients who remained on an antidepressant medication for at least 84 days
(12 weeks).
b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).
Exclusions or Exceptions
Patients who were actively on an antidepressant medication in the 90 days prior to the Index Prescription Start Date.
Entering Denominator Data
Patients 18 years of age and older with a diagnosis of major depression in the 180 days (6 months) prior to the measurement period or the first 180 days (6 months) of the measurement period, who were treated with antidepressant medication, and with a visit during the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or with a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
Ref: 1117.18 93
ICD-9: 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 298.0, 300.4, 309.1, 311
ICD-10: F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1
SNOMED: 832007, 2506003, 2618002, 3109008, 14183003, 15193003, 15639000, 18818009,
19694002, 20250007, 25922000, 28475009, 30605009, 33078009, 33135002, 33736005, 36170009, 36474008, 36923009, 38451003, 38694004, 39809009, 40379007, 42810003, 42925002, 60099002, 63778009, 66344007, 67711008, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000, 76441001, 77911002, 78667006, 79298009, 83176005, 83458005, 84788008, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000, 191610000, 191611001, 191613003, 191676002, 192049004, 231499006, 231504006, 268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001, 370143000, 430852001,
A prescription for a qualifying antidepressant medication must have been written within 30 days prior to and 14 days after the visit in which depression was diagnosed. Write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
Entering Numerator Data
Numerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date.
Numerator 2: Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231-day period following the Index Prescription Start Date.
To report on this measure for acute phase treatment, you must prescribe antidepressant medication for 84 days (12 weeks) within the 4 months following the new episode of major depression.
To report on this measure for continuation phase treatment, you must prescribe antidepressant medication for 180 days (6 months) within 8 months following the new episode of major depression.
To report the antidepressant therapy, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
94 Ref: 1117.18
CMS 129; NQF 0389; PQRS 102 Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Domain
Efficient Use of Healthcare Resources
Measure
Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer
Exclusions or Exceptions
Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician).
Entering Denominator Data
All patients, regardless of age, with a diagnosis of prostate cancer.
The patient must be male, and must have an active diagnosis of prostate cancer before or during the measurement period with a low risk for prostate cancer recurrence and a PSA test of less than or equal to 10 ng/mL and a Gleason Score of less than or equal to 6 before or during the prostate cancer treatment.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 185
ICD-10: C61
SNOMED: 93974005, 94503003, 254900004, 278060005, 314969001, 369485004, 369486003, 396198006, 399068003, 399490008, 399590005, 427492003
You must order the desired lab test using the appropriate procedure code with the procedure code type Lab. If you did not order the test, you may enter the procedure into the patient’s history. To do this, you must create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window.
Ref: 1117.18 95
Whether the procedure was ordered or entered in the patient history, you must enter the result of the test and give them a status of Resulted or Approved.
The test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the result values in a positive/negative or numerical format. The lab test in the template must be associated with an appropriate LOINC code.
LOINC for Gleason results: 35266-6
LOINC for PSA results: 10508-0, 10886-0, 12841-3, 15323-9, 15324-7, 15325-4, 19195-7, 19201-3, 2857-1, 33667-7, 34611-4, 35741-8
You must perform at least one prostate cancer treatment during the measurement period. Enter an appropriate CPT code or a procedure coded associated with an appropriate SNOMED code on the SP or SO tab of the patient visit note window.
CPT codes for treatment: 55810, 55812, 55815, 55840, 55842, 55845, 55866, 55873, 55875,
55876, 77427, 77776, 77777, 77778, 77787
SNOMED for therapy: 8782006, 10492003, 14473006, 19149007, 21190008, 21372000,
24242005, 26294005, 27877006, 28579000, 29860002, 30426000, 36253005, 37851009, 38915000, 41371003, 41416003, 57525009, 62867004, 64978007, 65381004, 65551008, 67598001, 68986004, 72388004, 77613002, 81232004, 83154001, 84755001, 85768003, 87795007, 90199006, 90470006, 91531008, 113120007, 116244007, 118161009, 118162002, 118163007, 168922004, 169327006, 169328001, 169329009, 169340001, 169349000, 169359004, 169374002, 176106009, 176258007, 176260009, 176261008, 176262001, 176263006, 176267007, 176286004, 176288003, 176319004, 228677009, 228684001, 228688003, 228690002, 228692005, 228693000, 228694006, 228695007, 228697004, 228698009, 228699001, 228701001, 228702008, 236209003, 236211007, 236252003, 265589001, 271291003, 312235007, 314202001, 359922007, 359926005, 384691004, 384692006, 394902000, 394918006, 399124002, 399180008, 399315003, 420529003, 427357007, 427985002, 433224001, 433225000, 440093006, 440094000
Entering Numerator Data
Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer.
To report on this measure, you would not have ordered a bone scan for the patient at any time since diagnosis of prostate cancer. Therefore, you will not have received results for the bone scan, and none of the following LOINC codes would be in the patient’s chart. To ensure accurate reporting, one of the following LOINC codes should be associated to all bone scan procedures performed or ordered by the practice.
LOINC: 25031-6, 25032-4, 39627-5, 39812-3, 39813-1, 39814-9, 39815-6, 39816-4, 39817-2,
39818-0, 39819-8, 39820-6, 39858-6, 39879-2, 39880-0, 39881-8, 39882-6, 39883-4, 39884-2, 39901-4, 39902-2, 39903-0, 39904-8, 39905-5, 41772-5, 41836-8, 42700-5, 44142-8
96 Ref: 1117.18
CMS 130; NQF 0034; PQRS 113 Colorectal Cancer Screening
Domain
Clinical Process/Effectiveness
Measure
Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.
Exclusions or Exceptions
Patients with a diagnosis or past history of total colectomy or colorectal cancer.
Entering Denominator Data
Patients 50-75 years of age with a visit during the measurement period.
Entering Numerator Data
Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria below:
Fecal occult blood test (FOBT) during the measurement period.
Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period.
Colonoscopy during the measurement period or the nine years prior to the measurement period.
To report on this measure, you must perform or order the screening test or enter the procedure into the patient’s history. You must also enter the results during or prior to measurement period.
To perform or order the procedure, enter the appropriate procedure code on the SP or SO tab. If entered on the SO tab. To enter the procedure in the patient’s history, you must create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window.
To document the FOBT test and its results, chart the performance of the screening test using one of the procedure codes listed below. Then enter and approve the screening results in the Patient Results window, and give them a status of Resulted or Approved.
FOBT test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting. Results must have a status of Resulted or Approved.
Ref: 1117.18 97
You must associate a LOINC code to the FOBT test item on each lab template for both manually entered and electronic results.
For the flexible sigmoidoscopy or colonoscopy test, it is recommended that you enter or attach the results of the test, whether performed or ordered by you or by another provider. Results should have a status of Resulted or Approved.
FOBT
LOINC codes: 12503-9, 12504-7, 14563-1, 14564-9, 14565-6, 2335-8, 27396-1, 27401-9, 27925-
7, 27926-5, 29771-3, 56490-6, 56491-4, 57905-2, 58453-2
Flexible Sigmoidoscopy
CPT codes: 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341,
45342, 45345
HCPCS codes: G0104
SNOMED codes: 44441009, 112870002, 396226005, 425634007
Colonoscopy
CPT codes: 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379,
45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, 45392
HCPCS codes: G0105, G0121
SNOMED codes: 8180007, 12350003, 25732003, 34264006, 73761001, 174158000, 174184006,
235150006, 235151005, 303587008, 310634005, 367535003, 418714002, 427459009, 443998000, 444783004, 446521004, 446745002, 447021001
Please note that if the patient refuses the screening, then you must chart the screening procedure as described above and then enter a negation reason for the procedure. The patient will then be included in the measure denominator, since the patient meets the requirements. The patient will not be included in the numerator since the screening was not performed.
CMS 131; NQF 0055; PQRS 117 Diabetes: Eye Exam
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period.
98 Ref: 1117.18
Exclusions or Exceptions
Patients with a diagnosis of gestational diabetes during the measurement period.
Entering Denominator Data
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a
SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,
81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
Entering Numerator Data
Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following:
A retinal or dilated eye exam by an eye care professional in the measurement period or
A negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period.
Please note that the exam must be performed by an ophthalmologist or optometrist.
To perform or order the procedure, enter the appropriate procedure code on the SP or SO tab. If entered on the SO tab, you must also give the results a status of Resulted or Approved.
Ref: 1117.18 99
You may also create a procedure history category, and then include the procedure in that history category in the Hx tab of Full Note Composer or the Patient History window. A procedure performed in the year prior to the reporting period counts for this measure only if the results were negative.
Negative findings must be entered through a lab template using Patient Results. The observation item associated with the lab template must have the SNOMED code for the retinal or dilated eye exam, and the value of the result must be “Neg” or “Negative”. The application automatically populates the appropriate SNOMED code for a negative finding when the value of the result includes the text “Neg” or “Negative”.
You must enter the SNOMED in the Observation Item window.
SNOMED codes: 6615001, 252779009, 252780007, 252781006, 252782004, 252783009,
252784003, 252788000, 252789008, 252790004, 274795007, 274798009, 308110009, 314971001, 314972008, 410451008, 410452001, 410453006, 410455004, 420213007, 425816006, 427478009
CMS 132; NQF 0564; PQRS 192 Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures
Domain
Patient Safety
Measure
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.
Exclusions or Exceptions
Patients with any one of a specified list of comorbid conditions that impact the surgical complication rate.
Entering Denominator Data
All patients aged 18 years and older who had cataract surgery and no significant pre-operative ocular conditions impacting the surgical complication rate.
100 Ref: 1117.18
Enter the procedure code or a procedure code associated with a SNOMED code for the cataract surgery in the SP or SO tab of Full Note Composer or other clinical note type or in the surgical history category of the Hx tab of Full Note Composer or the Patient History window.
CPT: 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
SNOMED: 5130002, 9137006, 10178000, 12163000, 31705006, 35717002, 39243005, 46309001,
46426006, 46562009, 50538003, 51839008, 54885007, 65812008, 67760003, 69360005, 74490003, 75814005, 79611007, 82155009, 84149000, 85622008, 88282000, 89153001, 110473004, 112963003, 112964009, 231744001, 308694002, 308695001, 313999004, 335636001, 336651000, 361191005, 385468004, 397544007, 404628003, 415089008, 417493007, 418430006, 419767009, 420260004, 420526005, 424945000, 446548003
Entering Numerator Data
Patients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.
Enter the procedure code or a procedure code associated with a SNOMED code in the SP or SO tab of Full Note Composer or other clinical note type or in the surgical history category of the Hx tab of Full Note Composer or the Patient History window.
CPT: 65235, 65900, 65920, 65930, 66030, 66250, 66820, 66825, 66830, 66852, 66986, 67005,
67010, 67015, 67025, 67028, 67030, 67031, 67036, 67039, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67141, 67145, 67250, 67255
SNOMED: 2536007, 3499006, 3938007, 4143006, 4344007, 4503005, 5671007, 8813000, 8920006, 9137006, 9255007, 10006000, 10807008, 12651006, 12868007, 13767004, 14707009, 18752000, 20647004, 21491001, 22768003, 30113009, 30246007, 31530007, 35552007, 37332006, 37958004, 43908008, 45817009, 46562009, 47470009, 48671003, 48933009, 49789002, 50737005, 51281007, 53570002, 54085006, 54211003, 54362002, 57103007, 58689006, 61220009, 64340000, 65812008, 66134002, 67546003, 68999001, 72199008, 74948004, 75734004, 77950003, 78191003, 78290008, 78362007, 78917001, 84016007, 84077007, 84542000, 85145001, 85231002, 89788006, 89942008, 90997007, 120119003, 172426003, 172451002, 172498005, 172548007, 172574001, 223217009, 224227005, 225184003, 231741009, 231751005, 231752003, 231780001, 287233001, 287236009, 287242008, 296867007, 312705004, 312706003, 312707007, 312714009, 360405005, 360411008, 363726008, 416773006, 417297006, 430833007, 444600006, 445023004, 445024005
Ref: 1117.18 101
CMS 133; NQF 0565; PQRS 191 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery.
Exclusions or Exceptions
Patients with specified comorbid conditions that impact the visual outcome of surgery.
Entering Denominator Data
All patients aged 18 years and older who had cataract surgery.
Enter the procedure code or a procedure code associated with a SNOMED code for the cataract surgery in the SP or SO tab of Full Note Composer or other clinical note type or in the surgical history category of the Hx tab of Full Note Composer or the Patient History window.
CPT: 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
SNOMED: 5130002, 9137006, 10178000, 12163000, 31705006, 35717002, 39243005, 46309001, 46426006, 46562009, 50538003, 51839008, 54885007, 65812008, 67760003, 69360005, 74490003, 75814005, 79611007, 82155009, 84149000, 85622008, 88282000, 89153001, 110473004, 112963003, 112964009, 231744001, 308694002, 308695001, 313999004, 335636001, 336651000, 361191005, 385468004, 397544007, 404628003, 415089008, 417493007, 418430006, 419767009, 420260004, 420526005, 424945000, 446548003
Entering Numerator Data
Patients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following cataract surgery.
There are two was you can report on this measure. You can use observation items or you can use a physical exam item.
To use observations, you must have set up an observation item or items for the visual acuity test, and put these observation items in an observation template. The observation item for must be associated with a qualifying SNOMED code for the test.
102 Ref: 1117.18
SNOMED: 422497000, 423059004, 423862000, 424703005
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the test. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Perform the visual acuity test, and enter the results in the observation template on the Observation tab.
To use a physical exam, you must have set up a visual acuity finding in a physical exam. The finding must have SNOMED code 419775003 in the ID field of the PE Finding window.
Then, perform the visual acuity test, and select the finding in the physical exam.
CMS 134; NQF 0062; PQRS 119 Diabetes: Urine Protein Screening
Domain
Clinical Process/Effectiveness
Measure
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.
Exclusions or Exceptions
Patients with a diagnosis of gestational diabetes during the measurement period.
Entering Denominator Data
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a
SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40,
Ref: 1117.18 103
E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001, 81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
Entering Numerator Data
Patients with a screening for nephropathy or evidence of nephropathy during the measurement period.
To report on this measure, you must either diagnose the patient with nephropathy, or order or perform urine screening and then enter the results, or order or perform a procedure that indicates nephropathy. For this measure, a prescription for an ACE inhibitor or ARB medication is also an indication of nephropathy.
To use the diagnosis, enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.
ICD-9: 250.40, 250.41, 250.42, 250.43
ICD-10: E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22, E11.29, E13.21, E13.22, E13.29
SNOMED: 38046004, 127013003, 236499007, 236500003, 401110002, 420514000, 420715001, 421305000, 421986006, 445170001
To use the urine screening, perform the urine screening, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the urine microalbumin value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the test item on each lab template for both manually entered and electronic results.
Microalbumin LOINC: 1755-8, 1753-3, 1754-1, 1757-4, 2887-8, 2888-6, 2889-4, 2890-2, 9318-7,
11218-5, 12842-1, 13705-9, 13801-6, 14585-4, 14956-7, 14957-5, 14958-3, 14959-1,
104 Ref: 1117.18
18373-1, 20621-9, 21059-1, 21482-5, 26801-1, 27298-9, 30003-8, 30000-4, 30001-2, 32209-9, 32294-1, 32551-4, 34366-5, 35663-4, 40486-3, 40662-9, 40663-7, 43605-5, 43606-3, 43607-1, 44292-1, 47558-2, 49023-5, 50949-7, 53121-0, 53532-8, 53530-2, 53531-0, 56553-1, 57369-1, 58448-2, 58992-9, 59159-4, 60678-0, 63474-1
Macroalbumin LOINC: 1753-3, 24356-8, 24357-6, 39264-7, 50556-0, 50564-4, 50949-7, 57019-2, 57020-0, 58077-9
To use a procedure that indicates nephropathy, you must enter a qualifying procedure code or a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
Dialysis education SNOMED: 59596005, 66402002, 385972005
Dialysis services CPT: 90920, 90921, 90924, 90925, 90935, 90937, 90940, 90945, 90947
Dialysis services HCPCS: 108241001
Dialysis services SNOMED: 676002, 10848006, 11932001, 14684005, 34897002, 57274006,
67970008, 68341005, 71192002, 108241001, 180273006, 225230008, 225231007, 233575001, 233576000, 233577009, 233578004, 233579007, 233580005, 233581009, 233582002, 233583007, 233584001, 233585000, 233586004, 233587008, 233588003, 233589006, 233590002, 238316008, 238317004, 238318009, 238319001, 238321006, 238322004, 238323009, 265764009, 288182009, 302497006, 427053002, 428648006, 439278006, 439976001
ESRD Monthly Outpatient Services CPT: 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 90989, 90993, 90997, 90999, 99512
Kidney transplant CPT: 50340, 50360, 50365, 50370, 50380
Kidney transplant SNOMED: 175899003, 175901007, 175902000, 236138007, 313030004, 48994000, 52213001, 70536003, 88930008
Other Services Related to Dialysis SNOMED: 3257008, 73257006, 233591003, 385970002, 385971003, 385973000, 406168002
Vascular access for dialysis CPT: 36145, 36147, 36148, 36800, 36810, 36815, 36818, 36819, 36820, 36821, 36831, 36832, 36833
Vascular access for dialysis SNOMED: 676002, 7459007, 22800003, 34163007, 54817007,
61160002, 61740001, 63421002, 69380006, 79827002, 80634002, 180272001, 180277007, 225892009, 233468004, 233471007, 233472000, 233547003, 238314006, 238315007, 271418008, 426340003, 427992007, 428118009, 431418000, 431440009, 431781000, 432509002, 432654009, 434435000, 438341004, 438342006, 439241008, 439322008, 439349008, 439534001, 443683004, 448591002, 449400003
To use medication as an indicator of nephropathy, enter the prescription for an ACE inhibitor or ARB medication in the SIG Writer window, and print or electronically submit the prescription.
Ref: 1117.18 105
CMS 135; NQF 0081; PQRS 5 Heart Failure (HF): Angiotensin- Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
Exclusions or Exceptions
Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons)
Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., patient declined, other patient reasons)
Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., other system reasons)
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of heart failure.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
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, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9
ICD-10: I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9
SNOMED: 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007, 43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003, 77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007, 92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005, 195112003, 195114002, 206586007, 233924009, 277639002, 314206003,
106 Ref: 1117.18
359617009, 359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001, 426263006, 426611007, 441481004, 441530006
To report on this measure, you must order or perform an LVEF test and enter the result data. When the LVEF result is equal to or less than 40 percent, then you must prescribe either an ACE inhibitor or ARB therapy.
LVEF test results may entered as results in a lab template using LOINC codes, or as observation items in an observation template using SNOMED codes.
To report the LVEF test using a lab template, the results must either be received through an interface or entered as discrete, quantifiable data in the Patient Results window using a lab template enabling you to enter the LVEF percentage. The results must be given a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the LVEF test item on each lab template for both manually entered and electronic results.
LOINC: 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9,
18045-5, 18049-7, 18043-0, 18046-3, 18047-1
To report the LVEF test using an observation template, you must have set up an observation item for the LVEF test, and put the observation item in an observation template. The observation item must include the appropriate SNOMED code.
SNOMED: 134401001, 981000124106, 991000124109
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the LVEF test. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include the test.
Entering Numerator Data
Patients who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting or at hospital discharge.
To report the ACE inhibitor or ARB therapy, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
Ref: 1117.18 107
CMS 136; NQF 0108; PQRS 366 Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication
Domain
Clinical Process/Effectiveness
Measure
Percentage of children 6 through 12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported.
Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase.
Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.
Exclusions or Exceptions
Denominator Exclusion 1: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.
Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 30 days after the IPSD.
Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.
Denominator Exclusion 2: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period.
Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 300 days after the IPSD.
Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.
Entering Denominator Data
The patient must be between 6 and 12 years of age, and must have at least one visit during the measurement period.
108 Ref: 1117.18
For the first denominator, you must prescribe an ADHD medication for the patient for the first time will be included in the denominator. (The patient is excluded if already taking an ADHD medication.) The first prescription must be written between 90 days prior to start of the measurement period and no later than 60 days from the start of the measurement period.
For the second denominator, the patient must meet the requirements for the first denominator and must remain on medication for at least 210 of the 300 days following the IPSD.
Write the prescription through the SIG Writer window and print the prescription or send it electronically.
Entering Numerator Data
To include the patient in the numerator for the first part of this measure, you must conduct a follow-up visit with the patient within 30 of the initial ADHD prescription and within the measurement period.
A patient must be in the numerator for the first part of this measure in order to be included in the numerator for the second part.
To be included in the second numerator, you must conduct a second follow-up visit at least 31 days after and no more than 300 days after the initial ADHD prescription. The patient must also have been on the ADHD medication for at least 210 days. To report the medication, write the prescriptions and/or refills through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
CMS 137; NQF 0004; PQRS 305 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported.
a. Percentage of patients who initiated treatment within 14 days of the diagnosis.
b. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.
Exclusions or Exceptions
Patients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to the first episode of alcohol or drug dependence.
Ref: 1117.18 109
Entering Denominator Data
Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or drug dependency during a visit in the first 11 months of the measurement period.
Patients presenting with a subsequent episode of alcohol and other drug (AOD) dependence are not eligible for this measure.
ICD-9: 291.0, 291.1, 291.2, 291.3, 291.4, 291.5, 291.81, 291.82, 291.89, 291.9, 292.0, 292.11,
292.12, 292.2, 292.81, 292.82, 292.83, 292.84, 292.85, 292.89, 292.9, 303.00, 303.01, 303.02, 303.90, 303.91, 303.92, 304.00, 304.01, 304.02, 304.10, 304.11, 304.12, 304.20, 304.21, 304.22, 304.30, 304.31, 304.32, 304.40, 304.41, 304.42, 304.50, 304.51, 304.52, 304.60, 304.61, 304.62, 304.70, 304.71, 304.72, 304.80, 304.81, 304.82, 304.90, 304.91, 304.92, 305.00, 305.01, 305.02, 305.20, 305.21, 305.22, 305.30, 305.31, 305.32, 305.40, 305.41, 305.42, 305.50, 305.51, 305.52, 305.60, 305.61, 305.62, 305.70, 305.71, 305.72, 305.80, 305.81, 305.82, 305.90, 305.91, 305.92, 535.30, 535.31, 571.1
ICD-10: F10, F10.10, F10.120, F10.121, F10.129, F10.14, F10.150, F10.151, F10.159, F10.180, F10.181, F10.182, F10.188, F10.19, F10.20, F10.220, F10.221, F10.229, F10.230, F10.231, F10.232, F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, F10.27, F10.280, F10.281, F10.282, F10.288, F10.29, F10.920, F10.921, F10.929, F10.94, F10.950, F10.951, F10.959, F10.96, F10.97, F10.980, F10.981, F10.982, F10.988, F10.99, F11.10, F11.120, F11.121, F11.122, F11.129, F11.14, F11.150, F11.151, F11.159, F11.181, F11.182, F11.188, F11.19, F11.20, F11.220, F11.221, F11.222, F11.229, F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F11.90, F11.920, F11.921, F11.922, F11.929, F11.93, F11.94, F11.950, F11.951, F11.959, F11.981, F11.982, F11.988, F11.99, F12.10, F12.120, F12.121, F12.122, F12.129, F12.150, F12.151, F12.159, F12.180, F12.188, F12.19, F12.20, F12.220, F12.221, F12.222, F12.229, F12.250, F12.251, F12.259, F12.280, F12.288, F12.29, F12.90, F12.920, F12.921, F12.922, F12.929, F12.950, F12.951, F12.959, F12.980, F12.988, F12.99, F13.10, F13.120, F13.121, F13.129, F13.14, F13.150, F13.151, F13.159, F13.180, F13.181, F13.182, F13.188, F13.19, F13.20, F13.220, F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, F13.250, F13.251, F13.259, F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F13.29, F13.90, F13.920, F13.921, F13.929, F13.930, F13.931, F13.932, F13.939, F13.94, F13.950, F13.951, F13.959, F13.96, F13.97, F13.980, F13.981, F13.982, F13.988, F13.99, F14.10, F14.120, F14.121, F14.122, F14.129, F14.14, F14.150, F14.151, F14.159, F14.180, F14.181, F14.182, F14.188, F14.19, F14.20, F14.220, F14.221, F14.222, F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, F14.281, F14.282, F14.288, F14.29, F14.90, F14.920, F14.921, F14.922, F14.929, F14.94, F14.950, F14.951, F14.959, F14.980, F14.981, F14.982, F14.988, F14.99, F15.10, F15.120, F15.121, F15.122, F15.129, F15.14, F15.150, F15.151, F15.159, F15.180, F15.181, F15.182, F15.188, F15.19, F15.20, F15.220, F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, F15.259, F15.280, F15.281, F15.282, F15.288, F15.29, F15.90, F15.920, F15.921, F15.922, F15.929, F15.93, F15.94, F15.950, F15.951, F15.959, F15.980, F15.981, F15.982, F15.988, F15.99, F16.10, F16.120, F16.121, F16.122, F16.129, F16.14, F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, F16.20, F16.220, F16.221, F16.229, F16.24, F16.250, F16.251, F16.259, F16.280, F16.283, F16.288, F16.29, F16.90, F16.920, F16.921, F16.929, F16.94,
110 Ref: 1117.18
F16.950, F16.951, F16.959, F16.980, F16.983, F16.988, F16.99, F18.10, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17, F18.180, F18.188, F18.19, F18.20, F18.220, F18.221, F18.229, F18.24, F18.250, F18.251, F18.259, F18.27, F18.280, F18.288, F18.29, F18.90, F18.920, F18.921, F18.929, F18.94, F18.950, F18.951, F18.959, F18.97, F18.980, F18.988, F18.99, F19.10, F19.120, F19.121, F19.122, F19.129, F19.14, F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, F19.182, F19.188, F19.19, F19.20, F19.220, F19.221, F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, F19.250, F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F19.29, F19.90, F19.920, F19.921, F19.922, F19.929, F19.930, F19.931, F19.932, F19.939, F19.94, F19.950, F19.951, F19.959, F19.96, F19.97, F19.980, F19.981, F19.982, F19.988, F19.99, F55.2, K29.20, K29.21, K70.10, K70.11
SNOMED: 281004, 1383008, 1686006, 1973000, 2403008, 4863002, 5002000, 5444000, 5602001, 6348008, 7052005, 7071007, 7200002, 8635005, 8837000, 10028000, 10327003, 11061003, 11387009, 12380008, 14784000, 15167005, 15277004, 18653004, 18689007, 19445006, 20385005, 20876004, 21000000, 21647008, 25508008, 26714005, 27956007, 28368009, 28864000, 29212009, 29733004, 30310000, 30491001, 30871003, 31715000, 31956009, 32009006, 32358001, 32552001, 32875003, 33845003, 33871004, 34938008, 37331004, 37344009, 38247002, 39003006, 39807006, 39951001, 40571009, 41083005, 42344001, 43497001, 46721000, 46975003, 47664006, 50026000, 50320000, 50722006, 50933003, 50983008, 51339003, 51443000, 51493001, 52866005, 53050002, 53936005, 55967005, 56194001, 57588009, 58727001, 59651006, 61104008, 61144001, 63649001, 63983005, 64386003, 66590003, 69482004, 70328006, 70340006, 70545002, 70655008, 70932007, 71328000, 73097000, 74851005, 74934004, 75122001, 75544000, 77355000, 78267003, 78358001, 78524005, 79578000, 80868005, 82339009, 83168008, 83367009, 84758004, 85005007, 85561006, 87132004, 89451009, 90755006, 90790003, 95635002, 95661003, 105546006, 105549004, 111479008, 111480006, 191471000, 191475009, 191476005, 191477001, 191478006, 191480000, 191483003, 191484009, 191485005, 191486006, 191492000, 191493005, 191494004, 191495003, 191496002, 191802004, 191804003, 191805002, 191811004, 191812006, 191813001, 191816009, 191819002, 191820008, 191825003, 191826002, 191829009, 191831000, 191832007, 191837001, 191838006, 191843004, 191844005, 191849000, 191850000, 191853003, 191855005, 191856006, 191865004, 191867007, 191868002, 191871005, 191873008, 191874002, 191877009, 191882002, 191883007, 191891003, 191893000, 191894006, 191899001, 191900006, 191905001, 191906000, 191907009, 191909007, 191912005, 191913000, 191914006, 191916008, 191918009, 191919001, 191920007, 191924003, 191925002, 191928000, 191930003, 191931004, 191939002, 199252002, 199253007, 199254001, 199255000, 226034001, 228371004, 228372006, 228373001, 228375008, 228376009, 228377000, 228378005, 228379002, 228380004, 228381000, 228382007, 228383002, 228384008, 228386005, 228387001, 228388006, 228389003, 230334008, 230443000, 231451006, 231458000, 231459008, 231461004, 231462006, 231467000, 231468005, 231469002, 231470001, 231472009, 231473004, 231474005, 231475006, 231477003, 231478008, 231479000, 231480002, 231481003, 231482005, 236751006, 237228001, 267206008, 268640002, 268641003, 268645007, 268646008, 268647004, 268648009, 268727002, 280982009, 280983004, 280984005, 280986007, 284591009, 301643003, 302507002, 307052004, 309279000, 310202009, 311173003, 312098001, 312936002, 313915006, 361049005, 361150008, 361151007, 363101005, 396344000, 403590001, 414874007, 416073003, 416714005, 417143004, 417360004, 425339005, 425885002, 426001001, 426095000, 426873000, 427205009, 427229002, 427327003,
Ref: 1117.18 111
427975003, 428219007, 428370001, 428406005, 428493006, 428495004, 428623008, 428659002, 428819003, 428823006, 429179002, 429299000, 429512006, 429672007, 429692000, 429782000, 441681009, 442351006, 442406005
Entering Numerator Data
Numerator 1: Patients who initiated treatment within 14 days of the diagnosis.
Numerator 2: Patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.
To report on this measure, you must document treatment using either a treatment procedure code associated with a SNOMED code or a psychotherapy visit procedure code.
You must enter the procedure code in the SP tab of Full Note Composer or other clinical note type window.
SNOMED for treatment: 24165007, 60112009, 171047005, 313071005, 370881007, 385989002,
386448003, 386449006, 386450006, 386451005, 408933008, 408934002, 408935001, 408936000, 408941008, 408942001, 408943006, 408944000, 408945004, 408947007, 408948002, 410419007, 413473000, 423416000, 424148004, 424407005, 424589009, 426928008
CPT for psychotherapy: 90832, 90834, 90837
For numerator 2, the patient must have initiated treatment within 14 days of the diagnosis, and then had two or more additional visits with treatment or psychotherapy visits within 30 days of the initial encounter.
CMS 138; NQF 0028; PQRS 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Domain
Population/Public Health
Measure
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.
Entering Denominator Data
The patient must be 18 years old or older.
This measure generally requires two office visits during the measurement period. Some types of office visits require only one during the measurement period.
112 Ref: 1117.18
Exclusions or Exceptions
Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason).
Entering Numerator Data
To report on this measure, you must enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in the patient visit note. Then when the patient is a tobacco user, you must provide cessation counseling or prescribe an approved cessation medication.
To report the patient’s smoking history, enter the patient’s use or non-use of tobacco in the Hx tab, Social History category, in Full Note Composer or other clinical note type window. The tobacco history answer selected must be associated with a qualifying SNOMED code in order to qualify. The following system-defined tobacco history answers are associated with the correct SNOMED codes.
Current every day smoker (SNOMED code 449868002)
Current some day smoker (SNOMED code 428041000124106)
Former smoker (SNOMED code 8517006)
Never smoker (SNOMED code 266919005)
Smoker, current status unknown (SNOMED code 77176002)
Heavy tobacco smoker (SNOMED code 428071000124103)
Light tobacco smoker (SNOMED code 428061000124105)
Has never smoked or chewed tobacco (SNOMED code 266919005)
If you have entered the patient’s tobacco use in a prior measurement period and that use has not changed, then you must select the checkbox for the Social History category indicating that you have reviewed the patient’s history, including tobacco use.
When the patient is a tobacco user, then you must either:
Enter CPT code 99406 or 99407 or HCPCS code G0436 to document the cessation counseling, or
Prescribe an approved cessation medication.
If you typically use an education form with or for cessation counseling, then you can associate the appropriate procedure code with the education form so that selecting the education form from the Education Form slider in Full Note Composer or other clinical note type will add the procedure code to the SP tab. The education form must also be associated with the Smoking Cessation patient communication type.
Smoking and tobacco use counseling to the patient is reported using CPT code 99406 (smoking and tobacco cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or code 99407 (smoking and tobacco cessation counseling visit; intensive, greater than 10 minutes).
Ref: 1117.18 113
Remember that these CPT codes are E&M codes, so if you use them along with another E&M code, you must include in the visit note proper documentation supporting the use of the procedure code. Counseling lasting less than 3 minutes is considered part of an evaluation and management (E/M) service and is not paid separately. Proper documentation for codes 99406 and 99407 includes the total time spent and what was discussed, including cessation techniques, resources and follow-up.
The counseling services must be provided by a physician or other qualified health professional and must be provided face-to-face. Some Medicaid programs have not yet adopted payment for these codes.
If you are using the optionally licensed Alere education forms, the Alere Smoking Cessation form is recommended. This education form is associated with HCPCS code G0436. This procedure code is associated with the SNOMED code 225323000 which qualifies for this measure.
If you not using the Alere education forms, then it is recommended that you associate the HCPCS code G0436 to the custom-defined education form that you use for this purpose.
Write the prescription through the SIG Writer window, and either print or electronically submit the prescription.
CMS 139; NQF 0101; PQRS 318 Screening for Future Fall Risk
Domain
Patient Safety
Measure
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.
Exclusions or Exceptions
Documentation of medical reason(s) for not screening for fall risk (e.g., patient is not ambulatory).
Entering Denominator Data
Patients aged 65 years and older with a visit during the measurement period.
Entering Numerator Data
Patients who were screened for future fall risk at least once within the measurement period.
114 Ref: 1117.18
To chart the screening, you must enter a procedure code that is associated with the LOINC code 73830-2. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
CPT code 3288F and 1100F are appropriate for this measure. You must verify that the procedure code used is associated to the LOINC code above.
CMS 140; NQF 0387; PQRS 71 Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
Please note that Aprima PRM 2014 is not certified for this measure. Therefore, information about this measure is not included in this document. This measure cannot be submitted through Aprima PRM.
CMS 141; NQF 0385; PQRS 72 Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients
Please note that Aprima PRM 2014 is not certified for this measure. Therefore, information about this measure is not included in this document. This measure cannot be submitted through Aprima PRM.
CMS 142; NQF 0089; PQRS 19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.
Exclusions or Exceptions
Documentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes.
Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the on-going care of the patient with diabetes.
Ref: 1117.18 115
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of diabetic retinopathy, and who had a dilated macular or fundus exam performed during the first visit. The patient must have two or more visits within the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 362.01, 362.02, 362.03, 362.04, 362.05, 362.06
ICD-10: E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359
SNOMED: 4855003, 25412000, 59276001, 193349004, 193350004, 232020009, 232021008,
232022001, 232023006, 311782002, 312903003, 312904009, 312905005, 312906006, 312907002, 312908007, 312909004, 312912001, 314010006, 314011005, 314014002, 314015001, 390834004, 399862001, 399863006, 399864000, 399865004, 399866003, 399868002, 399869005, 399870006, 399871005, 399872003, 399873008, 399874002, 399875001, 399876000, 399877009, 408409007, 408410002, 408411003, 408412005, 408413000, 408414006, 408415007, 408416008, 414892004, 414894003, 414908005, 414910007, 417677008, 420486006, 420789003, 421779007, 422034002
To report on this measure, you must order or perform a dilated macular or fundus exam, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate the LOINC code 32451-7 to the test item on each lab template for both manually entered and electronic results.
Entering Numerator Data
Patients with documentation, at least once within 12 months, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient’s diabetic care.
116 Ref: 1117.18
To report on this measure, you must define custom procedure codes for reporting this information to another provider. You will need three custom procedures codes: one for reporting macular edema findings present, one for reporting macular edema finds absent, and one for reporting the level of severity of retinopathy. Each of these procedure codes must be associated with an appropriate SNOMED code.
Report macular edema findings present: 37231002, 193350004, 193387007, 232020009,
312911008, 312912001, 312920004, 312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000, 408415007, 408416008, 414892004, 414908005, 420486006, 421779007, 432789001
Report macular edema findings absent: 428341000124108
Report level of severity of retinopathy: 193349004, 312903003, 312904009, 312905005,
390834004, 408411003, 408412005
CMS 143; NQF 0086; PQRS 12 Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic nerve head evaluation during one or more office visits within 12 months.
Exclusions or Exceptions
Documentation of medical reason(s) for not performing an optic nerve head evaluation.
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma. The patient must have two visits within the measurement period.
The first visit must include the diagnosis. Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window.
ICD-9: 365.10, 365.11, 365.12, 365.15
ICD-10: H40.10, H40.11, H40.121, H40.122, H40.123, H40.129, H40.151, H40.152, H40.153, H40.159
SNOMED: 48705003, 66990007, 77075001, 81416004, 84494001, 111513000
Ref: 1117.18 117
Entering Numerator Data
Patients who have an optic nerve head evaluation during one or more office visits within 12 months.
To report on this measure, you must order or perform an optic nerve head evaluation. This evaluation must include a cup-to-disc ratio and an optic disc exam for structural abnormalities. Then enter the test results and give them a status of Resulted or Approved.
Test results must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the test item on each lab template for both manually entered and electronic results.
Cup-to-disc ratio LOINC: 71484-0, 71485-7
Optic disc exam for structural abnormalities LOINC: 71486-5, 71487-3
CMS 144; NQF 0083; PQRS 8 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta- blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge
Exclusions or Exceptions
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the healthcare system).
118 Ref: 1117.18
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of heart failure, with a current or prior LVEF < 40%. The patient must have two or more visits during the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
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, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9
ICD-10: I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9,
SNOMED: 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007, 43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003, 77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007, 92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005, 195112003, 195114002, 206586007, 233924009, 277639002, 314206003, 359617009, 359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001, 426263006, 426611007, 441481004, 441530006
To include the patient in the denominator, you must order or perform an LVEF test and enter the result data. The result date must be on or before any of the qualifying patient visits. The LVEF test must be ordered and the results must have a result date within your reporting period.
The LVEF test results must either be received through an interface or entered as discrete, quantifiable data in the Patient Results window using a lab template enabling you to enter the LVEF percentage. The results must be given a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the LVEF test item on each lab template for both manually entered and electronic results.
LOINC: 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9,
18045-5, 18049-7, 18043-0, 18046-3, 18047-1
Ref: 1117.18 119
Entering Numerator Data
When the LVEF result is less than 40 percent, then you must prescribe beta-blocker therapy for LVSD (not simply beta blocker therapy). Patients who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting or at hospital discharge.
To report the beta-blocker therapy, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
CMS 145; NQF 0070; PQRS 7 Coronary Artery Disease (CAD): Beta- Blocker Therapy- Prior Myocardial infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapy.
Exclusions or Exceptions
Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons).
Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons).
Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system).
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period, and who also have prior MI or a current or prior LVEF <40%.. The patient must have two visits.
Please note that this measure produces results for two denominator and numerator combinations. The denominator information given here is correct for both.
120 Ref: 1117.18
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or in the problem enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
CAD ICD-9: 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03,
414.04, 414.05, 414.06, 414.07, 414.8, 414.9, V45.81, V45.82
CAD ICD-10: I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I24.9, I25.10, I25.110, I25.111, I25.118, I25.119, I25.5, I25.6, I25.700, I25.701, I25.708, I25.709, I25.710, I25.711, I25.718, I25.719, I25.720, I25.721, I25.728, I25.729, I25.730, I25.731, I25.738, I25.739, I25.750, I25.751, I25.758, I25.759, I25.760, I25.761, I25.768, I25.769, I25.790, I25.791, I25.798, I25.799, I25.89, I25.9, Z95.1, Z95.5, Z98.61
CAD SNOMED: 4557003, 10365005, 19057007, 21470009, 28248000, 29899005, 35928006,
41334000, 50570003, 53741008, 59021001, 61490001, 62207008, 63739005, 66189004, 67682002, 74218008, 75398000, 85284003, 87343002, 89323001, 92517006, 123641001, 123642008, 194823009, 194828000, 194842008, 194843003, 233817007, 233819005, 233821000, 233970002, 300995000, 314116003, 315025001, 315348000, 371803003, 371804009, 371805005, 371806006, 371807002, 371808007, 371809004, 371810009, 371811008, 371812001, 398274000, 408546009, 420006002, 421327009, 427919004, 429245005, 429559004
To document a prior MI, enter a problem associated with a SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
MI ICD-9: 410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30,
410.31, 410.32, 410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 412
MI ICD-10: I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I22.0, I22.1, I22.2, I22.8, I22.9, I24.1, I25.2
MI SNOMED: 1755008, 10273003, 15990001, 22298006, 30277009, 32574007, 42531007, 52035003, 54329005, 57054005, 58612006, 62695002, 65547006, 70211005, 70422006, 73795002, 79009004, 129574000, 161502000, 161503005, 194798004, 194802003, 194809007, 194856005, 233835003, 233838001, 233839009, 233840006, 233841005, 233842003, 233843008, 275905002, 304914007, 307140009, 308065005, 314207007, 371068009, 394710008, 399211009, 401303003, 401314000, 418044006, 428196007, 428752002
To document cardiac surgery, enter the procedure with a qualifying procedure code or procedure code associated with a SNOMED code in the SP or SO tab of Full Note Composer or other clinical note type window. Or enter the surgery in the surgical history category in the Hx tab of Full Note Composer or the Patient History window. The history question used to enter the cardiac surgery must be associated with a SNOMED code.
Cardiac surgery CPT: 33140, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519,
33521, 33522, 33523, 33533, 33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92980, 92981, 92982, 92984, 92995, 92996
Ref: 1117.18 121
Cardiac surgery SNOMED: 3546002, 10326007, 15256002, 30670000, 39202005, 39724006, 48431000, 74371005, 81266008, 82247006, 90205004, 119564002, 119565001, 174911007, 175007008, 175008003, 175009006, 175011002, 175021005, 175022003, 175024002, 175025001, 175026000, 175036008, 175037004, 175038009, 175039001, 175040004, 175041000, 175045009, 175047001, 175048006, 175050003, 232717009, 232719007, 232720001, 232721002, 232722009, 232723004, 232724005, 265481001, 275215001, 275216000, 275227003, 275252001, 275253006, 287277008, 309814006, 359597003, 359601003, 414088005
To report on this measure, you must order or perform an LVEF test and enter the result data. When the LVEF result is equal to or less than 40 percent, then you must prescribe a beta blocker.
The LVEF test results must either be received through an interface or entered as discrete, quantifiable data in the Patient Results window using a lab template enabling you to enter the LVEF percentage. The results must be given a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the LVEF test item on each lab template for both manually entered and electronic results.
LOINC: 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9,
18045-5, 18049-7, 18043-0, 18046-3, 18047-1
Entering Numerator Data
Patients who were prescribed beta-blocker therapy.
To report the beta-blocker therapy, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
CMS 146; NQF 0002; PQRS 66 Appropriate Testing for Children with
Pharyngitis
Domain
Efficient Use of Healthcare Resources
Measure
Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.
122 Ref: 1117.18
Exclusions or Exceptions
Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis.
Entering Denominator Data
Children 2-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit.
You must diagnosis the patient with pharyngitis using one of the diagnosis codes below during a visit within the measurement period.
ICD-9: 034.0, 462, 463
ICD-10: J02.8, J02.9, J03.80, J03.81, J03.90, J03.91
SNOMED: 1532007, 17741008, 40766000, 43878008, 55355000, 58031004, 195655000, 195656004, 195657008, 195658003, 195659006, 195660001, 195662009, 195666007, 195667003, 195668008, 195669000, 195670004, 195671000, 195672007, 195673002, 195676005, 195677001, 232399005, 232400003, 302911003, 363746003
Then you must prescribe an antibiotic within 3 days following the visit.
To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically. The antibiotic must be dispensed within three days after the qualifying visit.
Entering Numerator Data
Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis.
To report on this measure, you must prescribe an antibiotic and order a group A streptococcus (strep) test and enter the test results.
To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and print the prescription or send it electronically.
To report the strep test, order the test and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
The strep test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the strep value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the strep test item on each lab template for both manually entered and electronic results. LOINC codes for this result are listed below.
Ref: 1117.18 123
LOINC: 626-2, 5036-9, 6559-9, 6556-5, 6557-3, 6558-1, 11268-0, 17656-0, 18481-2, 31971-5, 49610-9, 60489-2, 68954-7
CMS 147; NQF 0041; PQRS 110 Preventative Care and Screening: Influenza Immunization
Domain
Population/Public Health
Measure
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.
Exclusions or Exceptions
Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons).
Documentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons).
Documentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons).
Entering Denominator Data
Patients aged 6 months and older, and seen for a visit between October 1 and March 31.
The patient must have a visit during flu season, which is defined as October of the prior year through March of the current year.
The patient must also have one, or in some circumstances two, additional visits during the reporting period.
Entering Numerator Data
Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization.
To report on this measure, you must document the administration of the flu immunization, or enter it in the vaccine history category. The vaccine must have been administered between October of the prior year and March of the current year.
124 Ref: 1117.18
To document the influenza immunization, enter the vaccination in the vaccine administration record using one of the following CPT codes or a procedure code associated with a SNOMED code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window. Then document the vaccination details in the vaccine administration record.
To document a vaccination given in the past, you must use a type of vaccine associated with the qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or in the Patient History window. Then, identify the type of vaccine when documenting the vaccine details in the vaccine administration record. Please note that you must make this entry in a visit during the flu season.
CPT: 90656, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668
SNOMED: 86198006, 442333005
CVX: 111, 135, 140, 141, 144, 149, 150
CMS 148; NQF 0060; PQRS 365 Hemoglobin A1c Test for Pediatric Patients
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement period.
Exclusions or Exceptions
Patients with a diagnosis of gestational diabetes during the measurement period.
Entering Denominator Data
Patients 5 to 17 years of age with a diagnosis of diabetes and a face-to-face visit for diabetes care between the physician and the patient that predates the most recent visit by at least 12 months.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72,
Ref: 1117.18 125
250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001, 81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
You must have charted a patient visit note for a face-to-face visit with the patient at least 12 months prior to the visit during the reporting period.
Entering Numerator Data
Patients with documentation of date and result for an HbA1c test during the measurement period.
To report on this measure, you must order or perform an A1c test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
The A1c test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the HGB A1c value. Results stored in the database as text notes or image file cannot be used reporting.
You must associate a LOINC code to the A1C test item on each lab template for both manually entered and electronic results.
LOINC: 17855-8, 17856-6, 4548-4
126 Ref: 1117.18
CMS 149; NQF NA; PQRS 281 Dementia: Cognitive Assessment
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month period.
Exclusions or Exceptions
Documentation of medical reason(s) for not assessing cognition (e.g., patient with very advanced stage dementia, other medical reason).
Documentation of patient reason(s) for not assessing cognition.
Entering Denominator Data
All patients, regardless of age, with a diagnosis of dementia. The patient must have two visits.
ICD-9: 094.1, 290.0, 290.10, 290.11, 290.12, 290.13, 290.20, 290.21, 290.3, 290.40, 290.41,
290.42, 290.43, 290.8, 290.9, 294.10, 294.11, 294.20, 294.21, 294.8, 331.0, 331.11, 331.19, 331.82
ICD-10: A52.17, F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F05, F06.0, F06.8, G30.0, G30.1, G30.8, G30.9, G31.01, G31.09, G31.83
SNOMED: 281004, 4817008, 6475002, 10349009, 10532003, 12348006, 14070001, 15662003, 25772007, 26852004, 32875003, 51928006, 52448006, 54502004, 55009008, 56267009, 59651006, 62239001, 65096006, 66108005, 70936005, 82959004, 90099008, 111480006, 191449005, 191451009, 191452002, 191454001, 191455000, 191457008, 191458003, 191459006, 191461002, 191463004, 191464005, 191465006, 191466007, 191493005, 230270009, 230283005, 230286002, 230287006, 230288001, 230290000, 278857002, 279982005, 312991009, 371024007, 371026009, 416780008, 420614009, 421023003, 421529006, 425390006, 429998004, 442344002, 428351000124105
Entering Numerator Data
Patients for whom an assessment of cognition is performed and the results reviewed at least once within a 12-month period.
To report on this measure, enter the assessment using a procedure code or a procedure code associated with a SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
Ref: 1117.18 127
CPT: 97003, 97004
SNOMED: 4719001, 113024001
To report on this measure, you must have set up an observation item for the score of each assessment that you use, and put these observation items in an observation template. The observation item for each assessment’s score must include the appropriate LOINC code for the functional status assessment.
LOINC: 58151-2, 71492-3, 71493-1, 71722-3, 72106-8, 72172-0, 72173-8
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the functional status assessment in the observation template on the Observation tab.
Please note that entries in the Cognitive and Functional Assessment history categories do not count for this measure.
CMS 153; NQF 0033; PQRS 310 Chlamydia Screening for Women
Domain
Population/Public Health
Measure
Percentage of women 16 through 24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period.
Exclusions or Exceptions
Women who received a pregnancy test solely as a safety precaution before ordering an x-ray or specified medications.
Entering Denominator Data
This measure reports for two groups of patients. Those age 16 to 20, and those age 21 to 24. The patient must have at least one visit during the measurement period.
128 Ref: 1117.18
The patient must be identified as sexually active. Patients may identified as sexually active in a number of ways, including a procedure for a pregnancy test, a diagnosis for pregnancy or pregnancy related problem, a procedure for a birth, a lab test for or a diagnosis for a sexually transmitted infection, a prescription for contraceptives, a procedure for a contraceptive device, and a procedure for infertility treatments.
Patients who received a pregnancy test solely as a safety precaution before ordering an x-ray or specified medications are excluded. However, this exclusion does not apply to patients who qualify for the denominator based on services other than the pregnancy test alone.
Entering Numerator Data
To report on this measure, you must order or perform a chlamydia test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Chlamydia test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the chlamydia test item on each lab template for both manually entered and electronic results.
LOINC codes: 4993-2, 5089-8, 5090-6, 5087-2, 5088-0, 6352-9, 6349-5, 6353-7, 6350-3, 6354-5,
6357-8, 6351-1, 6355-2, 6356-0, 6918-7, 6919-5, 6920-3, 7824-6, 13220-9, 13217-5, 13221-7, 13218-3, 13219-1, 14201-8, 14199-4, 14202-6, 14203-4, 14200-0, 14204-2, 14461-8, 14462-6, 14465-9, 14463-4, 14470-9, 14464-2, 14467-5, 14471-7, 14468-3, 14472-5, 14469-1, 14474-1, 14507-8, 14508-6, 14509-4, 14513-6, 14510-2, 14511-0, 16596-9, 16594-4, 16597-7, 16600-9, 16598-5, 16595-1, 16601-7, 16599-3, 18492-9, 18490-3, 18491-1, 21188-8, 21189-6, 21190-4, 21187-0, 21191-2, 21192-0, 21613-5, 22187-9, 22188-7, 22192-9, 22189-5, 22193-7, 22190-3, 22194-5, 22197-8, 22191-1, 22198-6, 22195-2, 22201-8, 22199-4, 22196-0, 22202-6, 22200-0, 23838-6, 26626-2, 26663-5, 26666-8, 26664-3, 26667-6, 26668-4, 26665-0, 26715-3, 27167-6, 27185-8, 27370-6, 27371-4, 27368-0, 28556-9, 28557-7, 28558-5, 30204-2, 31295-9, 31293-4, 31296-7, 31294-2, 31297-5, 31298-3, 31771-9, 31768-5, 31772-7, 31769-3, 31776-8, 31770-1, 31774-3, 31777-6, 31775-0, 32006-9, 32007-7, 32005-1, 33574-5, 33575-2, 33605-7, 33604-0, 34709-6, 34710-4, 36902-5, 36903-3, 38469-3, 40710-6, 40855-9, 40856-7, 40854-2, 41157-9, 42931-6, 43058-7, 43062-9, 43059-5, 43060-3, 43061-1, 43175-9, 43173-4, 43174-2, 43304-5, 43355-7, 43356-5, 43357-3, 43406-8, 43404-3, 43405-0, 43848-1, 44005-7, 44079-2, 44806-8, 44807-6, 44983-5, 44986-8, 44984-3, 44987-6, 44991-8, 44988-4, 44985-0, 44992-6, 44995-9, 44989-2, 44993-4, 44996-7, 44990-0, 44994-2, 44997-5, 45000-7, 44998-3, 45004-9, 45001-5, 44999-1, 45002-3, 45005-6, 45009-8, 45003-1, 45006-4, 45007-2, 45008-0, 45067-6, 45068-4, 45072-6, 45075-9, 45069-2, 45073-4, 45076-7, 45070-0, 45080-9, 45074-2, 45078-3, 45085-8, 45086-6, 45090-8, 45084-1, 45091-6, 45092-4, 45095-7, 45089-0, 45093-2, 45096-5, 45094-0, 45130-2, 45135-1, 46176-4, 46177-2, 46178-0, 47211-8, 47212-6, 47234-0, 47362-9, 49096-1, 50387-0, 51734-2, 53925-4, 53926-2, 57287-5, 57288-3, 64017-7
Ref: 1117.18 129
CMS 154; NQF 0069; PQRS 65 Appropriate Treatment for Children with Upper Respiratory Infection (URI)
Domain
Efficient Use of Healthcare Resources
Measure
Percentage of children 3 months through 18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.
Exclusions or Exceptions
Exclude children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of URI.
Entering Denominator Data
The patient must be between 3 months and 18 years of age.
The patient must have an outpatient or emergency department visit with a diagnosis of upper respiratory infection (URI) during the measurement period. You must diagnosis the patient with an upper respiratory infection using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.
ICD-9 codes: 460, 465.0, 465.8, 465.9
ICD-10: J00, J06.0, J06.9
SNOMED codes: 195708003, 281794004, 54150009, 54398005, 55355000, 78337007, 82272006
Entering Numerator Data
To report on this measure, you must not write a prescription for an antibiotic on the date of the visit or within three days of the visit.
Patients for whom an antibiotic prescription is written are included in the denominator, but not in the numerator.
130 Ref: 1117.18
CMS 155; NQF 0024; PQRS 239 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents
Domain
Population/Public Health
Measure
Percentage of patients 3 through 17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported.
Percentage of patients with height, weight, and body mass index (BMI) percentile documentation
Percentage of patients with counseling for nutrition
Percentage of patients with counseling for physical activity
Exclusions or Exceptions
Patients who have a diagnosis of pregnancy during the measurement period.
Entering Denominator Data
The patient must between 3 and 17 years old. The patient must have at least one visit with a primary care physician or an obstetrician/gynecologist (OB/GYN) during the measurement period.
Entering Numerator Data
This measure has three different numerators.
To be included in the first numerator, you must record the BMI. To record the BMI percentile, you must enter the patient’s height and weight in the Vitals tab of the patient visit note. The application automatically calculates the BMI.
To be included in the second numerator, you must record your performance of nutrition counseling, regardless of the patient’s BMI. Enter one of the following CPT codes in the SP tab of the patient visit note. You may also associate a valid SNOMED code for nutrition counseling to another procedure code, and enter that code in the SP tab if desired.
CPT codes: 97802, 97803, 97804
To be included in the third numerator, you must record your performance of physical activity counseling, regardless of the patient’s BMI. To do this, you must associate a valid SNOMED code for physical activity counseling to a procedure code and then enter that procedure code in the SP tab of the patient visit note.
Ref: 1117.18 131
If you typically use an education form with or for nutrition or physical activity counseling and the procedure code is associated with the education form, then selecting the education form from the Education Form slider in Full Note Composer or other clinical note type will add the procedure code to the SP tab. The education form must also be associated with the patient communication type Nutrition or the patient communication type Physical Activity.
CMS 156; NQF 0022; PQRS 238 Use of High-Risk Medications in the Elderly
Domain
Patient Safety
Measure
Percentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported.
Percentage of patients who were ordered at least one high-risk medication.
Percentage of patients who were ordered at least two high-risk medications.
Exclusions or Exceptions
None.
Entering Denominator Data
The patient must be 66 years old or older and must have at least one visit during the measurement period.
Entering Numerator Data
To report on this measure, you must write all prescriptions through the SIG Writer window or prescription refill message and print the prescriptions or send them electronically.
Patients 66 years old or older are counted in the first numerator if there is a prescription for a high-risk medication. These patients are counted in the second numerator if there are prescriptions for two or more high-risk medications.
CMS 157; NQF 0384; PQRS 143 Oncology: Medical and Radiation – Pain Intensity Quantified
Please note that Aprima PRM 2014 is not certified for this measure. Therefore, information about this measure is not included in this document. This measure cannot be submitted through Aprima PRM.
132 Ref: 1117.18
CMS 158; NQF 0608; PQRS 369 Pregnant Women that had HBsAg testing
Domain
Clinical Process/Effectiveness
Measure
This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy.
Exclusions or Exceptions
Patients with current or past Hepatitis B infection.
Entering Denominator Data
All female patients aged 12 and older who had a full term delivery during the measurement period.
To chart the delivery, you must enter a procedure code or a procedure code that is associated with a SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
CPT: 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622,
80055, 87340
SNOMED: 1807002, 2321005, 4504004, 5191001, 5556001, 5556001, 10745001, 10745001, 11466000, 14119008, 14119008, 15413009, 15413009, 16819009, 16819009, 17860005, 17860005, 18625004, 18625004, 19390001, 19390001, 22633006, 22633006, 25296001, 25296001, 25828002, 25828002, 26313002, 26313002, 28542003, 28860009, 29613008, 29613008, 30476003, 30476003, 33807004, 38479009, 38479009, 40219000, 40219000, 40704000, 40792007, 45718005, 45718005, 46972000, 48204000, 54973000, 54973000, 56620000, 57271003, 58705005, 61027002, 61586001, 61586001, 62508004, 62508004, 62688006, 65243006, 66201006, 69162008, 69162008, 69422002, 69422002, 69621003, 71166009, 71166009, 72492007, 72492007, 75928003, 84195007, 85403009, 85403009, 89053004, 89346004, 89346004, 89849000, 89849000, 90438006, 90438006, 177128002, 177141003, 177142005, 177143000, 177152009, 177152009, 177157003, 177157003, 177158008, 177158008, 177161009, 177161009, 177162002, 177162002, 177164001, 177164001, 177167008, 177167008, 177168003, 177168003, 177170007, 177170007, 177173009, 177173009, 177174003, 177174003, 177175002, 177175002, 177176001, 177176001, 177179008, 177179008, 177180006, 177180006, 177181005, 177181005, 177184002, 177184002, 177185001, 177203002, 177203002, 177204008, 177212000, 236973005, 236973005, 236974004, 236974004, 236975003, 236975003, 236976002, 236976002, 236977006, 236977006, 236978001, 236978001, 236980007, 236981006, 236982004, 236983009, 236984003, 236985002, 236986001, 236989008, 236991000, 236994008,
Ref: 1117.18 133
237311001, 237311001, 265639000, 265639000, 274128005, 274129002, 274130007, 275168001, 275168001, 275169009, 275169009, 287976008, 287976008, 287977004, 288193006, 302382009, 302382009, 302383004, 302383004, 302384005, 306727001, 306727001, 359940006, 359940006, 359943008, 359943008, 384729004, 384729004, 384730009, 386622003, 387711001, 398307005, 416055001, 416055001, 417121007, 417121007, 450798003
You may also chart the delivery using a diagnosis code or a diagnosis code associated with a qualifying SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window or in the problem/diagnosis category of the Patient History window.
ICD-9: 640.01, 640.81, 640.91, 641.01, 641.11, 641.21, 641.31, 641.81, 641.91, 642.01,
642.02, 642.11, 642.12, 642.21, 642.22, 642.31, 642.32, 642.41, 642.42, 642.51, 642.52, 642.61, 642.62, 642.71, 642.72, 642.91, 642.92, 643.01, 643.11, 643.21, 643.81, 643.91, 644.21, 645.11, 645.21, 646.01, 646.11, 646.12, 646.21, 646.22, 646.31, 646.41, 646.42, 646.51, 646.52, 646.61, 646.62, 646.71, 646.81, 646.82, 646.91, 647.01, 647.02, 647.11, 647.12, 647.21, 647.22, 647.31, 647.32, 647.41, 647.42, 647.51, 647.52, 647.61, 647.62, 647.81, 647.82, 647.91, 647.92, 648.01, 648.02, 648.11, 648.12, 648.21, 648.22, 648.31, 648.32, 648.41, 648.42, 648.51, 648.52, 648.61, 648.62, 648.71, 648.72, 648.81, 648.82, 648.91, 648.92, 649.01, 649.02, 649.11, 649.12, 649.21, 649.22, 649.31, 649.32, 649.41, 649.42, 649.51, 649.61, 649.62, 649.71, 649.81, 649.82, 650, 651.01, 651.11, 651.21, 651.31, 651.41, 651.51, 651.61, 651.71, 651.81, 651.91, 652.01, 652.11, 652.21, 652.31, 652.41, 652.51, 652.61, 652.71, 652.81, 652.91, 653.01, 653.11, 653.21, 653.31, 653.41, 653.51, 653.61, 653.71, 653.81, 653.91, 654.01, 654.02, 654.11, 654.12, 654.21, 654.31, 654.32, 654.41, 654.42, 654.51, 654.52, 654.61, 654.62, 654.71, 654.72, 654.81, 654.82, 654.91, 654.92, 655.01, 655.11, 655.21, 655.31, 655.41, 655.51, 655.61, 655.71, 655.81, 655.91, 656.01, 656.11, 656.21, 656.31, 656.51, 656.61, 656.71, 656.81, 656.91, 657.01, 658.01, 658.11, 658.21, 658.31, 658.41, 658.81, 658.91, 659.01, 659.11, 659.21, 659.31, 659.41, 659.51, 659.61, 659.71, 659.81, 659.91, 660.01, 660.11, 660.21, 660.31, 660.41, 660.51, 660.61, 660.71, 660.81, 660.91, 661.01, 661.11, 661.21, 661.31, 661.41, 661.91, 662.01, 662.11, 662.21, 662.31, 663.01, 663.11, 663.21, 663.31, 663.41, 663.51, 663.61, 663.81, 663.91, 664.01, 664.11, 664.21, 664.31, 664.41, 664.51, 664.61, 664.81, 664.91, 665.01, 665.11, 665.22, 665.31, 665.41, 665.51, 665.61, 665.71, 665.72, 665.81, 665.82, 665.91, 665.92, 666.02, 666.12, 666.22, 666.32, 667.02, 667.12, 668.01, 668.02, 668.11, 668.12, 668.21, 668.22, 668.81, 668.82, 668.91, 668.92, 669.01, 669.02, 669.11, 669.12, 669.21, 669.22, 669.32, 669.41, 669.42, 669.51, 669.61, 669.71, 669.81, 669.82, 669.91, 669.92, 670.02, 671.01, 671.02, 671.11, 671.12, 671.21, 671.22, 671.31, 671.42, 671.51, 671.52, 671.81, 671.82, 671.91, 671.92, 672.02, 673.01, 673.02, 673.11, 673.12, 673.21, 673.22, 673.31, 673.32, 673.81, 673.82, 674.01, 674.02, 674.12, 674.22, 674.32, 674.42, 674.51, 674.52, 674.82, 674.92, 675.01, 675.02, 675.11, 675.12, 675.21, 675.22, 675.81, 675.82, 675.91, 675.92, 676.01, 676.02, 676.11, 676.12, 676.21, 676.22, 676.31, 676.32, 676.41, 676.42, 676.51, 676.52, 676.61, 676.62, 676.81, 676.82, 676.91, 676.92, 678.01, 678.11, 679.01, 679.02, 679.11, 679.12, V27.0, V27.2, V27.3, V27.5, V27.6
ICD-10: O10.22, O10.32, O10.42, O10.92, O15.1, O24.02, O24.12, O24.32, O24.420, O24.424, O24.429, O24.82, O24.92, O25.2, O26.62, O26.72, O41.8X25, O60.10X0, O60.10X1, O60.10X2, O60.10X3,
134 Ref: 1117.18
O60.10X4, O60.10X5, O60.10X9, O60.12X0, O60.12X1, O60.12X2, O60.12X3, O60.12X4, O60.12X5, O60.12X9, O60.13X0, O60.13X1, O60.13X2, O60.13X3, O60.13X4, O60.13X5, O60.13X9, O60.14X0, O60.14X1, O60.14X2, O60.14X3, O60.14X4, O60.14X5, O60.14X9, O60.20X0, O60.20X1, O60.20X2, O60.20X3, O60.20X4, O60.20X5, O60.20X9, O60.22X0, O60.22X1, O60.22X2, O60.22X3, O60.22X4, O60.22X5, O60.22X9, O60.23X0, O60.23X1, O60.23X2, O60.23X3, O60.23X4, O60.23X5, O60.23X9, O61.0, O61.1, O61.8, O61.9, O62.0, O62.1, O62.2, O62.3, O62.4, O62.8, O62.9, O63.0, O63.1, O63.2, O63.9, O64.0XX0, O64.0XX1, O64.0XX2, O64.0XX3, O64.0XX4, O64.0XX5, O64.0XX9, O64.1XX0, O64.1XX1, O64.1XX2, O64.1XX3, O64.1XX4, O64.1XX5, O64.1XX9, O64.2XX0, O64.2XX1, O64.2XX2, O64.2XX3, O64.2XX4, O64.2XX5, O64.2XX9, O64.3XX0, O64.3XX1, O64.3XX2, O64.3XX3, O64.3XX4, O64.3XX5, O64.3XX9, O64.4XX0, O64.4XX1, O64.4XX2, O64.4XX3, O64.4XX4, O64.4XX5, O64.4XX9, O64.5XX0, O64.5XX1, O64.5XX2, O64.5XX3, O64.5XX4, O64.5XX5, O64.5XX9, O64.8XX0, O64.8XX1, O64.8XX2, O64.8XX3, O64.8XX4, O64.8XX5, O64.8XX9, O64.9XX0, O64.9XX1, O64.9XX2, O64.9XX3, O64.9XX4, O64.9XX5, O64.9XX9, O65.0, O65.1, O65.2, O65.3, O65.4, O65.5, O65.8, O65.9, O66.0, O66.1, O66.2, O66.3, O66.40, O66.41, O66.5, O66.6, O66.8, O66.9, O68, O69.0XX0, O69.0XX1, O69.0XX2, O69.0XX3, O69.0XX4, O69.0XX5, O69.0XX9, O69.1XX0, O69.1XX1, O69.1XX2, O69.1XX3, O69.1XX4, O69.1XX5, O69.1XX9, O69.2XX0, O69.2XX1, O69.2XX2, O69.2XX3, O69.2XX4, O69.2XX5, O69.2XX9, O69.3XX0, O69.3XX1, O69.3XX2, O69.3XX3, O69.3XX4, O69.3XX5, O69.3XX9, O69.4XX0, O69.4XX1, O69.4XX2, O69.4XX3, O69.4XX4, O69.4XX5, O69.4XX9, O69.5XX0, O69.5XX1, O69.5XX2, O69.5XX3, O69.5XX4, O69.5XX5, O69.5XX9, O69.81X0, O69.81X1, O69.81X2, O69.81X3, O69.81X4, O69.81X5, O69.81X9, O69.82X0, O69.82X1, O69.82X2, O69.82X3, O69.82X4, O69.82X5, O69.82X9, O69.89X0, O69.89X1, O69.89X2, O69.89X3, O69.89X4, O69.89X5, O69.89X9, O69.9XX0, O69.9XX1, O69.9XX2, O69.9XX3, O69.9XX4, O69.9XX5, O69.9XX9, O70.0, O70.1, O70.2, O70.3, O70.4, O70.9, O71.00, O71.02, O71.03, O71.1, O71.2, O74.1, O74.2, O74.3, O74.4, O74.7, O74.9, O75.0, O75.1, O75.5, O75.81, O75.82, O75.89, O75.9, O76, O77.0, O77.8, O77.9, O80, O82, O88.02, O88.12, O88.22, O88.32, O88.82, O98.02, O98.12, O98.22, O98.32, O98.42, O98.52, O98.62, O98.72, O98.82, O98.92, O99.02, O99.12, O99.214, O99.284, O99.314, O99.324, O99.334, O99.344, O99.354, O99.42, O99.52, O99.62, O99.72, O99.814, O99.824, O99.834, O99.844, O9A.12, O9A.22, O9A.32, O9A.42, O9A.52, Z37.0, Z37.2, Z37.3, Z37.50, Z37.51, Z37.52, Z37.54, Z37.59, Z37.61, Z37.62, Z37.63, Z37.64, Z37.69, Z38.00, Z38.01, Z38.1, Z38.2, Z38.30, Z38.31, Z38.4, Z38.5, Z38.61, Z38.62, Z38.63, Z38.64, Z38.65, Z38.66, Z38.68, Z38.69, Z38.7, Z38.8
Entering Numerator Data
Patients who were tested for Hepatitis B surface antigen (HBsAg) during pregnancy within 280 days prior to delivery.
To report on this measure, you must order or perform a HBsAg test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
Ref: 1117.18 135
You must associate a LOINC code to the HBsAg test item on each lab template for both manually entered and electronic results.
LOINC: 5196-1, 5195-3, 5197-9, 7905-3, 10674-0, 10675-7, 24313-9, 24363-4, 24364-2, 42191-
7, 58452-4, 63557-3, 65633-0, 70154-0, 72061-5
CMS 159; NQF 0710; PQRS 370 Depression Remission at Twelve Months
Domain
Clinical Process/Effectiveness
Measure
Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
Exclusions or Exceptions
1: Patients who died.
2: Patients who received hospice services.
3: Patients who were permanent nursing home residents (> 1 year).
4: Patients with a diagnosis of bipolar disorder.
5: Patients with a diagnosis of personality disorder.
Entering Denominator Data
Adults age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ- 9 score greater than 9 during an outpatient encounter.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33,
296.34, 296.35, 298.0, 300.4, 309.1, 311
ICD-10: F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1, F34.1
SNOMED: 832007, 2506003, 2506003, 2618002, 3109008, 3109008, 14183003, 15193003, 15639000, 18818009, 19694002, 19694002, 20250007, 25922000, 28475009, 30605009, 33078009, 33135002, 33736005, 36170009, 36170009, 36474008, 36923009, 38451003,
136 Ref: 1117.18
38451003, 38694004, 39809009, 40379007, 42810003, 42925002, 60099002, 63778009, 66344007, 67711008, 67711008, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000, 76441001, 77911002, 78667006, 78667006, 79298009, 83176005, 83176005, 83458005, 84788008, 85080004, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000, 191610000, 191611001, 191613003, 191676002, 192049004, 231499006, 231504006, 268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001, 370143000, 430852001
To report on this measure, you must have set up an observation item for the PHQ-9 assessment score, and put the observation item in an observation template. The observation item must include the appropriate LOINC code for the PHQ-9 assessment.
LOINC: 44249-1, 44257-4, 44261-6, 54635-8
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the PHQ-9 assessment in the observation template on the Observation tab.
Entering Numerator Data
Adults who achieved remission at twelve months as demonstrated by a twelve month (+/- 30 days) PHQ-9 score of less than five.
The visit that includes the follow up PHQ-9 assessment must be at least 11 months after and less than 13 months after the first assessment.
To report on this measure, you must have set up an observation item for the PHQ-9 assessment score, and put the observation item in an observation template. The observation item must include the appropriate LOINC code for the PHQ-9 assessment.
LOINC: 44249-1, 44257-4, 44261-6, 54635-8
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the PHQ-9 assessment in the observation template on the Observation tab.
Ref: 1117.18 137
CMS 160; NQF 0712; PQRS 371 Depression Utilization of the PHQ-9 Tool
This measure cannot be reported on if the reporting period is less than one year.
Domain
Clinical Process/Effectiveness
Measure
Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit.
Exclusions or Exceptions
1: Patients who died.
2: Patients who received hospice services.
3: Patients who were permanent nursing home residents (> 1 year).
4: Patients with a diagnosis of bipolar disorder.
5: Patients with a diagnosis of personality disorder.
Entering Denominator Data
Adult patients age 18 and older with an office visit and the diagnosis of major depression or dysthymia during each four-month period.
Denominator 1: The patient must have an active diagnosis of major depression or dysthymia during the last 4 months of the measurement year.
Denominator 2: The patient must have an active diagnosis of major depression or dysthymia during the 5th to 8th months of the measurement year.
Denominator 3: The patient must have an active diagnosis of major depression or dysthymia prior during the first 4 months of the measurement year.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33,
296.34, 296.35, 298.0, 300.4, 309.1, 311
138 Ref: 1117.18
ICD-10: F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1, F34.1
SNOMED: 832007, 2506003, 2506003, 2618002, 3109008, 3109008, 14183003, 15193003,
15639000, 18818009, 19694002, 19694002, 20250007, 25922000, 28475009, 30605009, 33078009, 33135002, 33736005, 36170009, 36170009, 36474008, 36923009, 38451003, 38451003, 38694004, 39809009, 40379007, 42810003, 42925002, 60099002, 63778009, 66344007, 67711008, 67711008, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000, 76441001, 77911002, 78667006, 78667006, 79298009, 83176005, 83176005, 83458005, 84788008, 85080004, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000, 191610000, 191611001, 191613003, 191676002, 192049004, 231499006, 231504006, 268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001, 370143000, 430852001
Entering Numerator Data
Adult patients who have a PHQ-9 tool administered at least once during the four-month period.
Numerator 1: The PHQ-9 assessment must be performed in the last 4 months of the measurement year.
Numerator 2: The PHQ-9 assessment must be performed in the 5th to 8th months of the measurement year.
Numerator 3: The PHQ-9 assessment must be performed in the first 4 months of the measurement year.
To report on this measure, you must have set up an observation item for the PHQ-9 assessment score, and put the observation item in an observation template. The observation item must include the appropriate LOINC code for the PHQ-9 assessment.
LOINC: 44249-1, 44257-4, 44261-6, 54635-8
You must also have a clinical note type defined to include the Observation tab so that you can use the observation template to chart the assessment. None of the system-defined clinical note type windows (such as Full Note Composer) include the Observation tab. So, you must use a custom clinical note type window to chart patient visit notes that will include a functional status assessment.
Enter the score of the PHQ-9 assessment in the observation template on the Observation tab.
Ref: 1117.18 139
CMS 161; NQF 0104; PQRS 107 Major Depressive Disorder (MDD): Suicide Risk Assessment
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period.
Exclusions or Exceptions
None
Entering Denominator Data
All patients aged 18 years and older with a new diagnosis or recurrent episode of MDD.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 296.20, 296.21, 296.22, 296.23, 296.24, 296.30, 296.31, 296.32, 296.33, 296.34
ICD-10: F32.0, F32.1, F32.2, F32.3, F32.9, F33.0, F33.1, F33.2, F33.3, F33.9,
SNOMED: 832007, 2618002, 14183003, 15193003, 15639000, 18818009, 20250007, 25922000, 28475009, 33078009, 33736005, 36474008, 36923009, 38694004, 39809009, 40379007, 42925002, 60099002, 63778009, 66344007, 69392006, 71336009, 73867007, 75084000, 76441001, 77911002, 79298009, 87512008, 191610000, 191611001, 191613003, 268621008, 319768000, 320751009, 370143000, 430852001,
Entering Numerator Data
Patients who had suicide risk assessment completed at each visit.
To chart the assessment, you must enter a procedure code that is associated with the SNOMED code 225337009. HCPCS procedure code G8932 is now associated with this SNOMED code.
Enter the procedure in the SP tab of Full Note Composer or other clinical note type window.
140 Ref: 1117.18
CMS 163; NQF 0064; PQRS 2 Diabetes: Low Density Lipoprotein (LDL) Management
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18–75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.
Exclusions or Exceptions
Exclude patients with a diagnosis of gestational diabetes during the measurement period.
Entering Denominator Data
Patients 18-75 years of age with diabetes with a visit during the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a
SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window. The diagnosis must be active.
ICD-9: 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21,
250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04
ICD-10: E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13
SNOMED: 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,
81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009, 190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001, 199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004, 314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008, 359642000, 359939009
Ref: 1117.18 141
Entering Numerator Data
Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL.
To report on this measure, you must order or perform an LDL-C test, and then either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the LDL-C test item on each lab template for both manually entered and electronic results.
This uses the most recent test results.
LOINC: 2089-1, 13457-7, 18262-6
CMS 164; NQF 0068; PQRS 204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.
Exclusions or Exceptions
None.
Entering Denominator Data
Patients 18 years of age and older with a visit during the measurement period, and an active diagnosis of ischemic vascular disease (IVD) or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period.
142 Ref: 1117.18
The patient must either
Have an active diagnosis of IVD during the measurement period, or
Have an active diagnosis of AMI within 12 months before the start of the measurement period and still active during the measurement period, or
Have had a PCI performed within 12 months before the start of the measurement period, or
Have had CABG performed within 12 months before the start of the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
Acute Myocardial Infarction
ICD-9: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91
ICD-10: I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4
SNOMED: 282006, 10273003, 15990001, 30277009, 52035003, 54329005, 57054005, 58612006,
59063002, 62695002, 64627002, 65547006, 70211005, 70422006, 70998009, 73795002, 76593002, 79009004, 194798004, 194802003, 194809007, 233825009, 233826005, 233827001, 233828006, 233829003, 233830008, 233831007, 233832000, 233833005, 233834004, 233835003, 233836002, 233837006, 233838001, 304914007, 307140009, 401303003, 401314000,
Ischemic Vascular Disease
ICD-9: 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03,
414.04, 414.05, 414.06, 414.07, 414.2, 414.8, 414.9, 429.2, 433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.4, 444.0, 444.1, 444.21, 444.22, 444.81, 444.89, 444.9, 445.01, 445.02, 445.81
ICD-10: I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I24.9, I25.10, I25.110, I25.111, I25.118, I25.119, I25.5, I25.6, I25.700, I25.701, I25.708, I25.709, I25.710, I25.711, I25.718, I25.719, I25.720, I25.721, I25.728, I25.729, I25.730, I25.731, I25.738, I25.739, I25.750, I25.751, I25.758, I25.759, I25.760, I25.761, I25.768, I25.769, I25.790, I25.791, I25.798, I25.799, I25.810, I25.811, I25.812, I25.82, I25.89, I25.9, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09, I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.20, I63.211, I63.212, I63.219, I63.22, I63.231, I63.232, I63.239, I63.29, I63.30, I63.311, I63.312, I63.319, I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40, I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441, I63.442, I63.449, I63.49, I63.50, I63.511, I63.512, I63.519, I63.521, I63.522, I63.529, I63.531, I63.532, I63.539, I63.541, I63.542, I63.549, I63.59, I63.6, I63.8, I63.9, I65.01, I65.02, I65.03, I65.09, I65.1, I65.21, I65.22, I65.23, I65.29, I65.8, I65.9, I66.01, I66.02, I66.03,
Ref: 1117.18 143
I66.09, I66.11, I66.12, I66.13, I66.19, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I70.1, I70.201, I70.202, I70.203, I70.208, I70.209, I70.211, I70.212, I70.213, I70.218, I70.219, I70.221, I70.222, I70.223, I70.228, I70.229, I70.231, I70.232, I70.233, I70.234, I70.235, I70.238, I70.239, I70.241, I70.242, I70.243, I70.244, I70.245, I70.248, I70.249, I70.25, I70.261, I70.262, I70.263, I70.268, I70.269, I70.291, I70.292, I70.293, I70.298, I70.299, I70.92, I74.0, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8, I74.9, I75.011, I75.012, I75.013, I75.019, I75.021, I75.022, I75.023, I75.029, I75.81, I75.89
SNOMED: 1055001, 4557003, 5534004, 14977000, 19057007, 20059004, 21470009, 23687008,
25106000, 26900001, 28790007, 29899005, 35928006, 39823006, 41334000, 45281005, 48601002, 49176002, 50808002, 51274000, 51677000, 52674009, 53741008, 54519002, 54687002, 55382008, 57357009, 59021001, 59062007, 60989005, 61490001, 63739005, 64586002, 64775002, 65084004, 65198009, 66189004, 67682002, 67992007, 69742007, 71444005, 72092001, 73192008, 75543006, 81817003, 85284003, 87343002, 88174006, 89323001, 90520006, 92517006, 95458005, 95459002, 95580006, 109381003, 111291001, 111296006, 111298007, 111299004, 123641001, 123642008, 129573006, 194823009, 194828000, 194842008, 194843003, 194849004, 195182007, 195183002, 195185009, 195186005, 195189003, 195190007, 195200006, 195206000, 195230003, 195231004, 195232006, 195233001, 195234007, 195235008, 195236009, 195254008, 195317001, 195318006, 195319003, 195320009, 195321008, 195323006, 195324000, 195325004, 195326003, 195327007, 195335005, 195336006, 195337002, 195340002, 195341003, 195342005, 195343000, 225566008, 230692004, 230693009, 230694003, 230695002, 230698000, 230699008, 230700009, 230701008, 230702001, 230703006, 230704000, 230706003, 230707007, 230708002, 233817007, 233819005, 233821000, 233823002, 233844002, 233955003, 233956002, 233958001, 233959009, 233960004, 233961000, 233962007, 233964008, 233970002, 233972005, 233973000, 233974006, 236120009, 251024009, 266253001, 266254007, 266262004, 266263009, 274101000, 276219001, 280871000, 281091000, 287731003, 297136002, 297138001, 297141005, 300917007, 300920004, 300995000, 301755001, 302728008, 302904002, 302910002, 302930003, 307363008, 307406004, 307407008, 307408003, 307409006, 307766002, 307767006, 312375001, 312378004, 312822006, 314116003, 315025001, 315348000, 361132001, 361133006, 363340006, 371039008, 371803003, 371804009, 371805005, 371806006, 371807002, 371808007, 371809004, 371810009, 371811008, 371812001, 394659003, 402861007, 408546009, 408665008, 413102000, 413439005, 413444003, 413552002, 413838009, 413844008, 414545008, 414795007, 420006002, 425527003, 426107000, 426651005, 427296003, 427567003, 428196007, 428507003, 429245005, 429559004, 429673002, 431466007, 432083006, 432504007, 441574008, 442224005, 442240008, 442421004, 442439008, 442693003, 442701004, 442735001, 443502000, 443971004, 444855007, 444856008, 446712002
To chart the CABG or PCI, enter a procedure code or a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
Coronary Artery Bypass Graft
HCPCS: S2205, S2206, S2207, S2208, S2209
CPT: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
144 Ref: 1117.18
SNOMED: 3546002, 10326007, 30670000, 39202005, 39724006, 48431000, 74371005, 82247006, 119564002, 119565001, 175007008, 175008003, 175009006, 175011002, 175021005, 175022003, 175024002, 175025001, 175026000, 175029007, 175030002, 175031003, 175032005, 175033000, 175045009, 175047001, 175048006, 175050003, 232717009, 232719007, 232720001, 232721002, 232722009, 232723004, 232724005, 265481001, 275215001, 275216000, 275252001, 275253006, 309814006, 359597003, 359601003, 414088005, 418551006, 419132001
Percutaneous Coronary Interventions
HCPCS: G0290
CPT: 33140, 92980, 92982, 92995
SNOMED: 11101003, 15256002, 75761004, 80762004, 85053006, 91338001, 175066001,
232727003, 232728008, 232729000, 397193006, 397431004, 414089002, 414509005, 415070008, 428488008, 429499003, 429639007, 431759005
Entering Numerator Data
Patients who have documentation of use of aspirin or another antithrombotic during the measurement period.
To report the aspirin or other antithrombotic therapy, write the prescription through the SIG Writer window or prescription refill message and print the prescription or send it electronically.
CMS 165; NQF 0018; PQRS 236 Controlling High Blood Pressure
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18 through 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.
Exclusions or Exceptions
Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.
Entering Denominator Data
The patient must be between 18 and 85 years old.
Ref: 1117.18 145
The patient must have had a diagnosis of essential hypertension at any time prior to the measurement period or be given this diagnosis within the first six months of the measurement period.
You may enter the diagnosis in the Dx tab of Full Note Composer or another clinical note type window, or in the Problem/Diagnosis category in the Hx tab of Full Note Composer or in the Patient History window.
ICD-9: 401.0, 401.1, 401.9
ICD-10: I10
SNOMED: 1201005, 10725009, 46481004, 48146000, 52698002, 56218007, 59621000, 59720008, 62275004, 65518004, 78975002, 276789009, 371125006, 429198000, 429457004
Entering Numerator Data
To report on this measure, you must enter the patient’s blood pressure (both systolic and diastolic values) in the Vitals tab of Full Note Composer or other clinical note type window. Use the system-defined blood pressure fields (Blood Pressure 1, 2, or 3). These observation items for these blood pressure fields are associated with the appropriate LOINC codes.
Patients are included in the numerator if the blood pressure entered for the most recent visit in the measurement period is less than the target blood pressure. The systolic pressure must be less than 140 and diastolic pressure must be less than 90.
CMS 166; NQF 0052; PQRS 312 Use of Imaging Studies for Low Back Pain
Domain
Efficient Use of Healthcare Resources
Measure
Percentage of patients 18 through 50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.
Exclusions or Exceptions
Exclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to the outpatient or emergency department visit.
Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.
146 Ref: 1117.18
Entering Denominator Data
The patient must be between 18 and 50 years old.
The patient must be given a diagnosis of low back pain during an outpatient or emergency department visit. This visit must occur prior to the last 28 days of the measurement period (that is, within the first 337 days of the measurement period). You must diagnosis the patient with lower back pain using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other clinical note type window.
ICD-9: 721.3, 722.10, 722.32, 722.52, 722.93, 724.02, 724.03, 724.2, 724.3, 724.5, 724.6,
724.70, 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, 847.2
ICD-10: M43.27, M43.28, M46.46, M46.47, M47.26, M47.27, M47.28, M47.816, M47.817, M47.818, M47.896, M47.897, M47.898, M48.06, M48.07, M51.26, M51.27, M51.36, M51.37, M51.46, M51.47, M51.86, M51.87, M53.2X7, M53.2X8, M53.3, M53.86, M53.87, M53.88, M54.30, M54.31, M54.32, M54.40, M54.41, M54.42, M54.5, M54.89, M54.9, M99.03, M99.04, M99.23, M99.33, M99.43, M99.53, M99.63, M99.73, S33.6XXA, S33.8XXA, S33.9XXA,
SNOMED: 161894002, 202794004, 247368002, 267067009, 267982002, 278860009, 278862001, 279039007, 279040009, 279041008, 279042001, 300957005
Patients are excluded from the denominator of this measure if they have:
A diagnosis of cancer any time in their history, or
A diagnosis of trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to the visit in which lower back pain is diagnosed, or
A diagnosis of low back pain within the 180 days prior to the visit in which lower back pain is diagnosed.
Entering Numerator Data
To report on this measure, the patient would not have a CT scan, MRI, or x-ray of the lower spine performed within 28 days of diagnosis of low back pain.
To ensure accurate reporting, you must associate the procedure codes for all CT scans, MRIs, x-rays, and other imaging studies of the lower spine with one of the following LOINC codes.
LOINC Codes: 24665-2, 24929-2, 24930-0, 24963-1, 24964-9, 24965-6, 24967-2, 24968-0,
24969-8, 24970-6, 24971-4, 24972-2, 24975-5, 24977-1, 24984-7, 30620-9, 30678-7, 30679-5, 30713-2, 30714-0, 30715-7, 30716-5, 30717-3, 30773-6, 30774-4, 30775-1, 30776-9, 30777-7, 30778-5, 30797-5, 30854-4, 30855-1, 30883-3, 30884-1, 36058-6, 36059-4, 36060-2, 36069-3, 36100-6, 36110-5, 36111-3, 36245-9, 36246-7, 36247-5, 36332-5, 36390-3, 36391-1, 36392-9, 36402-6, 36520-5, 36521-3, 36522-1, 36647-6, 36670-8, 36674-0, 36681-5, 36688-0, 36735-9, 36946-2, 36949-6, 36990-0, 36992-6, 37003-1, 37009-8, 37011-4, 37073-4, 37078-3, 37101-3, 37105-4, 37132-8, 37172-4, 37208-6, 37232-6, 37256-5, 37257-3, 37259-9, 37260-7, 37261-5, 37288-8, 37300-1, 37340-7, 37341-5, 37342-3, 37351-4, 37353-0, 37355-5, 37356-3, 37357-1, 37509-7,
Ref: 1117.18 147
37515-4, 37516-2, 37651-7, 37652-5, 37653-3, 37658-2, 37659-0, 37660-8, 37974-3, 37975-0, 38008-9, 38060-0, 38061-8, 38121-0, 38123-6, 38124-4, 39049-2, 39061-7, 39063-3, 39067-4, 39333-0, 39340-5, 39367-8, 42163-6, 42378-0, 42379-8, 42401-0, 42403-6, 42406-9, 42407-7, 42408-5, 42410-1, 42411-9, 42413-5, 42424-2, 42425-9, 42426-7, 42427-5, 42428-3, 42429-1, 42472-1, 42690-8, 42692-4, 42698-1, 43569-3, 43784-8, 43791-3, 44114-7, 44178-2, 44179-0, 44194-9, 44196-4, 44203-8, 44206-1, 46340-6, 47382-7, 47984-0, 48436-0, 48452-7, 48469-1, 48473-3, 69116-2, 69264-0, 69273-1, 70928-7
CMS 167; NQF 0088; PQRS 18 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 months.
Exclusions or Exceptions
Documentation of medical reason(s) for not performing a dilated macular or fundus examination.
Documentation of patient reason(s) for not performing a dilated macular or fundus examination.
Entering Denominator Data
All patients aged 18 years and older with a diagnosis of diabetic retinopathy.
ICD-9: 362.01, 362.02, 362.03, 362.04, 362.05, 362.06
ICD-10: E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359, E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359
SNOMED: 4855003, 25412000, 59276001, 193349004, 193350004, 232020009, 232021008,
232022001, 232023006, 311782002, 312903003, 312904009, 312905005, 312906006, 312907002, 312908007, 312909004, 312912001, 314010006, 314011005, 314014002,
148 Ref: 1117.18
314015001, 390834004, 399862001, 399863006, 399864000, 399865004, 399866003, 399868002, 399869005, 399870006, 399871005, 399872003, 399873008, 399874002, 399875001, 399876000, 399877009, 408409007, 408410002, 408411003, 408412005, 408413000, 408414006, 408415007, 408416008, 414892004, 414894003, 414908005, 414910007, 417677008, 420486006, 420789003, 421779007, 422034002
Entering Numerator Data
Patients who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy AND the presence or absence of macular edema during one or more office visits within 12 months.
To report on this measure, you must order or perform a dilated macular or fundus exam during the measurement period. Then you must document the level of severity of retinopathy and the presence or absence of macular edema as test results.
To chart the dilated macular or fundus exam, you must use a procedure code associated with the macula findings LOINC code 32451-7. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
Macula test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You can also enter the findings for macula edema and the severity of retinopathy using a procedure code associated with one of the following SNOMED codes. Enter the procedure code in the SP or SO tab of Full Note Composer or other clinical note type window.
Macula edema absent SNOMED: 428341000124108
Macula edema present SNOMED: 37231002, 193350004, 193387007, 232020009, 312911008,
312912001, 312920004, 312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000, 408415007, 408416008, 414892004, 414908005, 420486006, 421779007, 432789001
Severity of retinopathy SNOMED: 193349004, 312903003, 312904009, 312905005, 390834004, 408411003, 408412005
You may also document the severity of retinopathy and the macular edema findings as two separate items. Here is the code list for these.
SNOMED codes for severity of retinopathy: 193349004, 312903003, 312904009, 312905005,
390834004, 408411003, 408412005
SNOMED codes for macular edema findings: 37231002, 193350004, 193387007, 232020009, 312911008, 312912001, 312920004, 312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000, 399872003, 408415007, 408416008, 414892004, 414908005, 420486006, 421779007, 432789001, 6971000047100
Ref: 1117.18 149
CMS 169; NQF 0110; PQRS 367 Bipolar Disorder and Major Depression: Appraisal for Alcohol or Chemical Substance Use
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.
Exclusions or Exceptions
None
Entering Denominator Data
Patients 18 years of age or older at the start of the measurement period, and who have a new diagnosis of unipolar depression or bipolar disorder during the first 323 days of the measurement period, and evidence of treatment for unipolar depression or bipolar disorder within 42 days of diagnosis. The existence of a 'new diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or bipolar disorder during the 180 days prior to the diagnosis.
Depression or bipolar disorder may be identified by a diagnosis or by procedures for depression counseling or therapy or antidepressant or mood stabilizer medications.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.10, 296.11, 296.12, 296.13,
296.14, 296.15, 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.7, 296.80, 296.81, 296.82, 296.89, 300.4, 301.13, 311
ICD-10: F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.73, F31.75, F31.77, F31.81, F31.89, F31.9, F34.0, F32.0, F32.1, F32.2, F32.3, F32.4, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1
SNOMED: 162004, 832007, 1196001, 1499003, 2618002, 4441000, 5703000, 9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14183003, 14495005, 15193003, 15639000, 16295005, 16506000, 17782008, 18818009, 19300006, 19527009, 20250007, 20960007, 21900002, 22407005, 25922000, 26203008, 26530004, 28475009, 28663008,
150 Ref: 1117.18
28884001, 29929003, 30520009, 30605009, 30687003, 31446002, 33078009, 33135002, 33380008, 33736005, 34315001, 35481005, 35489007, 35722002, 35846004, 36474008, 36583000, 36923009, 38694004, 39809009, 40379007, 40926005, 41552001, 41832009, 41932008, 42810003, 42925002, 43568002, 43769008, 45479006, 46229002, 46244001, 48937005, 49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007, 60099002, 61403008, 63249007, 63412003, 63778009, 64731001, 65042007, 66344007, 66631006, 67002003, 68019004, 68569003, 69392006, 70546001, 70747007, 71294008, 71336009, 71984005, 73471000, 73867007, 74686005, 75084000, 75360000, 75752004, 76105009, 76441001, 77911002, 78269000, 78640000, 78667006, 79298009, 79584002, 81319007, 82998009, 83225003, 85248005, 86058007, 87203005, 87512008, 87950005, 191583000, 191584006, 191586008, 191590005, 191592002, 191593007, 191595000, 191610000, 191611001, 191613003, 191618007, 191620005, 191621009, 191623007, 191627008, 191629006, 191630001, 191632009, 191636007, 191638008, 191639000, 191641004, 191658009, 192362008, 231444002, 231494001, 231495000, 231496004, 268619003, 268621008, 319768000, 320751009, 370143000, 371596008, 371599001, 371600003, 371604007, 430852001
Counseling or therapy for depression is indicated by a qualifying procedure code or procedure code associated with qualifying SNOMED codes entered in either the SP or SO tab of Full Note Composer or other clinical note type window.
Counseling for depression SNOMED: 428201000124103
Electroconvulsive therapy CPT: 90870
Electroconvulsive therapy SNOMED: 11075005, 23835007, 231079005, 231080008, 284468008, 313019002, 313020008,
Medication for depression is indicated by a prescription for a qualifying antidepressant or mood stabilizer medication written through the SIG Writer window, and then either printed or submitted electronically. Or, by a qualifying medication in the patient’s medication history.
Entering Numerator Data
Patients in the denominator with evidence of an assessment for alcohol or other substance use following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of treatment for that diagnosis.
(Note: the endorsed measure calls for the assessment to be performed prior to discussion of the treatment plan with the patient, but the current approach was considered more feasible in an EHR setting. The "Assessment for Alcohol or Other Drug Use" required in the numerator is meant to capture a provider's assessment of the patient's symptoms of substance use. The essence of the measure is to avoid treating the patient for unipolar depression or bipolar disorder without an assessment of their use of alcohol or other drugs.)
Enter the assessment using a procedure code or a procedure code that is associated with a qualifying SNOMED code. Enter the procedure in either the SP tab of Full Note Composer or other clinical note type window.
HCPCS: H0001, H0049
Ref: 1117.18 151
CPT: 99408, 99409
SNOMED: 105355005, 117251007, 171208001, 252170002, 273347006, 408942001, 408946003, 428211000124100
CMS 177; NQF 1365; PQRS 382 Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment
Domain
Patient Safety
Measure
Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder with an assessment for suicide risk.
Please note that the denominator and numerator counts for this measure are a count of distinct visits, not of distinct patients. Therefore, on the CQM 2015 report, the denominator and numerator counts on the summary page will not equal the count of patients in the patient list accessed through the hyperlink for the denominator and numerator.
Exclusions or Exceptions
None
Entering Denominator Data
All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorder.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
ICD-9: 296.20, 296.21, 296.22, 296.23, 296.24, 296.30, 296.31, 296.32, 296.33, 296.34
ICD-10: F32.0, F32.1, F32.2, F32.3, F32.9, F33.0, F33.1, F33.2, F33.3, F33.9
SNOMED: 832007, 2618002, 14183003, 15193003, 15639000, 18818009, 20250007, 25922000, 28475009, 33078009, 33736005, 36474008, 36923009, 38694004, 39809009, 40379007, 42925002, 60099002, 63778009, 66344007, 69392006, 71336009, 73867007, 75084000, 76441001, 77911002, 79298009, 87512008, 191610000, 191611001, 191613003, 268621008, 319768000, 320751009, 370143000, 430852001
152 Ref: 1117.18
Entering Numerator Data
Patient visits with an assessment for suicide risk.
To chart the assessment, you must enter a procedure code that is associated with the SNOMED code 225337009. Enter the procedure in the SP tab of Full Note Composer or other clinical note type window.
CMS 179; NQF NA; PQRS 380 ADE Prevention and Monitoring: Warfarin Time in Therapeutic Range
Please note that Aprima PRM 2014 is not certified for this measure. Therefore, information about this measure is not included in this document. This measure cannot be submitted through Aprima PRM.
CMS 182; NQF 0075; PQRS 241 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control
Domain
Clinical Process/Effectiveness
Measure
Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dL).
Exclusions or Exceptions
None
Entering Denominator Data
Patients 18 years of age and older with a visit during the measurement period, and an active diagnosis of ischemic vascular disease (IVD) during the measurement period, or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period.
Ref: 1117.18 153
The patient must either:
Have an active diagnosis of IVD during the measurement period, or
Have an active diagnosis of AMI within 12 months before the start of the measurement period and still active during the measurement period, or
Have had a PCI performed within 12 months before the start of the measurement period, or
Have had CABG performed within 12 months before the start of the measurement period.
Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full Note Composer or the Patient History window.
Acute Myocardial Infarction
ICD-9: 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91
ICD-10: I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4
SNOMED: 282006, 10273003, 15990001, 30277009, 52035003, 54329005, 57054005, 58612006,
59063002, 62695002, 64627002, 65547006, 70211005, 70422006, 70998009, 73795002, 76593002, 79009004, 194798004, 194802003, 194809007, 233825009, 233826005, 233827001, 233828006, 233829003, 233830008, 233831007, 233832000, 233833005, 233834004, 233835003, 233836002, 233837006, 233838001, 304914007, 307140009, 401303003, 401314000,
Ischemic Vascular Disease
ICD-9: 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03,
414.04, 414.05, 414.06, 414.07, 414.2, 414.8, 414.9, 429.2, 433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.4, 444.0, 444.1, 444.21, 444.22, 444.81, 444.89, 444.9, 445.01, 445.02, 445.81
ICD-10: I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I24.9, I25.10, I25.110, I25.111, I25.118, I25.119, I25.5, I25.6, I25.700, I25.701, I25.708, I25.709, I25.710, I25.711, I25.718, I25.719, I25.720, I25.721, I25.728, I25.729, I25.730, I25.731, I25.738, I25.739, I25.750, I25.751, I25.758, I25.759, I25.760, I25.761, I25.768, I25.769, I25.790, I25.791, I25.798, I25.799, I25.810, I25.811, I25.812, I25.82, I25.89, I25.9, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09, I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.20, I63.211, I63.212, I63.219, I63.22, I63.231, I63.232, I63.239, I63.29, I63.30, I63.311, I63.312, I63.319, I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40, I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441, I63.442, I63.449, I63.49, I63.50, I63.511, I63.512, I63.519, I63.521, I63.522, I63.529, I63.531, I63.532, I63.539, I63.541, I63.542, I63.549, I63.59, I63.6, I63.8, I63.9, I65.01, I65.02, I65.03, I65.09, I65.1, I65.21, I65.22, I65.23, I65.29, I65.8, I65.9, I66.01, I66.02, I66.03,
154 Ref: 1117.18
I66.09, I66.11, I66.12, I66.13, I66.19, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I70.1, I70.201, I70.202, I70.203, I70.208, I70.209, I70.211, I70.212, I70.213, I70.218, I70.219, I70.221, I70.222, I70.223, I70.228, I70.229, I70.231, I70.232, I70.233, I70.234, I70.235, I70.238, I70.239, I70.241, I70.242, I70.243, I70.244, I70.245, I70.248, I70.249, I70.25, I70.261, I70.262, I70.263, I70.268, I70.269, I70.291, I70.292, I70.293, I70.298, I70.299, I70.92, I74.0, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8, I74.9, I75.011, I75.012, I75.013, I75.019, I75.021, I75.022, I75.023, I75.029, I75.81, I75.89
SNOMED: 1055001, 4557003, 5534004, 14977000, 19057007, 20059004, 21470009, 23687008,
25106000, 26900001, 28790007, 29899005, 35928006, 39823006, 41334000, 45281005, 48601002, 49176002, 50808002, 51274000, 51677000, 52674009, 53741008, 54519002, 54687002, 55382008, 57357009, 59021001, 59062007, 60989005, 61490001, 63739005, 64586002, 64775002, 65084004, 65198009, 66189004, 67682002, 67992007, 69742007, 71444005, 72092001, 73192008, 75543006, 81817003, 85284003, 87343002, 88174006, 89323001, 90520006, 92517006, 95458005, 95459002, 95580006, 109381003, 111291001, 111296006, 111298007, 111299004, 123641001, 123642008, 129573006, 194823009, 194828000, 194842008, 194843003, 194849004, 195182007, 195183002, 195185009, 195186005, 195189003, 195190007, 195200006, 195206000, 195230003, 195231004, 195232006, 195233001, 195234007, 195235008, 195236009, 195254008, 195317001, 195318006, 195319003, 195320009, 195321008, 195323006, 195324000, 195325004, 195326003, 195327007, 195335005, 195336006, 195337002, 195340002, 195341003, 195342005, 195343000, 225566008, 230692004, 230693009, 230694003, 230695002, 230698000, 230699008, 230700009, 230701008, 230702001, 230703006, 230704000, 230706003, 230707007, 230708002, 233817007, 233819005, 233821000, 233823002, 233844002, 233955003, 233956002, 233958001, 233959009, 233960004, 233961000, 233962007, 233964008, 233970002, 233972005, 233973000, 233974006, 236120009, 251024009, 266253001, 266254007, 266262004, 266263009, 274101000, 276219001, 280871000, 281091000, 287731003, 297136002, 297138001, 297141005, 300917007, 300920004, 300995000, 301755001, 302728008, 302904002, 302910002, 302930003, 307363008, 307406004, 307407008, 307408003, 307409006, 307766002, 307767006, 312375001, 312378004, 312822006, 314116003, 315025001, 315348000, 361132001, 361133006, 363340006, 371039008, 371803003, 371804009, 371805005, 371806006, 371807002, 371808007, 371809004, 371810009, 371811008, 371812001, 394659003, 402861007, 408546009, 408665008, 413102000, 413439005, 413444003, 413552002, 413838009, 413844008, 414545008, 414795007, 420006002, 425527003, 426107000, 426651005, 427296003, 427567003, 428196007, 428507003, 429245005, 429559004, 429673002, 431466007, 432083006, 432504007, 441574008, 442224005, 442240008, 442421004, 442439008, 442693003, 442701004, 442735001, 443502000, 443971004, 444855007, 444856008, 446712002
To chart the CABG or PCI, enter a procedure code or a procedure code that is associated with a qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note Composer or other clinical note type window.
Coronary Artery Bypass Graft
HCPCS: S2205, S2206, S2207, S2208, S2209
CPT: 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533, 33534, 33535, 33536
Ref: 1117.18 155
SNOMED: 3546002, 10326007, 30670000, 39202005, 39724006, 48431000, 74371005, 82247006, 119564002, 119565001, 175007008, 175008003, 175009006, 175011002, 175021005, 175022003, 175024002, 175025001, 175026000, 175029007, 175030002, 175031003, 175032005, 175033000, 175045009, 175047001, 175048006, 175050003, 232717009, 232719007, 232720001, 232721002, 232722009, 232723004, 232724005, 265481001, 275215001, 275216000, 275252001, 275253006, 309814006, 359597003, 359601003, 414088005, 418551006, 419132001,
Percutaneous Coronary Interventions
HCPCS: G0290
CPT: 33140, 92980, 92982, 92995
SNOMED: 11101003, 15256002, 75761004, 80762004, 85053006, 91338001, 175066001,
232727003, 232728008, 232729000, 397193006, 397431004, 414089002, 414509005, 415070008, 428488008, 429499003, 429639007, 431759005
Entering Numerator Data
Numerator 1: Patients with a complete lipid profile performed during the measurement period.
Numerator 2: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dL.
To report on this measure, you must order or perform a complete lipid profile for numerator 1 and an LDL-C test for numerator 2. You must either enter the test results or receive them through an interface and give them a status of Resulted or Approved.
Test results not received through an interface must be entered as discrete, quantifiable data. Enter the results in the Patients Results window using a lab template enabling you to enter the test result value. Results stored in the database as text notes or image file cannot be used for reporting.
You must associate a LOINC code to the test item on each lab template for both manually entered and electronic results.
Complete lipid profile LOINC: 2085-9, 57698-3
Total cholesterol LOINC: 2093-3
HDL-C LOINC: 2085-9
LDL-C LOINC: 13457-7, 18262-6, 2089-1
Triglycerides LOINC: 12951-0, 2571-8
LDL-C LOINC: 13457-7, 18262-6, 2089-1
156 Ref: 1117.18
Clinical Quality Reports
The quality reports meet the requirements for reporting to Centers for Medicare & Medicaid Services (CMS) on several types of care that should be provided under specific circumstances. For all of the quality reports, the number of patients meeting the selection requirements for a rule is the denominator of the rule. The number of qualified patients who received the required care for the rule is the numerator of the rule.
It is important to understand that all quality reports for Meaningful Use and other CMS program reporting are clinical reports. The data in the reports is pulled from patient visit notes only. Therefore, the reports may not be accurate, depending on the report criteria used, if you enter procedures directly into superbills or into a third-party billing system.
CQM 2015
Use the CQM 2015 report to monitor the 2014 edition clinical quality measures. These measures may be used for Meaningful Use, PQRS, and the Comprehensive Primary Care Initiative.
At the conclusion of the reporting period, you must generate the QRDA report files used to submit your data using this same report. The CQM 2015 report is used to generate the files. The report generates the files in a two-step process. Generating the report generates a summary file of the patients in the numerator and denominator for the selected measures. Use the summary report to review the results. Make any changes needed to correct the result data. Then from the summary report, you can generate the detail files used to submit PQRS data.
PQRS GPRO
PQRS data may be submitted for individual providers or for a group of providers submitting under a single tax ID number (TIN). To submit as a group, you must register to take part in PQRS GPRO. Once you have registered, then group submission is the only submission mechanism that CMS will analyze to determine subjectivity to payment adjustment for the group and all associated NPIs who bill Medicare under the group's TIN. To generate the group data, select the PQRS Meaningful Use Group (GPRO) option, and leave the Provider field blank, so that all providers are included. You may generate by billing or rendering provider. This option is simply used to determine which providers had visits with patients.
When you register for PQRS GPRO, you must identify the submission method you will use. The only submission method supported by Aprima PRM for GPRO is the direct electronic health record (EHR) using certified EHR technology (CEHRT) method. Please see the Submission Methods section of this document for more information.
Please note that this option is only available in Aprima PRM 2015 and higher versions.
Ref: 1117.18 157
Comprehensive Primary Care Initiative
The Comprehensive Primary Care (CPC) Initiative uses the same clinical quality measures as Meaningful Use and PQRS. CPC data is submitted as a group. However, the QRDA file structure used for CPC data submission is different than the file structure used for PQRS. So you must select the CPC option to generate the data. Leave the Provider field blank, so that all providers are included. You may generate by billing or rendering provider. This option is simply used to determine which providers had visits with patients.
Please note that this option is only available in Aprima PRM 2015 and higher versions.
QRDA File Batches
Each time you generate the QRDA detail files, the application creates a document batch. The document batch includes the summary and detail files created with all the patient details for the measures’ numerators and denominators. This enables you to easily review and correct data. It also enables you to quickly generate again the QRDA files for the same patients and dates.
The batch includes all the filtering criteria, include the timespan. So, if you generate the report using a batch that has a timespan in the past, the report results will not include patient, visit, or other data entered after the timespan’s end date.
Generate the CQM 2015 Report
Use the CQM 2015 report to generate the summary QRDA report for a provider. You must perform the process for each provider participating in a particular program or for the group and program.
You may want to save a filter for this report or a filter for each provider since you may need to generate the report multiple times before you are ready to submit your files.
IMPORTANT: When submitting data for PQRS GPRO or Comprehensive Primary Care, CQM measures that have a zero numerator are not valid and cannot be submitted. If a measure on the report has a zero numerator, then you must generate the report again without that measure in order to produce a file that does not have a zero numerator.
1. Desktop → Reports ) icon
2. Select the Clinical Quality folder.
158 Ref: 1117.18
3. Select the CQM 2015 report.
4. In the Description field, you may select a previously generated batch to view it again. There will not be any batches to select from until you have generated the QRDA files from the report at least once.
5. Select the appropriate CMS Program option. This determines the content and structure of the files generated.
PQRS Meaningful Use Individual: Use this option to generate data for a single provider for PQRS submission or for combined PQRS and Meaningful Use submission. When selected, you must select a single provider in the Provider field.
PQRS Meaningful Use Group (GPRO): Use this option to generate data for providers submitting as a group. When selected, you must leave the Provider field blank so that all providers are included.
Meaningful Use: Use this option to generate data for a single provider for Meaningful Use submission. When selected, you must select a single provider in the Provider field.
CPC: Use this option to generate Comprehensive Primary Care data for providers submitting as a group. When selected, you must leave the Provider field blank so that all providers are included.
6. In the Payer field, select all Medicare insurance payers.
Please note that Medicare replacement (Medicare Part C and Medicare Advantage Plan) do not count for PQRS.
7. In the Provider field, either:
Select the desired provider to generate PQRS or Meaningful Use data for a single provider.
Leave the field blank to generate PQRS or CPC data for the group of providers.
Ref: 1117.18 159
8. Select the radio button for Billing Provider or for Rendering Provider.
When you generate by rendering provider, the application generates the report and files for the billing provider on the selected rendering provider’s superbills. This is because CMS requires PQRS data to be submitted by the billing provider.
9. In the Measure Date field, select the desired time span. For example:
Current Year: The current calendar year, January 1 through December 31.
Last Year: The last calendar year, January 1 through December 31.
Custom Date: Enter the desired start and end dates. Use this option if you started using Aprima PRM during the year.
10. In the Measure Name field, select the measures on which this provider or group wants to report.
11. If generating for analysis only (not for data submission), then you may:
Select one or more Financial Centers. (You must leave this field blank when generating data for submission.)
Select one or more Service Sites. (You must leave this field blank when generating data for submission.)
12. Either:
Deselect the Include Test Patient checkbox when generating files for submission. This excludes all patients who are flagged as test patients. Do not include test patients when generating data for submission.
Select the Include Test Patient checkbox if you want to include patients flagged as test patients. You may want to do this to review and assess your data.
11. Select the View button to generate the QRDA Calculated Summary Report.
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Review the QRDA Calculated Summary Report
Once you have a generated the summary report, you may review it to assess the data selected for each measure.
The report identifies each measure by PQRS measure number, measure title, NQF number, and eMeasure Identifier. The eMeasure Identifier is the CMS identifier for the corresponding meaningful use measure.
For each measure, the report lists the specific patient populations, such as the denominator and the numerator populations, and the number of patients in the population.
Review the report to verify that there are a number of patients in the denominator and numerator for each measure. If the population number for either the denominator or the numerator or if the combination of the population numbers for the denominator and the numerator do not seem correct to you, then you need to investigate.
Ref: 1117.18 161
Understanding the Report Layout
The QRDA Calculated Summary Report contains a large amount of information. Some of the information you will need while monitoring performance, and some will you will need when entering your attestation and submitting data. Other information is needed to ensure the validity of the report, but is not information that you generally need to be concerned with. The following fields on the report are important for you to understand.
Document Created: This is the date you generated the report.
Author: This identifies the provider for whom you generated the report, and the name of the database from which you generated it.
PRM Rule Number: This is the number in the ID field of the measure definition. You can use this number when searching for and selecting measures to include in the report.
eMeasure Title: This is the title of the measure. This is generally the title given to the measure by CMS, but the title may be abbreviated or shortened.
eMeasure Version Number: This is the version number of the measure definition. The version number is assigned by CMS.
NQF eMeasure Number: This is the NQF identifying number for the measure. NQF numbers are used by PQRS and may be used by other quality programs. Not all clinical quality measures have an NQF number. An NQF number may be used by more than one clinical quality measure, each with a distinct CMS number.
eMeasure Identifier: This is the CMS identifying number for the measure. CMS numbers are used by Meaningful User and may be used by other quality programs.
Performance Rate: This is the rate you will use for your attestation. The formula for calculating the performance rate is PerformanceRate = Numerator / (Denominator – Exclusion - Exception).
162 Ref: 1117.18
Reporting Rate: This rate is defined by CMS, but it not used in your attestation. The reporting rate and performance are calculated differently, and will not be the same for any measure that has exclusions or exceptions. The formula for calculating the reporting rate is ReportingRate = (Numerator + Exclusion + Exception) / Denominator.
Initial Patient Population: This the number of patients identified for the measure’s initial patient population. You can select the hyperlink to access the detail report identifying the population.
Denominator: This is the number of patients identified for the measure’s denominator, including patients that qualify for an exclusion or exception. You will use this number for your attestation. For many measures, the initial patient population and the denominator are the same. However, for some measures, the denominator has additional requirements, and so these populations are different. Also, some measures have more than one denominator. You can select the hyperlink to access the detail report identifying the population.
Numerator: This is the number of patients identified for the measure’s numerator. Some measures have more than one numerator population. You can select the hyperlink to access the detail report identifying the population.
Denominator Exclusions: This is the number of patients identified as being excluded or excepted from the measure.
Report Functionality
From the QRDA Calculated Summary Report, you may:
Select the population number hyperlink to access a detail report listing each patient in the population. This enables you to review and correct any data. See the Review the QRDA Calculated Summary Report – Patient Detail Report section for more information and instructions.
Select or unselect the checkbox for a population to display or hide a detailed list of the criteria for the measure, and the patient population for each criterion.
Select the Print ) icon to print the summary report. This prints the expanded version of the summary report.
Ref: 1117.18 163
Review the QRDA Calculated Summary Report – Patient Detail Report
Access the QRDA Calculated Summary Report – Patient Detail Report by selecting any population number hyperlink in the QRDA Calculated Summary Report. The detail report for the patient population lists all the patients in that population, and shows each patient’s relevant data for the measure and population.
You may only open the detail report for one patient population at a time. If you need to compare the patient populations for the denominator and the numerator of a measure, then
copy the table listing the patients from the patient detail report and paste it to a Microsoft®
Word document. The open the other patient detail report, and copy and paste the table of patient information from it to same Word document or a second Word document. Or if the list of patients is short, you can simply make a screen shot of one or both reports so that you can compare the populations.
From the Patient Detail Report, you may:
Use the patient name hyperlink to access the Patient Demographics window to review or correct any patient data.
Use the Review Past Notes icon ) to access the Review Past Notes window to review visit note and other clinical data. From the Review Past Notes window, you may access patient visit notes or other items to review or correct data.
164 Ref: 1117.18
Select the Back to Summary hyperlink, at the top or the bottom of the report, to return to the QRDA Calculated Summary Report.
Closing the report window closes both the detail report and the summary report. So, if you close the window for the detail report, you will need to generate the report again to return to the summary report.
If you correct errors identified in the Patient Detail Report, and then return to the QRDA Calculated Summary Report, the patient population numbers in summary report will not reflect your data changes. Likewise, accessing the Patient Detail Report again or accessing the Patient Detail Report for any other patient population will not reflect data changes you have made to correct errors. You must close the report, return to the Report window, and generate the CQM 2015 report again. This produces a new QRDA Calculated Summary Report and associated Patient Detail reports that reflect the data changes you have made to correct errors.
Generate the Detailed QRDA Files
After you have reviewed and corrected the data, you are ready to generate the detailed QRDA files used to submit the PQRS data. Generating the QRDA files may identify additional errors that you need to correct before your files are ready to submit.
You may start the file generation for one provider, and while the files are generating, start the file generation for another provider. Please be aware, however, that generating files for multiple providers at the same time may affect the response time of the application for all users. If so, you want to pause file generation for one or more providers until the processing completes for one batch of files.
1. From the QRDA Calculated Summary Report, select the Play ) icon to generate the QRDA files. You may close the report window while the files are being generated.
2. The green progress bar in the footer of the report window shows you the progress of file generation. The footer also shows the percentage complete, the number of successful file generations, and any errors.
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3. Select the Rename Batch ) icon at the top of the window to rename the current batch. The application assigns a name to batch when it is generated, but this name is derived from the selection criteria and can be hard to decipher. Renaming the batch can help you easily identify it for reuse.
Correct Errors in the Detailed QRDA Files
If there are errors, you must correct them before submitting the files. If you cannot identify the error needing correction, please contact Support.
1. If there are any errors:
a. Select the Errors hyperlink in the footer to access the list of errors. The errors display in the Report Status column of the patient detail table.
b. Select the hyperlink to access the provider, patient, or select the Review Past Notes
( ) icon to as appropriate.
Depending on the error, you may be able to correct it in the immediately accessed window, such as the Provider window. Or you may need to access additional windows to find and correct the problem. For example, you may need to access the Account window from the Patient Demographics or the Patient Results window from Review Past Notes.
You may also need to review and correct items such as the lab template used to enter a patient’s results or a patient history answer in the knowledge database in order to identify and correct errors. This type of error is the result of a SNOMED or LOINC code being incorrect or missing. Correcting this type of error for a single patient can correct errors for multiple patients at the same time. See the Reporting Configure section of this document for instructions.
2. Once you have made all the corrections or a significant number of corrections, select the
Play ) icon to regenerate the files that had errors.
3. If there are still errors, repeat steps 1 and 2 until there are either no more errors to correct or you have a sufficient numerator population to report for at least three measures.
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4. Select the Rename Batch ) icon to rename the current batch.
Aprima recommends that you rename and keep the batch used for PQRS file submission. This is important information to have in case you are audited. The batch name should include the provider’s name, and should indicate it is the final submission. For example, Patterson_Final_PQRS_2013.
5. Select the Export Files icon ):
a. Select the Export Patients Reports option to export the QRDA files.
b. In the Save As window, select the location in which you want to save the files.
c. Select the Save button.
d. A popup message will tell you when the export is complete.
This saves a zipped file containing all the patient detail files. The file is named “LastName, FirstName – CQM 2015 Patient Reports.zip”, where Last Name, FirstName is the name of the provider. Submit this file to CMS for reporting.
Delete Any Unneeded File Batches
As you review the QRDA reports and make corrections, you may generate and save a number of batches for each provider. As you work, you may want to delete saved batches that you no longer need. This will help keep uncluttered the list of saved batches shown in the Description field of the CQM 2015 report window.
Once you have generated the final batch that you will submit for each provider, we recommend that you delete all other, earlier batches. Then, if you are audited, you will be able to easily identify the batches you used for submission.
1. Desktop → Reports ) icon
2. Select the Clinical Quality folder.
3. Select the CQM 2015 report.
4. In the Description field, select the name of the batch you want to delete.
5. Select the View button to open the QRDA Calculated Summary Report window for that batch.
6. Select the Delete ) icon to delete the unneeded batch.
