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) Measures List
