numerator denominator

What are the Numerator and Denominator in PQRS


Physician Quality Reporting measures consist of two major components. Each component is defined by specific codes described in the respective measure’s specification along with the reporting instructions and use of modifiers.

The first measure component is the denominator, which describes the eligible cases for a measure or the eligible patient population. Physician Quality Reporting measure denominators are identified by ICD-9-CM (future ICD-10-CM), CPT Category I, and HCPCS codes, as well as patient demographics (age, gender, etc), and place of service (if applicable). For registry and EHR reporting, other clinical coding sets may be included such as SNOMED, LOINC, or RxNorm.

List of Denominator CPT Codes

Psychiatry – CPT 90801, CPT 90802, CPT 90804, CPT 90805, CPT 90806, CPT 90807, CPT 90808, CPT 90809, CPT 90862

Ophthalmology – CPT 92002, CPT 92004, CPT 92012, CPT 92014

Behavioral Health – CPT 96150, CPT 96151, CPT 96152

Office visits – CPT 99201, CPT 99202, CPT 99203, CPT 99204, CPT 99205, CPT 99211, CPT 99212, CPT 99213, CPT 99214, CPT 99215

Nursing facility care – CPT 99304, CPT 99305, CPT 99306, CPT 99307, CPT 99308, CPT 99309, CPT 99310, CPT 99315, CPT 99316

Assisted Living/Domiciliary – CPT 99324, CPT 99325, CPT 99326, CPT 99327, CPT 99328, CPT 99334, CPT 99335, CPT 99336, CPT 99337

Home visits – CPT 99341, CPT 99342, CPT 99343, CPT 99345, CPT 99347, CPT 99348, CPT 99349, CPT 99350

Pelvic/clinical breast exam – G0101

Diabetes Self-management training – G0108, G0109

The second component is the numerator describing the specific clinical action required by the measure for performance. Eligible professionals may use the codes present in the numerator to report the outcome of the action as indicated by the measure. Physician Quality Reporting measure numerators are quality-data codes (QDCs) consisting of specified non-payable CPT Category II codes and/or temporary G-codes. For registry and EHR reporting, other clinical coding sets may be included such as SNOMED, LOINC, or RxNorm in order to capture a specific quality action, test, or value.

Calculating the Physician Quality Reporting System reporting rate (dividing the numerator by the denominator) identifies the percentage of a defined patient population that was reported for the measure. For performance rate calculations, some patients may be excluded from the denominator based on medical, patient or system exclusions allowed by the measure.

The final performance rate calculation represents the eligible population that received a particular process of care or achieved a particular outcome. It is important to review and understand each measure’s specification, as it contains definitions and specific instructions for reporting the measure.

Please see http://www.cms.gov/PQRS/15_MeasuresCodes.asp for more information.

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