2016 Physician Quality Reporting System Data Collection Form: Sinusitis (for patients aged 18 and older)

Transcription

1 2016 Physician Quality Reporting System Data Collection Form: Sinusitis (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. This measures group contains one or more inverse measures. An inverse measure is a measure that represents a poor clinical quality action as meeting performance for the measure. For these measures, a lower performance rate indicates a higher quality of clinical care. Composite codes for measures groups that contain inverse measures are only utilized when the appropriate quality clinical care is given. Patient sample criteria for the Sinusitis Measure Group are patients aged 18 years and older with a specific diagnosis of Acute Sinusitis, accompanied by a specific patient encounter: One of the following diagnosis codes indicating acute sinusitis: ICD-10-CM: J01.00, J01.01, J01.10, J01.11, J01.20, J01.21, J01.30, J01.31, J01.40, J01.41, J01.80, J01.90 AND one of the following patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, Only patients with acute sinusitis are included in this measures group. Measure #332 need only be reported if sinusitis caused by, or presumed to be caused by, bacterial infection (G9364) and antibiotic regimen prescribed (G9498) or equivalents. **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. PLEASE REFER TO THE SINUSITIS MEASURES GROUP IN THE CMS 2016 PQRS MEASURES GROUPS SPECIFICATIONS MANUAL FOR CLINICAL RECOMMENDATIONS AND FURTHER INFORMATION.

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

3 Page 3 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 AND 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 - 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

4 Page 4 of 8 Physician Quality Reporting Measure # 131 : Pain Assessment and Follow-Up Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present Prolonged Dose Doses > 6 months in duration Pain Assessment - Documentation of a clinical assessment for the presence or absence of pain using a standardized tool is required. A multi-dimensional clinical assessment of pain using a standardized tool may include characteristics of pain; such as: location, intensity, description, and onset/duration. Standardized Tool An assessment tool that has been appropriately normalized and validated for the population in which it is used. Examples of tools for pain assessment, include, but are not limited to: Brief Pain Inventory (BPI), Faces Pain Scale (FPS), McGill Pain Questionnaire (MPQ), Multidimensional Pain Inventory (MPI), Neuropathic Pain Scale (NPS), Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), Verbal Descriptor Scale (VDS), Verbal Numeric Rating Scale (VNRS) and Visual Analog Scale (VAS). Follow-Up Plan A documented outline of care for a positive pain assessment is required. This must include a planned followup appointment or a referral, a notification to other care providers as applicable OR indicate the initial treatment plan is still in effect. These plans may include pharmacologic and/or educational interventions. Not Eligible A patient is not eligible if one or more of the following reason(s) is documented: Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others. For example, cases where pain cannot be accurately assessed through use of nationally recognized standardized pain assessment tools 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 Pain assessment documented as positive using a standardized tool AND a follow-up plan is documented - PM Pain assessment using a standardized tool is documented as negative, no follow-up plan required - PM Pain assessment NOT documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool - PE Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible - PE No documentation of pain assessment, reason not given - PNM Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given - PNM Note: The standardized tool used to assess the patient s pain must be documented in the medical record (exception: A provider may use a fraction such as 5/10 for Numeric Rating Scale without documenting this actual tool name when assessing pain for intensity)

5 Page 5 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 AND 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 AND 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

6 Page 6 of 8 Physician Quality Reporting Measure # 331 : Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Appropriate Use) Percentage of patients, aged 18 years and older, with a diagnosis of acute sinusitis who were prescribed an antibiotic within 7 days of diagnosis or within 10 days after onset of symptoms NOTE: INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The desired performance goal is not an antibiotic prescribing rate of zero. This measure is an overall rate of all patients receiving an antibiotic. Antibiotic regimen prescribed within 7 days of diagnosis or within 10 days after onset of symptoms - PM Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason - PE Antibiotic regimen not prescribed within 7 days of diagnosis or within 10 days after onset of symptoms - PNM

7 Page 7 of 8 Physician Quality Reporting Measure # 332 : Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use) Percentage of patients aged 18 years and older with a diagnosis of acute bacterial sinusitis that were prescribed amoxicillin, with or without clavulanate, as a first line antibiotic at the time of diagnosis Acute Bacterial Rhinosinusitis (ABRS): Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection; a clinician should diagnose ABRS when: (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening). Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis - PM Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (e.g., cystic fibrosis, immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history of sinus surgery within the past 12 months, and anatomic abnormalities, such as deviated nasal septum, resistant organisms, allergy to medication, recurrent sinusitis, chronic sinusitis, or other reasons) - PE Patient does not have Acute Bacterial Rhinosinusitis not eligible Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given - PNM

8 Page 8 of 8 Physician Quality Reporting Measure # 333 : Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse) Percentage of patients aged 18 years and older with a diagnosis of acute sinusitis who had a computerized tomography (CT) scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The Performance Not Met numerator option for this measure is the representation of the better clinical quality or control. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control, and therefore an inverse measure at 100% does not qualify for reporting purposes, however any reporting rate less than 100% does qualify Definition: Acute Sinusitis/Rhinosinusitis Up to 4 weeks of purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain-pressurefullness, or both: Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and may be reported by the patient or observed on physical examination Nasal obstruction may be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or may be diagnosed by physical examination. Facial pain-pressure-fullness may involve the anterior face, periorbital region, or manifest with headache that is localized or diffuse CT scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis - PM CT scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (e.g., persons with sinusitis symptoms lasting at least 7 to 10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other medical) - PE CT scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis - PNM