numerator, denominator

Numerator And Denominator In PQRS

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

Denominators

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-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

Denominator CPT codes for Psychiatry are;

  • CPT 90801;
  • CPT 90802;
  • CPT 90804;
  • CPT 90805;
  • CPT 90806;
  • CPT 90807;
  • CPT 90808;
  • CPT 90809, and
  • CPT 90862.

Denominator CPT codes for Ophthalmology are;

  • CPT 92002;
  • CPT 92004;
  • CPT 92012; and
  • CPT 92014.

Denominator CPT codes for behavioral health are;

  • CPT 96150;
  • CPT 96151; and
  • CPT 96152.

Denominator CPT codes for office visits are;

Denominator CPT codes for nursing facility care are;

  • CPT 99304;
  • CPT 99305;
  • CPT 99306;
  • CPT 99307;
  • CPT 99308;
  • CPT 99309;
  • CPT 99310;
  • CPT 99315; and
  • CPT 99316.

Denominator CPT codes for assisted living/domiciliary are;

  • CPT 99324;
  • CPT 99325;
  • CPT 99326;
  • CPT 99327;
  • CPT 99328;
  • CPT 99334;
  • CPT 99335;
  • CPT 99336; and
  • CPT 99337.

Denominator CPT codes for home visits are;

  • CPT 99341;
  • CPT 99342;
  • CPT 99343;
  • CPT 99345;
  • CPT 99347;
  • CPT 99348;
  • CPT 99349; and
  • CPT 99350.

Denominator CPT code for pelvic/clinical breast exam is G0101.

Denominator CPT codes for diabetes self management training are G0108 and G0109.

Numerators

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.

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