2014 Physician Quality Reporting System Data Collection Form: Cataracts (for patients aged 18 and older)

Transcription

1 2014 Physician Quality Reporting System Data Collection Form: Cataracts (for patients aged 18 and older) Physician Name: Patient Name: Last First MI Date of Birth: / / mm dd yyyy Gender: M F Patient Insured - Traditional Medicare*: Medicare Advantage: Other: *Note: A minimum of 11 patients must be Traditional Medicare Part B **Note: Currently, ICD-10 codes are not required. You may choose to use either the ICD-9 codes listed in each data collection form, or the ICD-10 codes in the document: PQRS2014 Applicable Measure Group Codes. This document also contains a list of ICD-9, encounter, and procedure codes. Not all measures groups require all 3 code types. Medical Record Number: Appointment Date: / / (1/1/14 12/31/14) mm dd yyyy ICD-9 (or ICD-10) Diagnosis Code**: Encounter Code: N/A Procedure Code: Patient sample criteria for the Cataracts Measures Group are: patients aged 18 years and older with specific procedure for cataract surgery performed: One of the following procedure codes indicating cataract surgery: 66840, 66850, 66852, 66920, 66930, 66940, 66983, WITHOUT Modifier 56 (pre-operative management only) IMPORTANT NOTE: Eligible professionals wanting to report this measures group must engage a third party to administer, receive results, and review the surveys required for measures #303 and #304. Eligible professionals who wish to report these measures must advise Covisint who will be administering, receiving and reviewing the surveys. Do not report measures #303 or #304 when the cataract surgery includes modifier 55 (post-operative management only). Include only procedures performed January 1 through September 30, 2014 of the reporting period. This will allow the post-operative period to occur within the reporting year. PLEASE REFER TO THE CATARACTS MEASURES GROUP IN THE CMS 2014 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR FURTHER INFORMATION.

2 Patient Name: Page 2 of 5 NOTE: Measures #191 and #192 need only be reported when the patient also has a diagnosis of uncomplicated cataract. Refer to the 2014 CMS Measure Group specifications manual for Cataracts for specific codes indicating a significant ocular (co-morbid) condition that excludes a patient from reporting for each of these two measures. Physician Quality Reporting Measure # 191 : Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery 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 bestcorrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgery group specifications for exclusion criteria related to this measure Best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following cataract surgery Not Eligible patient has Complicated Cataract OR Other Significant Ocular Condition(s) Best-corrected visual acuity of 20/40 or better (distance or near) not achieved within 90 days following cataract surgery, reason not otherwise specified

3 Patient Name: Page 3 of 5 Physician Quality Reporting Measure # 192 : Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures 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 group specifications for exclusion criteria related to this measure Must take into account codes for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence): 65235, 65800, 65810, 65815, 65860, 65880, 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, Measure Note: For performance, a lower rate indicates better performance. Surgical procedure performed within 30 days following cataract surgery for major complications Not Eligible patient has Complicated Cataract OR Other Significant Ocular Condition(s) Surgical procedure not performed within 30 days following cataract surgery for major complications

4 Patient Name: Page 4 of 5 Physician Quality Reporting Measure # 303 : Cataracts: Improvement in Patient s Visual Function within 90 Days Following Cataract Surgery Measure Note: Surveys must be administered by third party and sent to Covisint for review Percentage of patients aged 18 years and older in sample who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and post-operative visual function survey group specifications for important definitions related to this measure Improvement in visual function achieved within 90 days following cataract surgery Patient care survey was not completed by patient Improvement in visual function not achieved within 90 days following cataract surgery Not Eligible patient care limited to postoperative management ONLY Physician Quality Reporting Measure # 304 : Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery Measure Note: Surveys must be administered by third party and sent to Covisint for review Percentage of patients aged 18 years and older in sample who had cataract surgery and were satisfied with their care within 90 days following the cataract surgery, based on completion of the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey group specifications for important definitions related to this measure Satisfaction with care achieved within 90 days following cataract surgery Patient care survey was not completed by patient Satisfaction with care not achieved within 90 days following cataract surgery Not Eligible patient care limited to postoperative management ONLY

5 Patient Name: Page 5 of 5