2013 Hypertension Measure Group Patient Visit Form

Size: px

Start display at page:

Download "2013 Hypertension Measure Group Patient Visit Form"

Clinton Holland
5 years ago
Views:

1 Please complete the form below for 20 or more unique patients meeting patient sample criteria for the measure group for the current reporting year. A majority (11 or more) patients must be Medicare Part B Fee-For-Service (S) beneficiaries. Measures groups containing a measure with a 0% performance rate (100% for measures where a lower rate indicates better performance) will not be counted as satisfactorily reporting the measures group (For more details and exceptions, see the PQRS measure specification at 1. Patient ID Use the Patient ID that is automatically assigned, or enter an identifier that is meaningful to your practice. Keep a record of this identifier in case you need to make edits. 2. Patient Visit Date The visit date you are reporting on must occur within the 2013 Reporting Period. 3. Patient Age The patient must be 18 to 90 years of age at the time of the visit to qualify for the Hypertension Measure Group. If Age < 30, skip question Please choose the applicable diagnosis code for Hypertension as reported on the claim for this encounter. If t listed, the encounter is not eligible for the Hypertension Measure Group. ICD-10-CM diagnosis codes listed in the 2013 Physician Quality Reporting System Specifications Manual are listed as not reportable for the 2013 PQRS program; therefore ICD-10 codes are not included as reporting options t listed Please choose the applicable E & M code for this encounter. If t listed, the patient is not eligible for the Hypertension Measure Group G0438 G0439 t listed 6. Please choose the applicable diagnosis code for Stage 5 chronic kidney disease (GFR of < 15ml/min per 1.72 m2 or end-stage kidney disease). If the patient has stage 5 chronic kidney disease, this patient is not eligible for the Hypertension Measure Group Patient does not have stage 5 chronic kidney disease Is the patient a Medicare Part B Fee-For-Service (S) beneficiary (includes Railroad Retirement Board and Medicare Secondary Payer; does not include Medicare Advantage beneficiaries)? See Medicare Part B Requirements section below. YES NO Page 1 of 6

2 8. Was oral aspirin or other antithrombotic therapy prescribed? See definition section below: Oral Antiplatelet Therapy, Treatment of treatment goals is not clinically appropriate, Prescribed, Low Risk, Framingham Risk Score. Yes (G8895) (e.g., patient documented to be low risk, or patient with palliative care goals or treatment of hypertension with standard treatment goals is not clinically appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly controlled) (G8896) given (G8897) 9. Did the patient receive at least one lipid profile (must include total cholesterol, HDL-C, triglycerides and calculated LDL-C), where results were documented and reviewed within the last 60 months? See definition section below: What if I cannot calculate LDL-C due to high triglycerides? and Treatment of appropriate. Yes (G8767) hypertension with standard treatment goals is not clinically appropriate) (G8768) given (G8769) 10. Is there documentation of diagnosis of chronic kidney disease? If Yes (G8771), skip question 11, and move on to question 12. Yes (G8771) 11. Was a urine protein screening test (includes tests for albuminuria, microalbuminuria, or proteinuria) performed, where results were documented and reviewed within 36 months? See definition section below: Treatment of appropriate Yes (G8770) hypertension with standard treatment goals is not clinically appropriate) (G8772) given (G8773) 12. Was a serum creatinine test performed, where results were documented and reviewed within 12 months? See definition section below: Treatment of appropriate Yes (G8774) appropriate) (G8775) given (G8776) Page 2 of 6

3 13. Was a diabetes screening test performed within 36 months? See definition section below: Diabetes Screening Test and Treatment of treatment goals is not clinically appropriate Yes (G8777) appropriate) (G8778) given (G8779) 14. Is the patient documented as having chronic kidney disease or diabetes? If Yes, answer question 15, skip question 16, and then move on to question 17. If, skip question 15, and move on to question 16. Yes 15. Is the most recent blood pressure measurement performed within 12 months and under control? See definition section below: Blood Pressure Under Control, Multiple Blood Pressures on the Same Date of Service and Treatment of appropriate Yes, most recent systolic blood pressure < 130 AND the most recent diastolic blood pressure < 80 (G8886) appropriate) (G8887), most recent systolic blood pressure 130 OR most recent diastolic blood pressure 80 (G8888), there is no documentation of blood pressure measurement, (G8889) 16. Is the most recent blood pressure measurement performed within 12 months and under control? See definition section below: Blood Pressure Under Control, Multiple Blood Pressures on the Same Date of Service and Treatment of appropriate Yes, most recent systolic blood pressure < 140 AND the most recent diastolic blood pressure < 90 (G8886) appropriate) (G8887), most recent systolic blood pressure 140 OR most recent diastolic blood pressure 90 (G8888), there is no documentation of blood pressure measurement, (G8889) Page 3 of 6

4 17. Is the patient documented as having coronary heart disease, stroke or transient ischemic attack, peripheral artery disease, or diabetes? If Yes, skip questions 18, 20 and 21, answer question 19, and then move on to question 22. If, answer question Does the patient have any of the following risk factors: Male 45 years of age or older, Female 55 years of age or older, Low HDL (< 40 mg/dl) or on HDL-raising medication, Family history of premature CHD, Smoking, HDL cholesterol 60? If Yes, skip questions 19 and 21, answer question 20, and then move on to question 22. If, skip questions 19 and 20, and move on to question 21. Yes Yes 19. Is the most recent LDL-C level performed within 60 months and under control? See definition section below: LDL-C Under Control and Treatment of treatment goals is not clinically appropriate. Yes, most recent LDL-C level < 100 mg/dl, where results are documented and reviewed (G8890), LDL-C not under control but appropriate) (G8891), LDL-C level not performed but appropriate) (G8892), most recent LDL-C 100 mg/ dl (G8893), LDL-C level not performed, (G8894) 20. Is the most recent LDL-C level performed within 60 months and under control? See definition section below: LDL-C Under Control and Treatment of treatment goals is not clinically appropriate. Yes, most recent LDL-C level < 130 mg/dl, where results are documented and reviewed (G8890), LDL-C not under control but appropriate) (G8891), LDL-C level not performed but appropriate) (G8892), most recent LDL-C 130 mg/ dl (G8893), LDL-C level not performed, (G8894) Page 4 of 6

5 21. Is the most recent LDL-C level performed within 60 months and under control? See definition section below: LDL-C Under Control and Treatment of treatment goals is not clinically appropriate. Yes, most recent LDL-C level < 160 mg/dl, where results are documented and reviewed (G8890), LDL-C not under control but appropriate) (G8891), LDL-C level not performed but appropriate) (G8892), most recent LDL-C 160 mg/ dl (G8893), LDL-C level not performed, (G8894) 22. Did the patient receive dietary and physical activity counseling at least once within 12 months? See definition section below: Counseling and Treatment of treatment goals is not clinically appropriate Yes (G8780) or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) (G8781), patient reason(s) documented (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes) (G8949) given (G8782) Medicare Part B Requirements For this reporting year, only a majority of patients need to be Medicare Part B beneficiaries (11 or more). Definitions Oral Antiplatelet Therapy Oral antithrombotic therapy consists of aspirin, warfarin, clopidogrel, dabigatran, rivaroxaban, or combination of aspirin and extended release dipyridamole. Treatment of appropriate For some patients, treatment of goals may not be relevant, as might be the case for a patient with severe Alzheimer s disease. Page 5 of 6

6 Definitions continued Prescribed May include prescription/recommendation given to the patient for aspirin or other antithrombotic at one or more visits in the 12 month period OR patient already taking aspirin, warfarin, clopidogrel, dabigatran, rivaroxaban or combination of aspirin and extended release dipyridamole as documented in current medication list. Low Risk NO prior coronary heart disease AND NO prior stroke or transient ischemic attack, AND NO prior peripheral artery disease, AND NO prior diabetes, AND 10-year risk of developing CHD less than or equal to 10% as indicated by Framingham risk score and all elements of Framingham risk calculation are complete. Framingham Risk Score A risk assessment tool which uses recent data from the Framingham Heart Study to estimate 10-year risk for hard coronary heart disease outcomes (myocardial infarction and coronary death). This tool is designed to estimate risk in adults aged 20 and older who do not have heart disease or diabetes. What if I cannot calculate LDL-C due to high triglycerides? If the balance of the lipid profile is complete, but LDL-C could not be calculated due to high triglycerides, count as a complete lipid profile. Diabetes Screening Test Diabetes screening test consists of either a fasting glucose measurement, glycosylated hemoglobin test, or a two hour glucose tolerance test (three specimens). Blood Pressure Under Control Patients are considered to have most recent blood pressure under control if any of the following are documented: < 130/80 mmhg for those with chronic kidney disease OR diabetes < 140/90 mmhg for those without conditions listed above Multiple Blood Pressures on the Same Date of Service If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure. LDL-C Under Control Patients are considered to have most recent LDL-C level under control if any of the following are documented: < 100 mg/dl for those with coronary heart disease, OR stroke or transient ischemic attack, OR peripheral artery disease, OR diabetes < 130 mg/dl for those without conditions listed above, but with one or more additional risk factors for CHD (Low HDL (< 40 mg/dl) or on HDL-raising medication, risk age (men 45, women 55), family history of premature CHD, smoking); HDL cholesterol 60 acts as a negative risk factor < 160 mg/dl for those without conditions listed above, and without additional risk factors listed above Counseling May include documentation of prescribing any of the following dietary modifications: dietary saturated fat and cholesterol restriction, calorie restriction as part of weight reduction program for overweight/obese patients, DASH eating plan, dietary sodium restriction, increased fruits, vegetables and/or soluble fiber; and documentation of activity status for active patients or discussion of increase exercise or physical activity for inactive patients. Page 6 of 6

Primary and Secondary Prevention of Cardiovascular Disease. Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group

Primary and Secondary Prevention of Cardiovascular Disease Frank J. Green, M.D., F.A.C.C. St. Vincent Medical Group AHA Diet and Lifestyle Recommendations Balance calorie intake and physical activity to