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2011 PQRS Important Updates

2011 Physician Quality Reporting System (Physician Quality Reporting) Measure Specifications Manual for Claims and Registry Release Notes

CMS is pleased to announce the release of the 2011 Physician Quality Reporting System (“Physician Quality Reporting”, formerly known as Physician Quality Reporting Initiative or PQRI) Measure Specifications Manual for Claims and Registry Release Notes. Measure developers, professional organizations, and other stakeholders have provided comments, clarifications and technical corrections. The list below details changes to existing measures made since the release of the 2010 PQRI Measure Specifications, Version 4.1. Version 5.2 of the Release Notes corresponds to version 5.2 of the posted 2011 Physician Quality Reporting Measure Specifications Manual for Claims and Registry.

Measure #1

NO CHANGES : Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus

Measure #2

NO CHANGES : Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus

Measure #3

• Updated Description and Numerator Statement – to include less than 140/90 mmHg : Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus

Measure #5

• Deleted from Denominator Coding, ICD-9-CM codes 398.91, 425.0, 425.1, 425.2, 425.3, 425.4, 425.5, 425.7, 425.8, 425.9 : Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Measure #6

NO CHANGES : Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD

Measure #7

NO CHANGES : Coronary Artery Disease (CAD): Beta-blocker Therapy for CAD Patients with Prior Myocardial Infarction (MI)

Measure #8

• Deleted from Denominator Coding, ICD-9-CM codes 398.91, 425.0, 425.1, 425.2, 425.3, 425.4, 425.5, 425.7, 425.8, 425.9 : Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Measure #9

NO CHANGES : Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD

Measure #10

NO CHANGES : Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports

Measure #12

NO CHANGES : Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation

Measure #14

• Added Numerator Definitions for Macular Thickening and Severity of Macular Degeneration : Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Measure #18

• Updated Numerator Definition for Documentation : Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

• Added Numerator Definitions for Macular Edema and Severity of Retinopathy

Measure #19

• Updated Instructions : Diabetic Retinopathy: Communication with the Physician Managing On-going Diabetes Care

• Added 1P modifier to measure

Measure #20

• Updated Instructions : Perioperative Care: Timing of Antibiotic Prophylaxis – Ordering Physician

• Added Denominator Instruction

• Replaced CPT II codes 4047F, 4048F, 4047F-1P, 4047F-8P with G-codes G8629, G8630, G8631, G8632

• Added to Denominator Coding, CPT codes 0236T, 43327, 43328, 43332, 43333, 43334, 43335, 43336 and 43337

• Deleted from Denominator Coding, CPT codes 35481, 43324 and 43326

Measure #21

• Added Denominator Instruction : Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin

• Added to Denominator Coding, CPT codes 0236T, 43327, 43328, 43332, 43333, 43334, 43335, 43336 and 43337

• Deleted from Denominator Coding, CPT codes 35481, 43324 and 43326

Measure #22

• Added Denominator Instruction : Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures)

• Added to Denominator Coding, CPT codes 0236T, 43327, 43328, 43332, 43333, 43334, 43335, 43336 and 43337

• Deleted from Denominator Coding, CPT codes 35481, 43324 and 43326

Measure #23

• Added Denominator Instruction : Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)

• Added to Denominator Coding, CPT codes 43327, 43328, 43332, 43333, 43334, 43335, 43336 and 43337

• Deleted from Denominator Coding, CPT codes 39502, 39520, 39530, 39531, 43324 and 43326

Measure #24

NO CHANGES : Osteoporosis: Communication with the Physician Managing On-going Care Post-Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older

Measure #28

• Added to Denominator Coding, ICD-9-CM codes 410.00, 410.10, 410.20, 410.30, 410.40, 410.50, 410.60, 410.70, 410.80, 410.90 : Aspirin at Arrival for Acute Myocardial Infarction (AMI)

Measure #30

NO CHANGES : Perioperative Care: Timely Administration of Prophylactic Parenteral Antibiotics

Measure #31

NO CHANGES : Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage

Measure #32

• Added Numerator Note : Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy

Measure #33

• Added Numerator Note : Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge

Measure #35

NO CHANGES : Stroke and Stroke Rehabilitation: Screening for Dysphagia

Measure #36

• Added Numerator Note : Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services

Measure #39

NO CHANGES : Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older

Measure #40

• Updated Instructions : Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older

• Replaced CPT II codes 4005F, 4005F-1P, 4005F-2P, 4005F-3P, 4005F-8P with G-codes G8633, G8634, G8635

Measure #41

• Updated Numerator Statement : Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older

Measure #43

NO CHANGES : Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery

Measure #44

NO CHANGES : Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery

Measure #45

• Added Denominator Instruction : Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac Procedures)

Measure #46

NO CHANGES : Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility

Measure #47

NO CHANGES : Advance Care Plan

Measure #48

NO CHANGES : Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older

Measure #49

• Updated Description : Urinary Incontinence: Characterization of Urinary Incontinence in Women Aged 65 Years and Older

Measure #50

• Updated Description : Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older

Measure #51

NO CHANGES : Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation

Measure #52

NO CHANGES : Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy

Measure #53

• Updated Description, Denominator Statement and Denominator Criteria section to include patients aged 5 through 50 years : Asthma: Pharmacologic Therapy

• Deleted from Denominator Coding, ICD-9-CM codes 493.01, 493.11, 493.21, 493.91

Measure #54

NO CHANGES : 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain

Measure #55

NO CHANGES : 12-Lead Electrocardiogram (ECG) Performed for Syncope

Measure #56

• Added Numerator Definition for Vital Signs : Community-Acquired Pneumonia (CAP): Vital Signs

• Updated Numerator Definition for Documented and Reviewed

Measure #57

• Added Numerator Definition for Oxygen Saturation : Community-Acquired Pneumonia (CAP): Assessment of Oxygen Saturation

• Updated Numerator Definition for Documented and Reviewed

Measure #58

• Updated Numerator Definition for Assessed : Community-Acquired Pneumonia (CAP): Assessment of Mental Status

Measure #59

NO CHANGES : Community-Acquired Pneumonia (CAP): Empiric Antibiotic

Measure #64

• Updated Description, Denominator Statement and Denominator Criteria section to include patients aged 5 through 50 years : Asthma: Asthma Assessment

• Deleted from Denominator Coding, ICD-9-CM codes 493.01, 493.11, 493.21, 493.91

Measure #65

NO CHANGES : Treatment for Children with Upper Respiratory Infection (URI): Avoidance of Inappropriate Use

Measure #66

NO CHANGES : Appropriate Testing for Children with Pharyngitis

Measure #67

NO CHANGES : Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow

Measure #68

NO CHANGES : Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy

Measure #69

NO CHANGES : Multiple Myeloma: Treatment with Bisphosphonates

Measure #70

NO CHANGES : Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry

Measure #71

NO CHANGES : Breast Cancer: Hormonal Therapy for Stage IC - IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer

Measure #72

NO CHANGES : Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients

Measure #76

NO CHANGES : Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter (CVC) Insertion Protocol

Measure #79

• Updated Description, Instructions, Numerator and Denominator Statements : End Stage Renal Disease (ESRD): Influenza Immunization in Patients with ESRD

• Added Numerator Definition for Previous Receipt

• Replaced CPT II codes 4037F, 4037F-1P, 4037F-2P, 4037F-3P, 4037F-8P with G-codes G8636, G8637, G8638

Measure #81

• Updated Description and Denominator Statement : End Stage Renal Disease (ESRD): Plan of Care for Inadequate Hemodialysis in ESRD Patients

Measure #82

• Updated Rationale : End Stage Renal Disease (ESRD): Plan of Care for Inadequate Peritoneal Dialysis

Measure #83

NO CHANGES : Hepatitis C: Testing for Chronic Hepatitis C - Confirmation of Hepatitis C Viremia

Measure #84

NO CHANGES : Hepatitis C: Ribonucleic Acid (RNA) Testing Before Initiating Treatment

Measure #85

• Updated Numerator Statement : Hepatitis C: HCV Genotype Testing Prior to Treatment

Measure #86

NO CHANGES : Hepatitis C: Antiviral Treatment Prescribed

Measure #87

NO CHANGES : Hepatitis C: HCV Ribonucleic Acid (RNA) Testing at Week 12 of Treatment

Measure #89

NO CHANGES : Hepatitis C: Counseling Regarding Risk of Alcohol Consumption

Measure #90

NO CHANGES : Hepatitis C: Counseling Regarding Use of Contraception Prior to Antiviral Therapy

Measure #91

• Added to Denominator Coding, CPT codes 99281, 99282, 99283, 99284, 99285 : Acute Otitis Externa (AOE): Topical Therapy

• Added examples for 1P, medical reason(s), for performance exclusion

Measure #92

• Added to Denominator Coding, CPT codes 99281, 99282, 99283, 99284, 99285 : Acute Otitis Externa (AOE): Pain Assessment

Measure #93

• Added to Denominator Coding, CPT codes 99281, 99282, 99283, 99284, 99285 : Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use

• Added examples for 1P, medical reason(s), for performance exclusion

Measure #94

NO CHANGES : Otitis Media with Effusion (OME): Diagnostic Evaluation – Assessment of Tympanic Membrane Mobility

Measure #99

NO CHANGES : Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade

Measure #100

NO CHANGES : Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN Category (Regional Lymph Nodes) with Histologic Grade

Measure #102

NO CHANGES : Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low-Risk Prostate Cancer Patients

Measure #104

NO CHANGES : Prostate Cancer: Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients

Measure #105

NO CHANGES : Prostate Cancer: Three-dimensional (3D) Radiotherapy

Measure #106

NO CHANGES : Major Depressive Disorder (MDD): Diagnostic Evaluation

Measure #107

NO CHANGES : Major Depressive Disorder (MDD): Suicide Risk Assessment

Measure #108

NO CHANGES : Rheumatoid Arthritis (RA): Disease Modifying Anti-Rheumatic Drug (DMARD) Therapy

Measure #109

NO CHANGES : Osteoarthritis (OA): Function and Pain Assessment

Measure #110

• Updated Instructions : Preventive Care and Screening: Influenza Immunization for Patients = 50 Years Old

Measure #111

NO CHANGES : Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and Older

Measure #112

NO CHANGES : Preventive Care and Screening: Screening Mammography

Measure #113

NO CHANGES : Preventive Care and Screening: Colorectal Cancer Screening

Measure #114

RETIRED from PQRI effective January 1, 2011 : Preventive Care and Screening: Inquiry Regarding Tobacco Use

Measure #115:

RETIRED from PQRI effective January 1, 2011 Preventive Care and Screening: Advising Smokers and Tobacco Users to Quit

Measure #116

NO CHANGES : Antibiotic Treatment for Adults with Acute Bronchitis: Avoidance of Inappropriate Use

Measure #117

NO CHANGES : Diabetes Mellitus: Dilated Eye Exam in Diabetic Patient

Measure #118

• Deleted from Denominator Coding, ICD-9-CM codes 648.00, 648.01, 648.02, 648.03, 648.04 : Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD)

Measure #119 in Diabetic Patients : Diabetes Mellitus: Urine Screening for Microalbumin or Medical Attention for Nephropathy

NO CHANGES

Measure #121

NO CHANGES : Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphorus, Intact Parathyroid Hormone (iPTH) and Lipid Profile)

Measure #122

NO CHANGES : Chronic Kidney Disease (CKD): Blood Pressure Management

Measure #123

• Added Numerator Definition for Erythropoiesis-Stimulating Agents (ESA) : Chronic Kidney Disease (CKD): Plan of Care-Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA)

Measure #124

• Updated Description, Instructions, Numerator Statement and Rationale : Health Information Technology (HIT): Adoption/Use of Electronic Health Records (EHR)

• Added to Denominator Coding, CPT codes 92506, 92507, 92526, 92610, 92611, 92612

• Added Numerator Definitions for Authorized Testing and Certification Body (ATCB) and Other Acceptable Systems

• Updated Numerator Definition for Certified/Qualified Electronic Health Record

• Deleted Numerator Definitions for Basic Privacy and Security Elements, CCHIT, Manage a Medication List, Manage a Problem List and Discrete Searchable Data Elements

• Deleted Numerator Note

• Added Numerator Note

• Updated Language for Numerator G-codes G8447 and G8448

Measure #126

• Added to Denominator Coding, CPT codes 97597 and 97598 : Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation

• Deleted from Denominator Coding, CPT codes 11040 and 11041

Measure #127

• Added to Denominator Coding, CPT codes 97597 and 97598 : Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear

• Deleted from Denominator Coding, CPT codes 11040 and 11041

Measure #128

• Updated Description, Instructions, Rationale and Clinical Recommendations : Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

• Updated Numerator Definition for BMI, Follow-up Plan, and Not Eligible/Not Appropriate for BMI Measurement

• Added Numerator Definition for Elderly BMI

• Deleted Numerator Definition for Terminal Illness – now included under Not Eligible/Not Appropriate for BMI Measurement definition

Measure #130

• Updated Title, Description, Instructions, Numerator Statement, Rationale and Clinical Recommendations : Documentation of Current Medications in the Medical Record

• Added to the Denominator Coding, CPT codes 90957, 90958, 90959, 90960, 90962, 90965, 90966, 97804, 98961, 98962

• Updated Numerator Definition for Current Medications

• Deleted Numerator Definition for Verification and Authorized Representative

• Updated language for G-codes G8427, G8428

• Deleted G-codes G8507, G8429

Measure #131

• Updated Instructions, Numerator Statement, Rationale and Clinical Recommendations : Pain Assessment Prior to Initiation of Patient Therapy and Follow-up

• Updated Definition for Standardized Tool

• Updated language for G-codes G8440, G8508, G8441, G8509

Measure #134

• Updated Instructions, Numerator and Rationale : Screening for Clinical Depression and Follow-Up Plan

• Added to Denominator Coding, CPT codes 92590, 92626, 96150, 96151

Measure #135: Chronic Kidney Disease (CKD): Influenza Immunization

• Updated Description, Instructions, Denominator and Numerator Statements

• Added Definition for Previous Receipt

• Replaced CPT II codes 4037F, 4037F-1P, 4037F-2P, 4037F-3P, 4037F-8P with G-codes G8639, G8640, G8641

Measure #136

RETIRED from PQRI effective January 1, 2011 : Melanoma: Follow-Up Aspects of Care

Measure #137

NO CHANGES : Melanoma: Continuity of Care – Recall System

Measure #138

NO CHANGES : Melanoma: Coordination of Care

Measure #139

RETIRED from PQRI effective January 1, 2011 : Cataracts: Comprehensive Preoperative Assessment for Cataract Surgery with Intraocular Lens (IOL) Placement

Measure #140

• Updated Numerator Definition for Counseling : Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement

• Added Numerator Note

Measure #141

• Updated Numerator Definition for Plan of Care : Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care

• Added Numerator Definitions for Plan to Recheck and Glaucoma Treatment Not Failed

Measure #142

• Updated Denominator Statement : Osteoarthritis (OA): Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications

Measure #143

• Added to Denominator Coding, CPT code 96446 : Oncology: Medical and Radiation – Pain Intensity Quantified

• Deleted from Denominator Coding, CPT code 96445

Measure #144

• Added codes from Measure #143 to the Denominator Coding section to align the eligible cases for these paired measures : Oncology: Medical and Radiation – Plan of Care for Pain

Measure #145

• Deleted from Denominator Coding, CPT codes 24516, 27506, 62318, 62319, 64530, 64561, 64605, 64680, 64681, 75992, 75994, 75995, 93555, 93556 : Radiology: Exposure Time Reported for Procedures Using Fluoroscopy

• Added to Denominator Coding, CPT codes, 0234T, 0235T, 0238T, 37225, 37227, 37229, 37231, 93565, 93566, 93567, 93568

Measure #146

NO CHANGES : Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Mammography Screening

Measure #147

NO CHANGES : Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

Measure #148: Back Pain: Initial Visit

• See the 2011 Physician Quality Reporting System Measures Groups Specifications Manual and Release Notes (The link is given at the bottom of this post)

Measure #149

• See the 2011 Physician Quality Reporting System Measures Groups Specifications Manual and Release Notes : Back Pain: Physical Exam (The link is given at the bottom of this post)

Measure #150

• See the 2011 Physician Quality Reporting System Measures Groups Specifications Manual : Back Pain: Advice for Normal Activities (The link is given at the bottom of this post)

Measure #151

• See the 2011 Physician Quality Reporting System Measures Groups Specifications Manual and Release Notes : Back Pain: Advice Against Bed Rest (The link is given at the bottom of this post)

Measure #153

NO CHANGES : Chronic Kidney Disease (CKD): Referral for Arteriovenous (AV) Fistula

Measure #154

NO CHANGES : Falls: Risk Assessment

Measure #155

• Added codes from Measure #154 to the Denominator Coding section to align the eligible cases for these paired measures : Falls: Plan of Care

Measure #156

NO CHANGES : Oncology: Radiation Dose Limits to Normal Tissues

Measure #157

Cancer Resection : Thoracic Surgery: Recording of Clinical Stage for Lung Cancer and Esophageal

NO CHANGES

Measure #158

NO CHANGES : Carotid Endarterectomy: Use of Patch During Conventional Carotid Endarterectomy

Measure #159

NO CHANGES : HIV/AIDS: CD4+ Cell Count or CD4+ Percentage

Measure #160

NO CHANGES : HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis

Measure #161

NO CHANGES : HIV/AIDS: Adolescent and Adult Patients with HIV/AIDS Who Are Prescribed Potent Antiretroviral Therapy

Measure #162

NO CHANGES : HIV/AIDS: HIV RNA Control After Six Months of Potent Antiretroviral Therapy

Measure #163

NO CHANGES : Diabetes Mellitus: Foot Exam

Measure #164

NO CHANGES : Coronary Artery Bypass Graft (CABG): Prolonged Intubation (Ventilation)

Measure #165

NO CHANGES : Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate

Measure #166

NO CHANGES : Coronary Artery Bypass Graft (CABG): Stroke/Cerebrovascular Accident (CVA)

Measure #167

NO CHANGES : Coronary Artery Bypass Graft (CABG): Postoperative Renal Insufficiency

Measure #168

NO CHANGES : Coronary Artery Bypass Graft (CABG): Surgical Re-exploration

Measure #169

NO CHANGES : Coronary Artery Bypass Graft (CABG): Antiplatelet Medications at Discharge

Measure #170

NO CHANGES : Coronary Artery Bypass Graft (CABG): Beta-Blockers Administered at Discharge

Measure #171

NO CHANGES : Coronary Artery Bypass Graft (CABG): Lipid Management and Counseling

Measure #172

NO CHANGES : Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arterial Venous (AV) Fistula

Measure #173

NO CHANGES : Preventive Care and Screening: Unhealthy Alcohol Use – Screening

Measure #174

RETIRED from PQRI effective January 1, 2011 : Pediatric End Stage Renal Disease (ESRD): Plan of Care for Inadequate Hemodialysis

Measure #175

• Updated Description, Instructions, Denominator and Numerator Statements : Pediatric End Stage Renal Disease (ESRD): Influenza Immunization

• Added Definition for Previous Receipt

Measure #176

NO CHANGES : Rheumatoid Arthritis (RA): Tuberculosis Screening

Measure #177

NO CHANGES : Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity

Measure #178

NO CHANGES : Rheumatoid Arthritis (RA): Functional Status Assessment

Measure #179

NO CHANGES : Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis

Measure #180

NO CHANGES : Rheumatoid Arthritis (RA): Glucocorticoid Management

Measure #181

NO CHANGES : Elder Maltreatment Screen and Follow-Up Plan

Measure #182

NO CHANGES : Functional Outcome Assessment in Chiropractic Care

Measure #183

NO CHANGES : Hepatitis C: Hepatitis A Vaccination in Patients with HCV

Measure #184

NO CHANGES : Hepatitis C: Hepatitis B Vaccination in Patients with HCV

Measure #185

• Updated Description : Endoscopy & Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use

Measure #186

• Updated Denominator Criteria Section, including adding an Option for identifying eligible cases : Wound Care: Use of Compression System in Patients with Venous Ulcers

• Added to Denominator Coding, CPT codes 29580, 29581 to both Options

• Added to Denominator Coding, ICD-9 codes 459.11, 459.13 to Option 1

Measure #187

NO CHANGES : Stroke and Stroke Rehabilitation: Thrombolytic Therapy

Measure #188 the Ear : Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of

NO CHANGES

Measure #189

NO CHANGES : Referral for Otologic Evaluation for Patients with History of Active Drainage From the Ear Within the Previous 90 Days

Measure #190

• Added to Denominator Coding, CPT codes 92550, 92570 : Referral for Otologic Evaluation for Patients with a History of Sudden or Rapidly Progressive Hearing Loss

Measure #191

• Added Denominator Instruction : Cataracts: 20/40 or Better Visual Acuity Within 90 Days Following Cataract Surgery

• Changes made to Denominator Coding section for Comorbid Conditions, ICD-9-CM codes:

1. Acute and Subacute iridocyclitis: Deleted 362.02 and Added 364.02

2. Disseminated Chorioretinitis and Disseminated Retinochoroiditis: Added 363.13

3. Glaucoma: Added 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.22, 365.31, 365.32

4. High Myopia: Deleted 360.32 and Added 360.21

5. Retinopathy of Prematurity: Added 362.20, 362.22, 362.23, 362.24, 362.25, 362.26, 362.27

Measure #192: Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures

• Added Denominator Instruction

• Changes made to Denominator Coding section for Comorbid Conditions, ICD-9-CM codes:

1. Acute and Subacute iridocyclitis: Deleted 362.02 and Added 364.02

2. Adhesions and Disruptions of Iris and Ciliary Body: Added 364.82, 364.89

3. Glaucoma: Added 365.10, 365.11, 365.12, 365.13, 365.14, 365.15, 365.22, 365.31, 365.32

4. Hypotony of Eye: Deleted 360.21 and Added 360.32

• Added to Denominator Coding section for Comorbid Conditions and Numerator Instructions (Prior Pars Plana Virtectomy), CPT codes 67041, 67042, 67043

• Deleted from Denominator Coding section for Comorbid Conditions and Numerator Instructions (Prior Pars Plana Virtectomy), CPT code 67038

Measure #193

NO CHANGES : Perioperative Temperature Management

Measure #194

NO CHANGES : Oncology: Cancer Stage Documented

Measure #195

• Updated Title : Radiology: Stenosis Measurement in Carotid Imaging Studies

Measure #196

NO CHANGES : Coronary Artery Disease (CAD): Symptom and Activity Assessment

Measure #197

• Added Numerator Definition for Prescribed : Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol

Measure #198

• Deleted from Denominator Coding, ICD-9-CM codes 398.91, 425.0, 425.1, 425.2, 425.3, 425.4, 425.5, 425.7, 425.8, 425.9 : Heart Failure: Left Ventricular Function (LVF) Assessment

Measure #199: Heart Failure: Patient Education

• Deleted from Denominator Coding, ICD-9-CM codes 398.91, 425.0, 425.1, 425.2, 425.3, 425.4, 425.5, 425.7, 425.8, 425.9

Measure #200

• Deleted from Denominator Coding, ICD-9-CM codes 398.91, 425.0, 425.1, 425.2, 425.3, 425.4, 425.5, 425.7, 425.8, 425.9 : Heart Failure: Warfarin Therapy for Patients with Atrial Fibrillation

Measure #201

NO CHANGES : Ischemic Vascular Disease (IVD): Blood Pressure Management Control

Measure #202

NO CHANGES : Ischemic Vascular Disease (IVD): Complete Lipid Profile

Measure #203

NO CHANGES : Ischemic Vascular Disease (IVD): Low Density Lipoprotein (LDL–C) Control

Measure #204

NO CHANGES : Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

Measure #205

NO CHANGES : HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia and Gonorrhea

Measure #206

NO CHANGES : HIV/AIDS: Screening for High Risk Sexual Behaviors

Measure #207

NO CHANGES : HIV/AIDS: Screening for Injection Drug Use

Measure #208

NO CHANGES : HIV/AIDS: Sexually Transmitted Disease Screening for Syphilis

Measure #209

NO CHANGES : Functional Communication Measure - Spoken Language Comprehension

Measure #210

NO CHANGES : Functional Communication Measure - Attention

Measure #211

NO CHANGES : Functional Communication Measure - Memory

Measure #212

NO CHANGES : Functional Communication Measure - Motor Speech

Measure #213

NO CHANGES : Functional Communication Measure - Reading

Measure #214

NO CHANGES : Functional Communication Measure - Spoken Language Expression

Measure #215

NO CHANGES : Functional Communication Measure - Writing

Measure #216

NO CHANGES : Functional Communication Measure – Swallowing

Global Edits

• Program name changed to Physician Quality Reporting System (Physician Quality Reporting) formerly known as Physician Quality Reporting Initiative or PQRI

• Deleted reference to “line item” in Instruction and Denominator Criteria sections for measures reported via the claims method

• Updated Instruction for Measure Reporting via Claims – clarified the statement, “All measure-specific coding should be reported ON THE SAME CLAIM” to read “…on the claim(s) representing the eligible encounter.”

For complete informations on these Measures please visit

2011 Physician Quality Reporting System (Physician Quality Reporting) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures

2011 Physician Quality Reporting System (Physician Quality Reporting) Measures List


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