2016 Physician Quality Reporting System Data Collection Form: Coronary Artery Disease (CAD) (for patients aged 18 and older)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Coronary Artery Disease (CAD) (for patients aged 18 and older) IMPORTANT: Any measure with a 0% performance rate (100% for inverse measures) is not considered satisfactory reporting. Review your PQRS Submission Summary report, available after entering your data, to ensure this is not an issue. Each measure answer is identified as Performance Met (PM), Performance Not Met (PNM) or Performance Exclusion (PE). More information on this rule is available within the Covisint PQRS Web Application. Patient sample criteria for the CAD Measure Group are: patients aged 18 years and older with a specific diagnosis of CAD, accompanied by a specific patient encounter: One of the following diagnosis codes indicating coronary artery disease: ICD-10-CM: I20.0, I20.1, I20.8, I20.9, 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, I24.0, I24.1, I24.8, I24.9, I25.10, I25.110, I25.111, I25.118, I25.119, I25.2, 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, I25.83, I25.89, I25.9, Z95.1, Z95.5, Z98.61 Accompanied by: One of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Measure #7 need only be reported if the patient has one of the following diagnosis codes indicating coronary artery disease and also has Left Ventricular Systolic Dysfunction (LVEF< 40%): ICD-10-CM: 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, I25.83, I25.89, I25.9, Z95.1, Z95.5, Z98.61 Left ventricular ejection fraction (LVEF) < 40%: G8694 **Note: Refer to the Covisint PQRS2016 Applicable Measure Group Codes document which contains a list of diagnosis, encounter, and procedure codes for each measures group. Not all measures groups require all 3 code types.

2 Page 2 of 8 Physician Name: Patient Name: Last First MI Date of Birth: / / mm dd yyyy Gender: M F Practice Medical Record Number: Patient Insured - Traditional Medicare*: Medicare Advantage: Other: *Note: A minimum of 11 patients must be Traditional Medicare Part B Appointment Date: / / (1/1/16 12/31/16) mm dd yyyy ICD-10 Diagnosis Code: CPT Encounter (visit) Code: CPT Procedure Code: N/A REFER TO THE CORONARY ARTERY DISEASE (CAD) MEASURES GROUP WITHIN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR CLINICAL RECOMMENDATIONS FURTHER INFORMATION.

3 Page 3 of 8 Physician Quality Reporting Measure # 6 : Coronary Artery Disease (CAD): Antiplatelet Therapy Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12- month period who were prescribed aspirin or clopidogrel Prescribed May include prescription given to the patient for aspirin or clopidogrel at one or more visits in the measurement period OR patient already taking aspirin or clopidogrel as documented in current medication list. Aspirin or clopidogrel prescribed - PM Aspirin or clopidogrel not prescribed for PE Document reason in medical chart Medical Patient System Aspirin or clopidogrel not Prescribed, reason not otherwise specified - PNM

4 Page 4 of 8 Physician Quality Reporting Measure # 7 : Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior MI or LVSD (LVEF <40%) 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 May include prescription given to the patient for betablocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. For patients with prior LVEF < 40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate. For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. NOTE: In order for the patient to be considered for the measure, the diagnosis of CAD must be an active diagnosis and patient could have been diagnosed prior to the denominator eligible visits within the measurement year. The reporting numerator options contained within this specification are represented differently than the corresponding individual measure. Reference this specification only in order to satisfactorily report the measures group. Beta-blocker therapy prescribed or currently being taken - PM Documentation of reason(s) for not prescribing beta-blocker therapy - PE Beta-blocker therapy not prescribed, reason not given - PNM Patient does not have LVSD not eligible Medical Patient System For definitions and further information refer to the measures groups specifications manual

5 Page 5 of 8 Physician Quality Reporting Measure # 128 : Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter An eligible professional or their staff is required to measure both height and weight. Both the height and the weight must be measured within six months of the encounter and may be obtained from separate encounters. Self-reported values cannot be used. The documentation of a follow-up plan must be based on the most recent documented BMI within the previous six months. NOTE: BMI normal parameters are as follows: age BMI 18.5 and < 25 ; age 65 and older BMI 23 and < 30 Follow-Up Plan Proposed outline of treatment to be conducted as a result of a BMI out of normal parameters. A follow-up plan may include but is not limited to: documentation education, a referral (e.g., a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), pharmacological interventions, dietary supplements, exercise counseling, or nutrition counseling. Not Eligible for BMI Calculation or Follow-Up Plan A patient is not eligible if one or more of the following reasons are documented: Patient is receiving palliative care Patient is pregnant Patient refuses BMI measurement (refuses height and/or weight) Any other reason documented in the medical record by the provider why BMI calculation or follow-up plan was not appropriate 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. BMI is documented within normal parameters and no follow-up plan is required - PM BMI is documented above normal parameters and a follow-up plan is documented - PM BMI is documented below normal parameters and a follow-up plan is documented - PM Documentation the patient is not eligible for BMI calculation for follow-up plan - PE BMI not documented and no reason is given - PNM BMI documented outside normal parameters, no follow-up plan documented, no reason given - PNM

6 Page 6 of 8 Physician Quality Reporting Measure # 130 : Documentation of Current Medications in the Medical Record Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. Eligible professional attests to documenting, updating or reviewing a patient s current medications using all immediate resources available on the date of encounter. This list must include ALL known prescriptions, over-the counters, herbals, and vitamin/mineral/dietary (nutritional) supplements must contain the medications name, dosages, frequency and route of administration Not Eligible - A patient is not eligible if the following reason is documented: 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. Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient s current medications including no medications - PM Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional - PE Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given - PNM For definitions and further information refer to the measures groups specifications manual

7 Page 7 of 8 Physician Quality Reporting Measure # 226 : Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months who received cessation counseling intervention if identified as a tobacco user Note: In the event that a patient is screened for tobacco use and identified as a user but did not receive tobacco cessation counseling, choose answer option tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified. Tobacco Use includes any type of tobacco. Cessation Counseling Intervention includes brief counseling (3 minutes or less) and/or pharmacotherapy. Patient screened for tobacco use received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user - PM Current tobacco non-user - PM Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reasons) - PE Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified - PNM

8 Page 8 of 8 Physician Quality Reporting Measure # 242 : Coronary Artery Disease (CAD): Symptom Management Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period with an evaluation of level of activity and an assessment of whether anginal symptoms are present or absent with appropriate management of anginal symptoms within a 12-month period Evaluation of level of activity and evaluation of presence or absence of angina symptoms should include: Documentation of Canadian Cardiovascular Society (CCS) Angina Class OR Completion of a disease-specific questionnaire (e.g., Seattle Angina Questionnaire or other validated questionnaire) to quantify angina and level of activity For definitions and further information refer to the measures groups specifications manual Severity of angina assessed by level of activity Angina present Plan of care to manage anginal symptoms documented - PM Severity of angina assessed by level of activity Angina absent - PM Severity of angina assessed by level of activity Angina present Documentation of reason(s) for not providing any specified element of plan of care to achieve control of anginal symptoms - PE Medical Patient System Severity of angina assessed by level of activity Angina present Plan of care to achieve control of angina symptoms was not performed, reason not otherwise specified - PNM Severity of angina not assessed, reason not otherwise specified - PNM