Welcome to the ALL-AIM Alliance of IPAs.
Welcome to the ALL-AIM Alliance of IPAs.

PQRS 2015 Explanatory Notes

 

Physician Quality Measure Reporting System – Explanatory Notes

 

All AIM MSO working with COAIM Health IPA has contracted for a group discount with a qualified PQRS clinical data registry, MDInteractive.  We will assist our physicians in filing their annual PQRS reports, but these have to be filed before the end of February.  If you have not filed by then you will not receive a 0.5% bonus and will receive a 2% penalty next year for a net 2.5% loss on all Medicare billing which will run into thousands of dollars less for most physicians.  Contact us for details and instructions (see ‘Contact Us’ on our website) on how to most quickly complete your PQRS reporting and receive the vendor discount. Also, see the text attachment below explaining PQRS Medical Record Details which will help you choose the most appropriate measures group to fit your style of documentation.  If you are not a member of our IPAs then you must join immediately (the COAIM Health IPA application can be printed from this website and faxed back to us. 

 

The Centers for Medicare and Medicaid Services (CMS) has developed quality initiatives that support new payment systems to encourage improved quality care, rather than simply paying based on the volume of services and subsequently implemented the Physician Quality Reporting Initiative, now called Physician Quality Reporting System (PQRS).  CMS is required to post on a website the names of eligible professionals and group practices who have satisfactorily reported under the PQRS. The 2010 Affordable Care Act (ACA) called for PQRS payment penalties starting in 2015. Those physicians who elect not to participate or are found unsuccessful during the 2013 program year, will receive a 1.5 percent payment penalty, and 2 percent thereafter. In the 2014 Medicare Physician Fee Schedule Rule, CMS finalized its proposal to base 2016 PQRS penalties off of 2014 reporting. Therefore, physicians who do not participate in PQRS Maintenance of Certification (MOC) program in 2014 will receive a 2 percent penalty in 2016; but since 2014 is the last year a physician can receive an additional incentive those who report satisfactorily will also receive an incentive.   Note that Physicians participating who are in an ACO group are exempt from PQRS reporting.  Individual PQRS reporting should be submitted continuously throughout the year, but an additional PQRS reporting option allows physicians to submit their data for a single PQRS measures group to CMS all at once via a qualified clinical data registry vendor.  We can help.

 

Medicare Physician Quality Reporting System Incentives and Penalties

2013

0.5% (performance year for 2015 penalty)

2014

0.5% (performance year for 2016 penalty)

2015

-1.5%

2016

-2%

 

Physician Quality Reporting System (PQRS) group measures require smaller patient sample sizes (e.g. 20 patients minimum) than the individual measures which require reporting most of a practice’s patients having a particular diagnosis. Measures groups of clinically-related measures identified by CMS for use in PQRS 2014 through a registry-based submission process include twenty-five groups: Hypertension (HTN), Heart Failure (HF), Coronary Artery Disease (CAD), Ischemic Vascular Disease (IVD), Asthma, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Chronic Kidney Disease (CKD), Back Pain, Cardiovascular Prevention, Preventive Care, Sleep Apnea, Hepatitis C, Inflammatory Bowel Disease (IBD), Dementia, Parkinson’s Disease, Cataracts, Rheumatoid Arthritis (RA), HIV- AIDS, Oncology, Coronary Artery Bypass Graft (CABG), Total Knee Replacement (TKR), Perioperative Care, General Surgery, and Optimizing Patient Exposure to Ionizing Radiation (OPEIR).  Measures groups containing a single measure with a 0% performance rate will not be counted as satisfactorily reporting the measures group. ThPhysician Quality Reporting System (PQRS) Measures Groups Specifications Manual, contains detailed descriptions and can be found at: 

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/MeasuresCodes.html.

 

Measures Groups Participation Strategy:

 

 

Become familiar with the registry-based submission method for satisfactory reporting of measures groups:

20 Patient Sample Method via registry 12-month or 6-month reporting period  (we recommend 20-25 patients)

     A participating eligible professional must report on all applicable measures within the selected measures group for a minimum sample of at least 20 unique patients, a majority ((> 11of which must be Medicare Part B FFS patients, who meet patient sample criteria for the measures group. If the eligible professional does not have at least 20 unique patients (a majority of which must be Medicare Part B FFS patients) who meet patient sample criteria for the measures group, the eligible professional will need to choose another measures group or choose another reporting option. Please refer to the 2014 Physician Quality Reporting System (PQRS) Participation Decision Tree located in the 2014 PQRS Implementation Guide.

     All applicable measures within the group must be reported at least once for each patient within the sample population seen by the eligible professional during the reporting period (January 1 through December 31, 2014 or July 1 through December 31, 2014) for each of the 20 unique patients in which a majority are Medicare Part B FFS patients.

     Measures groups containing a measure with a 0% performance rate will not be counted as satisfactorily reporting the measures group.

 

Out of 22 groups, the 8 listed measures groups below and their individual clinical measures are the most appropriate for Internists, Dual Specialists/Internists and Family Practitioners.  Choose one measure group for your 20-25 patient sampling.  Some groups may have more PQRS measures but may be much easier to perform.

 

Suggested PQRS registry websites:

mdinteractive.com

pqrspro.com

pqrswizard.com

 

PQRS Group Measures List 2015  (Number Measure Title Page Overview) CQMs

Suggested (8 of 22) Simpler Group Measures for Primary Care Providers  

Preventive Care

Heart Failure (HF)

Coronary Artery Disease (CAD)

Asthma

Chronic Obstructive Pulmonary Disease (COPD)

Sinusitis

Diabetes

Chronic Kidney Disease (CKD)

 

Overview Preventive Care Measures Group 38 39

Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older 41 48

Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women 65 Years and Older 42 110

Preventive Care and Screening: Influenza Immunization 43 111

Pneumonia Vaccination Status for Older Adults 44 112

Breast Cancer Screening 45 113

Colorectal Cancer Screening 46 128

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 47 134

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 49 173

Preventive Care and Screening: Unhealthy Alcohol Use - Screening 51 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 52

 

Overview Heart Failure (HF) Measures Group 112 5

Heart Failure (HF): (ACEI) Inhibitor or (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) 114 8

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) 116 47

Care Plan 118 110

Preventive Care and Screening: Influenza Immunization 119 130

Documentation of Current Medications in the Medical Record 120 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 121

 

Overview Coronary Artery Disease (CAD) Measures Group 129 6

Coronary Artery Disease (CAD): Antiplatelet Therapy 131 7

Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior (MI) or LV Systolic Dysfunction (LVEF < 40%) 132 128

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 133 130

Documentation of Current Medications in the Medical Record 135 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 136 242

Coronary Artery Disease (CAD): Symptom Management 137

 

Overview Asthma Measures Group 163 53

Asthma: Pharmacologic Therapy for Persistent Asthma - Ambulatory Care Setting 165 110

Preventive Care and Screening: Influenza Immunization 166 128

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 167 130

Documentation of Current Medications in the Medical Record 169 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 170 402

Tobacco Use and Help with Quitting Among Adolescents 171

 

Overview Chronic Obstructive Pulmonary Disease (COPD) Measures Group 179 47

Care Plan 181 51

Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation 182 52

Chronic Obstructive Pulmonary Disease (COPD): Inhaled Bronchodilator Therapy 183 110

Preventive Care and Screening: Influenza Immunization 184 111

Pneumonia Vaccination Status for Older Adults 185 130

Documentation of Current Medications in the Medical Record 186 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 187

 

Overview Sleep Apnea Measures Group 209 128

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 211 130

Documentation of Current Medications in the Medical Record 213 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 214 276

Sleep Apnea: Assessment of Sleep Symptoms 215 277

Sleep Apnea: Severity Assessment at Initial Diagnosis 216 278

Sleep Apnea: Positive Airway Pressure Therapy Prescribed 217 279

Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy 218

 

Overview Sinusitis Measures Group 366 130

Documentation of Current Medications in the Medical Record 368 131**

Pain Assessment and Follow-Up 369 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 371 331

Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Appropriate Use) 372 332

Adult Sinusitis: Appropriate Choice Antibiotic: Amoxicillin Prescribed for Patients w Acute Bacterial Sinusitis 373 333

Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse) 374

 

Overview Acute Otitis Externa (AOE) Measures Group 382 91

Acute Otitis Externa (AOE): Topical Therapy 384 93

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use 385 130

Documentation of Current Medications in the Medical Record 386 131

Pain Assessment and Follow-Up 387 154         

Falls: Risk Assessment 389 155

Falls: Plan of Care 390 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 391 317

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 392

 

Diabetes Measures Group 10 1 Diabetes:

Hemoglobin A1c Poor Control 13 110

Preventive Care and Screening: Influenza Immunization 14 117

Diabetes: Eye Exam 15 119

Diabetes: Medical Attention for Nephropathy 16 163

Diabetes: Foot Exam 17 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 18

 

Overview Chronic Kidney Disease (CKD) Measures Group 24 47

Care Plan 26 110

Preventive Care and Screening: Influenza Immunization 27 121

Adult Kidney Disease: Laboratory Testing (Lipid Profile) 28 122

Adult Kidney Disease: Blood Pressure Management 29 130

Documentation of Current Medications in the Medical Record 30 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 31

 

Overview Inflammatory Bowel Disease (IBD) Measures Group 194 110

Preventive Care and Screening: Influenza Immunization 196 111

Pneumonia Vaccination Status for Older Adults 197 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 198 270

Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Sparing Therapy 199 271

Inflammatory Bowel Disease (IBD): Prev Care: Corticosteroid Related Iatrogenic Injury – Bone Loss Assessm 200 274

Inflammatory Bowel Disease (IBD): Testing for Latent (TB) Before Initiating Anti-TNF Therapy 201 275

Inflammatory Bowel Disease (IBD): Assessm of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF Therapy 202

 

Overview Hepatitis C Measures Group 96 84

Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment 98 85

Hepatitis C: HCV Genotype Testing Prior to Treatment 99 87

Hepatitis C: Hepatitis C Virus (HCV) Ribonucleic Acid (RNA) Testing Betw 4-12 Wks After Initiation of Treatment 100 130 Documentation of Current Medications in the Medical Record 101 183

Hepatitis C: Hepatitis A Vaccination 102 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 103 390

Discussion and Shared Decision Making Surrounding Treatment Options 104 401

Screening for Hepatocellular Carcinoma (HCC) in Patients with Hepatitis C Cirrhosis 105

 

Overview Dementia Measures Group 227 47

Care Plan 229 280

Dementia: Staging of Dementia 230 281

Dementia: Cognitive Assessment 231 282

Dementia: Functional Status Assessment 232 283

Dementia: Neuropsychiatric Symptom Assessment 233 284

Dementia: Management of Neuropsychiatric Symptoms 235 285

Dementia: Screening for Depressive Symptoms 236 286

Dementia: Counseling Regarding Safety Concerns 237 287

Dementia: Counseling Regarding Risks of Driving 239 288

Dementia: Caregiver Education and Support 240

 

Overview Parkinson’s Disease Measures Group 250 47

Care Plan 252 289

Parkinson’s Disease: Annual Parkinson’s Disease Diagnosis Review 253 290

Parkinson’s Disease: Psychiatric Disorders or Disturbances Assessment 254 291

Parkinson’s Disease: Cognitive Impairment or Dysfunction Assessment 255 292

Parkinson’s Disease: Querying about Sleep Disturbances 256 293

Parkinson’s Disease: Rehabilitative Therapy Options 257 294

Parkinson’s Disease: Parkinson’s Disease Medical and Surgical Treatment Options Reviewed 258

 

Overview Cataracts Measures Group 266 130

Documentation of Current Medications in the Medical Record 268 191

Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery 269 192

Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures 276 226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 282 303

Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery 283 304

Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery 284 388

Cataract Surgery w Intra-Operative Complications (Unplanned Rupture Posterior Capsule Requiring Unplanned Vitrectomy) 285 389

Cataract Surgery: Difference Between Planned and Final Refraction 286

 

Overview Total Knee Replacement (TKR) Measures Group 323 130

Documentation of Current Medications in the Medical Record 325 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 326 350

Total Knee Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy 327 351

Total Knee Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation 328 352

Total Knee Replacement: Preoperative Antibiotic Infusion with Proximal Tourniquet 329 353

Total Knee Replacement: Identification of Implanted Prosthesis in Operative Report 330

 

Overview Rheumatoid Arthritis (RA) Measures Group 75 108

Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD)Therapy 77 128

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 79 131

Pain Assessment and Follow-Up 81 176

Rheumatoid Arthritis (RA): Tuberculosis Screening 83 177

Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity 84 178

Rheumatoid Arthritis (RA): Functional Status Assessment 85 179

Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis 86 180

Rheumatoid Arthritis (RA): Glucocorticoid Management 87

 

Overview Oncology Measures Group 305 71

Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer 311 72

Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients 312 110

Preventive Care and Screening: Influenza Immunization 313 130

Documentation of Current Medications in the Medical Record 314 143

Oncology: Medical and Radiation – Pain Intensity Quantified 315 144

Oncology: Medical and Radiation – Plan of Care for Pain 316 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 317

 

Overview HIV/AIDS Measures Group 146 47

Care Plan 148 134

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan 149 160

HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis 151 205

HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, and Syphilis 152 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 153 338

HIV Viral Load Suppression 154 339

Prescription of HIV Antiretroviral Therapy 155 340

HIV Medical Visit Frequency 156

 

Overview Optimizing Patient Exposure to Ionizing Radiation (OPEIR) Measures Group 354 359

Optimizing Patient Expos to Ionizing Rad: Utilization of Standardized Nomenclature for (CT) Imaging Description 356 360

Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: Computed Tomography (CT) and Cardiac Nuclear Medicine Studies 357 361

Optimizing Patient Exposure to Ionizing Radiation: Reporting to a Radiation Dose Index Registry 358 362

Optimizing Patient Expos to Ionizing Rad: (CT) Images Available for Patient Follow-up and Comparison Purposes 359 363

Optimizing Patient Exposure to Ionizing Radiation: Search for Prior Computed Tomography (CT) Studies Through a Secure, Authorized, Media-Free, Shared Archive 360 364

Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines 361

 

Overview General Surgery Measures Group 336 130

Documentation of Current Medications in the Medical Record 339 226

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 340 354

Anastomotic Leak Intervention 341 355

Unplanned Reoperation within the 30 Day Postoperative Period 342 356

Unplanned Hospital Readmission within 30 Days of Principal Procedure 343 357

Surgical Site Infection (SSI) 344 358

Patient-Centered Surgical Risk Assessment and Communication 345

 

Overview Coronary Artery Bypass Graft (CABG) Measures Group 63 43

Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients w Isolated CABG Surgery 65 44 Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery 66 164

Coronary Artery Bypass Graft (CABG): Prolonged Intubation 67 165

Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate 68 166

Coronary Artery Bypass Graft (CABG): Stroke 69 167

Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure 70 168

Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration 71

 

2015-2016 Note: 131 Pain Assessment & Follow-Up [is located in Community Popul Health domain, not Communic Care Coord domain]‒ NQS domains covered   Finalized Measures Domains:  Total Effective Clinical Care 18; Patient Safety 9; Efficiency and Cost Reduction 4; Community/ Population Health 1; Communication and Care Coordination 3; Person and Caregiver-Centered Experience and Outcomes 2.

(Measures for Removal:  ‒ 10 total removals from PQRS ‒ 9 measures being removed from claims and/or registry)

 

 

Preventive Care Measures Group  (9 measures)

Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older  (#39)

Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Older Women (#48)

Preventive Care and Screening: Influenza Immunization  (#110)

Pneumonia Vaccination Status for Older Adults  (#111)

Breast Cancer Screening  (#112)

Colorectal Cancer Screening  (#113)

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up  (#128)

Preventive Care and Screening: Unhealthy Alcohol Use – Screening  (#173)

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention  (#226)

 

Heart Failure (HF) Left Ventricular Systolic Dysfunction (LVSD) Measures Group  (4 measures)

Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Use (#5)

Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction  (#8)

Heart Failure: Left Ventricular Ejection Fraction (LVEF) Assessment  (#198)

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention  (#226) 

 

Coronary Artery Disease (CAD) Measures Group  (4 measures)

Coronary Artery Disease (CAD): Antiplatelet Therapy  (#6)

Coronary Artery Disease (CAD): Lipid Control  (#197)

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention  (#226)

Coronary Artery Disease (CAD): Symptom Management  (#242)  

 

 

Asthma Measures Group  (4 measures)

Asthma: Pharmacologic Therapy for Persistent Asthma- Ambulatory Care Setting  (#53)

Asthma: Assessment of Asthma Control - Ambulatory Care Setting  (#64)

Asthma: Tobacco Use: Screening - Ambulatory Care Setting  (#231)

Asthma: Tobacco Use: Intervention - Ambulatory Care Setting  (#232)     

Chronic Obstructive Pulmonary Disease (COPD) Measures Group  (5 measures)

Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation  (#51)

Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy  (#52)

Preventive Care and Screening: Influenza Immunization  (#110)

Preventive Care and Screening: Pneumococcal Vaccination for Older Adults (65 Years and Older)  (#111)

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention  (#226)

 

Diabetes Measures Group  (5 measures)

Diabetes: Hemoglobin A1c Poor Control  (#1)

Diabetes: Low Density Lipoprotein (LDL-C) Control (< 100 mg/dL)  (#2)

Diabetes: Eye Exam  (#117)

Diabetes: Medical Attention for Nephropathy  (#119)

Diabetes: Foot Exam  (#163)            

Chronic Kidney Disease (CKD) Measures Group  (4 measures)

Preventive Care and Screening: Influenza Immunization  (#110)

Adult Kidney Disease: Laboratory Testing (Lipid Profile)  (#121)

Adult Kidney Disease: Blood Pressure Management  (#122)

Adult Kidney Disease: Patients on Erythropoiesis Stimulating Agent (ESA) Hb Level >12.0 g/dL  (#123)                           

 

Measures  Group

 

 

 

 

 

 

PREVENTIVCARE MEASURE

GROUP:

For CPT Patient encounters: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99281, 99282, 99283, 99284, 99285, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99455, 99456, G0402, G0438, G0439.  

Use Measures Group if patient has ICD-9-CM … ICD-10-CM diagnosis code below:

 

Use These Measures for Male Patients: 

< 50 yearPatient doesn't qualify for measures group analysis;

50-64 years- 110, 113, 128, 173, 226;

65-75 years- 110, 111, 113, 128, 173, 226;

≥ 76 years- 110, 111, 128, 173, 226..  

Use These Measures for Female Patients: 

< 50 yearPatient does not qualify for measures group analysis;

50-64 years- 110, 112, 113, 128, 173, 226;

65-69 years- 39, 48, 110, 111, 112, 113, 128, 173, 226;

70-75 years- 39, 48, 110, 111, 113, 128, 173, 226;

≥ 76 years- 39, 48, 110, 111, 128, 173, 226..

HYPERTENSION MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

401.0, 401.1, 401.9, 402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 403.00, 403.10, 403.90, 404.00, 404.01, 404.10, 404.11, 404.90, 404.91...

 

I10, I11.0, I11.9, I12.9, I13.0, I13.10

HEART FAILURE (HF) MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9…

 

I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9

CORONARY ARTERY DISEASE (CAD) MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 411.0, 411.1, 411.81, 411.89, 412, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.2, 414.3, 414.8, 414.9, V45.81, V45.82…

 

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

ISCHEMIC VASCULAR DISEASE (IVD) MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91, 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.2, 414.8, 414.9, 429.2, 433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.4, 444.01, 444.09, 444.1, 444.21, 444.22, 444.81, 444.89, 444.9, 445.01, 445.02, 445.81, 445.89…

 

I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I20.0, I20.1, I20.8, I20.9, I21.11, I21.19, I21.21, I21.29, 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, I25.89, I25.9, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09, I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.20, I63.211, I63.212, I63.219, I63.22, I63.231, I63.232, I63.239, I63.29, I63.30, I63.311, I63.312, I63.319, I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40, I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441, I63.442, I63.449, I63.49, I63.50, I63.511, I63.512, I63.519, I63.521, I63.522, I63.529, I63.531, I63.532, I63.539, I63.541, I63.542, I63.549, I63.59, I63.6, I63.8, I63.9, I65.01, I65.02, I65.03, I65.09, I65.1, I65.21, I65.22, I65.23, I65.29, I65.8, I65.9, I66.01, I66.02, I66.03, I66.09, I66.11, I66.12, I66.13, I66.19, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I70.1, I70.201, I70.202, I70.203, I70.208, I70.209, I70.211, I70.212, I70.213, I70.218, I70.219, I70.221, I70.222, I70.223, I70.228, I70.229, I70.231, I70.232, I70.233, I70.234, I70.235, I70.238, I70.239, I70.241, I70.242, I70.243, I70.244, I70.245, I70.248, I70.249, I70.25, I70.261, I70.262, I70.263, I70.268, I70.269, I70.291, I70.292, I70.293, I70.298, I70.299, I70.92, I74.01, I74.09, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8, I74.9, I75.011, I75.012, I75.013, I75.019, I75.021, I75.022, I75.023, I75.029, I75.81, I75.89

ASTHMA MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

493.00, 493.01, 493.02, 493.10, 493.11, 493.12, 493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91, 493.92…

 

J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998

COPD MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

491.0, 491.1, 491.20, 491.21, 491.22, 491.8, 491.9, 492.0, 492.8, 493.20, 493.21, 493.22, 496…

 

J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9

DIABETES MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04…

 

E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13

CHRONIC KIDNEY DISEASE (CKD) MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

585.4, 585.5...

 

N18.4, N18.5 

(Note: The diagnosis code for stage 3 chronic kidney disease (583.3) is not included within the common denominator for reporting the CKD Measures Group

BACK PAIN MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

721.3, 721.41, 721.42, 721.90, 722.0, 722.10, 722.11, 722.2, 722.30, 722.31, 722.32, 722.39, 722.4, 722.51, 722.52, 722.6, 722.70, 722.71, 722.72, 722.73, 722.80, 722.81, 722.82, 722.83, 722.90, 722.91, 722.92, 722.93, 723.0, 724.00, 724.01, 724.02, 724.09, 724.2, 724.3, 724.4, 724.5, 724.6, 724.70, 724.71, 724.79, 738.4, 738.5, 739.3, 739.4, 756.12, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, 847.2...

 

M43.00, M43.10, M43.27, M43.28, M46.40, M46.41, M46.42, M46.43, M46.44, M46.45, M46.46, M46.47, M46.48, M46.49, M47.14, M47.15, M47.16, M47.17, M47.18, M47.20, M47.26, M47.27, M47.28, M47.816, M47.817, M47.818, M47.819, M47.896, M47.897, M47.898, M47.899, M47.9, M48.00, M48.01, M48.02, M48.03, M48.04, M48.05, M48.06, M48.07, M48.08, M50.00, M50.01, M50.02, M50.03, M50.20, M50.21, M50.22, M50.23, M50.30, M50.31, M50.32, M50.33, M50.80, M50.81, M50.82, M50.83, M50.90, M50.91, M50.92, M50.93, M51.04, M51.05, M51.06, M51.07, M51.14, M51.15, M51.16, M51.17, M51.24, M51.26, M51.27, M51.34, M51.35, M51.36, M51.37, M51.44, M51.45, M51.47, M51.87, M51.9, M53.2X7, M53.2X8, M53.86, M53.87, M53.88, M54.14, M54.15, M54.16, M54.17, M54.30, M54.31, M54.32, M54.40, M54.41, M54.42, M54.5, M54.89, M54.9, M96.1, M99.03, M99.04, M99.20, M99.21, M99.22, M99.23, M99.24, M99.25, M99.26, M99.27, M99.28, M99.29, M99.30, M99.31, M99.32, M99.33, M99.34, M99.35, M99.36, M99.37, M99.38, M99.39, M99.40, M99.41, M99.42, M99.43, M99.44, M99.45, M99.46, M99.47, M99.48, M99.49, M99.50, M99.51, M99.52, M99.53, M99.54, M99.55, M99.56, M99.57, M99.58, M99.59, M99.60, M99.61, M99.62, M99.63, M99.64, M99.65, M99.66, M99.67, M99.68, M99.69, M99.70, M99.71, M99.72, M99.73, M99.74, M99.75, M99.76, M99.77, M99.78, M99.79, M99.83, M99.84, Q76.2, S33.5XXA, S33.6XXA, S33.8XXA, S33.9XXA

CARDIOVASCULAR PREVENTION MEASURES GROUP

(ICD-9-CM codes…ICD-10-CM codes)

250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.00, 648.01, 648.02, 648.03, 648.04, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91, 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.2, 414.8, 414.9, 429.2, 433.00, 433.01, 433.10, 433.11, 433.20, 433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90, 434.91, 444.01, 444.09, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.4, 444.1, 444.21, 444.22, 444.81, 444.89, 444.9, 445.01, 445.02, 445.81, 445.89...

 

E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44, E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630, E10.638, E10.641, E10.649, E10.65, E10.69,E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29, E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359, E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610, E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9,

O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112, O24.113, O24.119, O24.12, O24.13,

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, 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, I25.89, I25.9, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09, I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.20, I63.211, I63.212, I63.219, I63.22, I63.231, I63.232, I63.239, I63.29, I63.30, I63.311, I63.312, I63.319, I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40, I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441, I63.442, I63.449, I63.49, I63.50, I63.511, I63.512, I63.519, I63.521, I63.522, I63.529, I63.531, I63.532, I63.539, I63.541, I63.542, I63.549, I63.59, I63.6, I63.8, I63.9, I65.01, I65.02, I65.03, I65.09, I65.1, I65.21, I65.22, I65.23, I65.29, I65.8, I65.9, I66.01, I66.02, I66.03, I66.09, I66.11, I66.12, I66.13, I66.19, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I70.1, I70.201, I70.202, I70.203, I70.208, I70.209, I70.211, I70.212, I70.213, I70.218, I70.219, I70.221, I70.222, I70.223, I70.228, I70.229, I70.231, I70.232, I70.233, I70.234, I70.235, I70.238, I70.239, I70.241, I70.242, I70.243, I70.244, I70.245, I70.248, I70.249, I70.25, I70.261, I70.262, I70.263, I70.268, I70.269, I70.291, I70.292, I70.293, I70.298, I70.299, I70.92, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8, I74.9, I75.011, I75.012, I75.013, I75.019, I75.021, I75.022, I75.023, I75.029, I75.81, I75.89

 

 
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