2015 Physician Quality Reporting System Data Collection Form: Inflammatory Bowel Disease (IBD) (for patients aged 18 and older)

Transcription

1 2015 Physician Quality Reporting System Data Collection Form: Inflammatory Bowel Disease (IBD) (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 IBD Measures Group are: patients aged 18 and older with a specific diagnosis of IBD, accompanied by a specific patient encounter: One of the following diagnosis codes indicating IBD: ICD-9-CM [for use 1/1/2015 9/30/2015]: 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.8, ICD-10-CM [for use 10/1/ /31/2015]: K50.00, K50.011, K50.012, K50.013, K50.014, K50.018, K50.019, K50.10, K50.111, K50.112, K50.113, K50.114, K50.118, K50.119, K50.80, K50.811, K50.812, K50.813, K50.814, K50.818, K50.819, K50.90, K50.911, K50.912, K50.913, K50.914, K50.918, K50.919, K51.00, K51.011, K51.012, K51.013, K51.014, K51.018, K51.019, K51.20, K51.211, K51.212, K51.213, K51.214, K51.218, K51.219, K51.30, K51.311, K51.312, K51.313, K51.314, K51.318, K51.319, K51.40, K51.411, K51.412, K51.413, K51.414, K51.418, K51.419, K51.50, K51.511, K51.512, K51.513, K51.514, K51.518, K51.519, K51.80, K51.811, K51.812, K51.813, K51.814, K51.818, K51.819, K51.90, K51.911, K51.912, K51.913, K51.914, K51.918, K one of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99401, 99402, 99403, 99404, 99406, **Note: ICD9 codes are applicable 1/1/15-9/30/15; ICD10 codes are applicable 10/1/15-12/31/15 unless changed per CMS rule. Refer to the Covisint PQRS2015 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. PLEASE REFER TO THE INFLAMMATORY BOWEL DISEASE MEASURES GROUP IN THE CMS 2015 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR FURTHER INFORMATION.

2 Page 2 of 8 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 Medical Record Number: Appointment Date: / / (1/1/15 12/31/15) mm dd yyyy ICD-9 (or ICD-10) Diagnosis Code**: Encounter Code: Procedure Code: N/A

3 Page 3 of 8 Physician Quality Reporting Measure # 110: Preventive Care and Screening: Influenza Immunization Percentage of patients aged 18 years 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 If reporting this measure between January 1, 2015 and March 31, 2015, choose answer option Influenza immunization administered or previously received when the influenza immunization is ordered or administered to the patient during the months of August, September, October, November, and December of 2014 or January, February, and March of 2015 for the flu season ending March 31, If reporting this measure between October 1, 2015 and December 31, 2015, choose answer option Influenza immunization administered or previously received when the influenza immunization is ordered or administered to the patient during the months of August, September, October, November, and December of 2015 for the flu season ending March 31, Influenza immunizations administered during the month of August or September of a given flu season (either flu season OR flu season) can be reported when a visit occurs during the flu season (October 1 - March 31). In these cases, choose answer option Influenza immunization administered or previously received. Patient visit occurred outside of acceptable date range (i.e., April 1 through September 30, 2015) patient not eligible Influenza immunization administered or previously received - PM Influenza immunization was not ordered or administered for reasons documented by clinician (e.g., patient allergy or other medical reason, patient declined or other patient reasons, or other system reasons) - PE Document reason in medical chart Influenza immunization was not ordered or administered, reason not given - PNM Previous Receipt - Receipt of the current season s influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st).

4 Page 4 of 8 Physician Quality Reporting Measure # 111 : Pneumonia Vaccination Status for Older Adults For men or women aged 65 and older Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine Pneumococcal vaccine administered or previously received - PM Pneumococcal vaccine not administered or previously received, reason not otherwise specified - PNM 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 (eg, limited life expectancy, other medical reasons) - PE Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified - PNM

5 Page 5 of 8 Physician Quality Reporting Measure # 270: Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Sparing Therapy Percentage of patients aged 18 years and older with a diagnosis of inflammatory bowel disease who have been managed by corticosteroids greater than or equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days or a single prescription equating to 600mg prednisone or greater for all fills that have been prescribed corticosteroid sparing therapy in the last reporting year Corticosteroids Prednisone equivalents used expressly for the treatment of IBD and not for other indications (including premedication before anti-tnf therapy, non-ibd indications) can be determined using the following: 1 mg of prednisone = 1 mg of prednisolone; 5 mg of cortisone; 4 mg of hydrocortisone; 0.8 mg of triamcinolone; 0.8 mg of methylprednisolone; 0.15 mg of dexamethasone; 0.15 mg of betamethasone. Corticosteroid sparing therapy prescribed equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PM Documentation of medical reason(s) for not treating with corticosteroid sparing therapy (eg, benefits of continuing steroid therapy outweigh the risk of continuing steroid therapy or initiating steroid sparing therapy, patient is receiving the first course of corticosteroids for the treatment of IBD) Document reason in medical chart equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PE Documentation of patient reason(s) for not treating with corticosteroid sparing therapy (eg, patient refuses to initiate steroid sparing therapy) equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PE Patient not receiving corticosteroids 10 mg/day of prednisone equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PE Corticosteroid sparing therapy not prescribed, reason not otherwise specified - PNM

6 Page 6 of 8 Physician Quality Reporting Measure # 271: Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Related Iatrogenic Injury Bone Loss Assessment Percentage of patients aged 18 years and older with an inflammatory bowel disease encounter who were prescribed prednisone equivalents greater than or equal to 10 mg/day for 60 or greater consecutive days or a single prescription equating to 600mg prednisone or greater for all fills and were documented for risk of bone loss once during the reporting year or the previous calendar year. Corticosteroids Prednisone equivalents used expressly for the treatment of IBD and not for other indications (including premedication before anti-tnf therapy, non-ibd indications) can be determined using the following: 1 mg of prednisone = 1 mg of prednisolone; 5 mg of cortisone; 4 mg of hydrocortisone; 0.8 mg of triamcinolone; 0.8 mg of methylprednisolone; 0.15 mg of dexamethasone; 0.15 mg of betamethasone. Documented Documentation that an assessment for risk of bone loss has been performed or ordered. This includes, but is not limited to, review of systems and medication history, and ordering of Central Dual-energy X-Ray Absorptiometry (DXA) scan. Within the past 2 years, Central Dualenergy X-Ray Absorptiometry (DXA) ordered and documented review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PM Patient not receiving corticosteroids 10 mg/day of prednisone equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PE Within the past 2 years, Central Dualenergy X-Ray Absorptiometry (DXA) not ordered and documented, no review of systems and no medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed equivalents for 60 consecutive days or a single prescription equating to 600mg prednisone for all fills - PNM

7 Page 7 of 8 Physician Quality Reporting Measure # 274: Inflammatory Bowel Disease (IBD): Testing for Latent Tuberculosis (TB) Before Initiating Anti- TNF (Tumor Necrosis Factor) Therapy Percentage of patients aged 18 years and older with a diagnosis of inflammatory bowel disease (IBD) for whom a tuberculosis (TB) screening was performed and results interpreted within six months prior to receiving a first course of anti-tnf (tumor necrosis factor) therapy First Course of anti-tnf therapy the first (ever) course of anti-tnf therapy Documentation that tuberculosis (TB) screening test performed and results interpreted Patients receiving a first course of anti-tnf therapy - PM Patient not receiving a first course of anti-tnf (tumor necrosis factor) therapy - PE TB screening test not performed within 6 months prior to receiving a first course of anti-tnf therapy received for Patient receiving a first course of anti-tnf (tumor necrosis factor) therapy - PE Document reason in medical chart Medical Reason Patient Reason TB screening test not performed within 6 months prior to receiving a first course of anti-tnf therapy received, reason not specified Patient receiving a first course of anti-tnf (tumor necrosis factor) therapy - PNM

8 Page 8 of 8 Physician Quality Reporting Measure # 275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy Percentage of patients aged 18 years and older with a diagnosis of inflammatory bowel disease (IBD) who had Hepatitis B Virus (HBV) status assessed and results interpreted within one year prior to receiving a first course of anti-tnf (tumor necrosis factor) therapy HBV status must be assessed by one of the following: HBsAG, HBsAG neutralization, HBcAb total, HBcAB IgM, HBsAB First Course of anti-tnf therapy the first (ever) course of anti-tnf therapy Hepatitis B vaccine administered or previously received Hepatitis B Virus (HBV) status assessed and results interpreted within one year prior to receiving a first course of anti-tnf (tumor necrosis factor) therapy - PM Patient has documented immunity to hepatitis B and is receiving a first course of anti- TNF therapy - PM Hepatitis B vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy - PE Patient not receiving a first course of anti-tnf therapy - PE Documentation of patient reason(s) for not assessing Hepatitis B Virus (HBV) status (eg, patient declined) within one year prior to receiving first course of anti-tnf therapy - PE Document reason in medical chart Hepatitis B virus (HBV) status not assessed and results interpreted within one year prior to receiving a first course of anti- TNF (tumor necrosis factor) therapy, reason not specified - PNM