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Chart Talk2012:Quality Measures MUPhase 1

4/30/2012

How to perform Chart Talk’s Clinical Quality Measures

Introduction

This document aims to explain, in layman’s terms, the process of demonstrating the NQF endorsed Meaningful Use Quality Measures using Chart Talk. The Chart Talk method of performing Clinical Quality Measures utilizes the patient education and clinical decision support rule requirements of Meaningful Use to help providers identify the patients, and steps needed to perform various clinical quality measures.

Before we begin lets go over the terminology used in this document and in the conversation when discussing demonstrating quality in a clinical setting.

Clinical Quality Measures (CQM)- A set procedure of events that attempts to ensure that patients receive quality and consistent health care. Various organizations are responsible for developing the "quality measures" such as the National Quality Forum (NQF) and Physician Quality Reporting System (PQRS).

Denominators-Similar to other Meaningful Use measures, CQMs measure compliancy in percentages. Every quality measure targets a specific patient population. This targeted group becomes the denominator of the equation. For example, all patients that are over 18, that have been seen for more than two encounters in the reporting period, and that have a diagnosis of hypertension (401.9) make up the patient population for the denominator of one CQM.

Numerators-When referring to CQMs, the numerator is the number of patients from the initial population (Denominator) that have had the procedure, medication, immunization, or other requirement to demonstrate the quality measure. In the above example, patients in the numerator would be all patients that are over 18, that have been seen for more than two encounters in the reporting period, that have a diagnosis of hypertension (401.9) and have had their blood pressure measures. This shows that a hypertensive adult patient that has a relationship with the provider is having their blood pressure monitored. Simple enough, right?

Age Group Targeted- The age group targeted is the age group affected by the quality measure. Each measure targets a specific group. Remember that different measures target different age groups. Measures can even have more than one reportable percentage for different age groups.

Idea- The basic concept of the quality measure and why this is required/suggested for demonstrating clinical quality.

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Codes Needed to Demonstrate- These are CPT, ICD-9, ICD-10, HCPCS, SNOMED, LOINC, and RXNORM codes applicable for diagnosis, encounters, and other concepts required to successfully demonstrate a CQM.

Encounter – The term encounter implies an office visit by a patient. When calculating CQMs only certain encounter codes are only deemed applicable to different measures. In the document below all of these codes are listed for each measure. We have made an effort to highlight the most common codes that your clinic uses.

Diagnosis – Codes referencing certain problems. These can be ICD-9, ICD-10, SNOMED,or clinical measurements.

Chart Talk CQM Notification Actions – Chart Talk’s designers had the forethought to integrate patient notifications to use Clinical Decision Support rules to help demonstrate the intricate requirements for CQM. Patients that fall into the denominator of a measure can be flagged so that Chart Talk notifies the provider when they count towards a CQM. Following the onscreen decision rule and acknowledging or excluding the patient can write the necessary procedural code into the CQM field of the daily visit. CPT codes, HCPCS, SNOMED codes are used to complete the quality measure and move the patient into the numerator of the CQM.

Now that we have a basic vocabulary to discuss quality measures let’s look every measure specifically to understand how it is demonstrated.

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0013 – Hypertension Blood Pressure Management AGE GROUP TARGETED: All patients 18+

Idea

To demonstrate this quality ]measure all patients over 18 with two office encounters (exams) that are diagnosed with hypertension (e.g. 401.9) should have their blood pressure monitored.

Denominator All Patients that are over 18 years of age, with a diagnosis of hypertension and that have had two or more ENCONTERS during the reporting period.

Numerator Patients from the denominator that have had a blood pressure measurement within the reporting period.

Codes Need to Demonstrate: Encounter (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 , 99241, 99242, 99243, 99244, 99245, 99324, 99325,

99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

Diagnosis: Hypertension

ICD-9 -401.0, 401.1, 401.9, 402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 403.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00, 404.01,

404.02, 404.03, 404.10, 404.11, 404.12, 404.13, 404.90, 404.91, 404.92, 404.93

ICD-10-I10, I11, I13, I13.0, I13.10, I13.2

SNOMED: 10562009, 10725009, 111438007, 1201005, 123799005, 123800009, 14973001, 15394000, 15938005, 16147005, 169465000,

18416000, 193003, 194774006, 194783001, 194785008, 194788005, 194791005, 194793008, 19769006, 198941007, 198942000, 198944004,

198945003, 198946002, 198947006, 198949009, 198951008, 198952001, 198953006, 198954000, 198956003, 198958002, 198959005,

198965005, 198966006, 198967002, 198968007, 198997005, 198999008, 199000005, 199002002, 199003007, 199005000, 199007008,

199008003, 206596003, 23130000, 23717007, 237279007, 237281009, 237282002, 23786008, 24042004, 26078007, 276789009, 28119000,

288250001, 29259002, 307632004, 308551004, 31407004, 31992008, 32916005, 34694006, 35303009, 367390009, 371125006, 37618003,

38481006, 39018007, 39727004, 397748008, 398254007, 41114007, 427889009, 428575007, 429198000, 429457004, 46481004, 46764007,

48146000, 48194001, 48552006, 49220004, 50490005, 52698002, 56218007, 57684003, 59621000, 59720008, 59997006, 62275004,

63287004, 65402008, 65443008, 65518004, 67359005, 70272006, 71874008, 72022006, 73030000, 73410007, 74451002, 78544004,

78808002, 78975002, 81626002, 8218002, 84094009, 86041002, 86234004, 8762007, 89242004, 9901000

Chart Talk CQM Notification Actions: No action codes are necessary because quality is demonstrated using a blood pressure measurement. A good idea is to create your own notification rule to alert the clinic when the patients blood pressure is high. By definition hypertension is 140/90 – create an alert that notifies for all patients over 18 who has a systolic blood pressure over 140.

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NQF 0024 Weight Assessment and Counseling for Children and Adolescents

AGE GROUP TARGETED: All patients 2- 17

Idea- Children aged 2 to 17 with an clinical that have a BMI on record, are counseled about proper nutrition and activity.(three separate measurements and three separate age groups)

Denominator (General) All Patients that are between 2 and 17 years of age, with a diagnosis of hypertension and that have had one or more ENCONTERS during the reporting period.

Numerator (General) Patients from the denominator that have had a BMI measurement, activity counseling, and nutritional counseling.

Codes Needed to Demonstrate –

Encounter:

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 , 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244,

99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403,

99404, 99411, 99412, 99420, 99429, 99455, 99456

ICD-9-CM: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

Outpatient OB/GYN: V24, V25, V26, V27, V28, V45.5, V61.5, V61.6, V61.7, V69.2, V72.3, V72.4

Diagnosis : N/A

Chart Talk Notification Actions: There are three numerators for three age ranges resulting in nine reportable ratios for this measure

Denominator 1: All Patients that are between 2 and 17 years of age, with a diagnosis of hypertension and that have had one or more ENCONTERS during the reporting period.

Numerator 1.1 Patients from the Denominator 1that have had a BMI measurement.

Procedure: BMI Measurement

ICD-9: V85.5, V85.51, V85.52, V85.53, V85.54

ICD-10: Z68, Z68.1, Z68.5, Z68.51, Z68.52, Z68.53, Z68.54

SNOMED: 162860001, 162861002, 162862009, 162863004, 162864005, 35425004, 408512008, 412768003, 427090001, 48499001,

60621009, 6497000

Numerator 1.2 Patients from the Denominator 1that have had a Counseling for Nutrition

Procedure: Nutritional Counseling

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ICD-9: V65.3

ICD-10: Z00.1, Z00.10, Z00.11, Z00.2, Z00.3, Z00.7, Z00.70, Z00.71, Z00.8, Z72.3, Z72.4CPT: 97802, 97803, 97804

CPT: 97802, 97803, 97804

HCPCS: G0270, G0271, S9449, S9452, S9470

Numerator 1.3 Patients from the Denominator 1that have had counseling for nutrition.

Procedure: Nutritional Counseling

ICD-9: V65.41

ICD-10: Z71.3

HCPCS: S9451

Denominator 2: All Patients that are between 2 and 10 years of age, with a diagnosis of hypertension and that have had one or more ENCONTERS during the reporting period.

Numerator 2.1 Patients from the Denominator 2 that have had a BMI measurement.

Procedure: BMI Measurement

ICD-9: V85.5, V85.51, V85.52, V85.53, V85.54

ICD-10: Z68, Z68.1, Z68.5, Z68.51, Z68.52, Z68.53, Z68.54

SNOMED: 162860001, 162861002, 162862009, 162863004, 162864005, 35425004, 408512008, 412768003, 427090001, 48499001,

60621009, 6497000

Numerator 2.2 Patients from the Denominator 2 that have had a Counseling for Nutrition

Procedure: Nutritional Counseling

ICD-9: V65.3

ICD-10: Z00.1, Z00.10, Z00.11, Z00.2, Z00.3, Z00.7, Z00.70, Z00.71, Z00.8, Z72.3, Z72.4CPT: 97802, 97803, 97804

CPT: 97802, 97803, 97804

HCPCS: G0270, G0271, S9449, S9452, S9470

Numerator 2.3 Patients from the Denominator 2that have had counseling for nutrition.

Procedure: Nutritional Counseling

ICD-9: V65.41

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Chart Talk2012:Quality Measures MUPhase 1

ICD-10: Z71.3

HCPCS: S9451

Denominator 3: All Patients that are between 11 and 17 years of age, with a diagnosis of hypertension and that have had one or more ENCONTERS during the reporting period.

Numerator 3.1 Patients from the Denominator 3 that have had a BMI measurement.

Procedure: BMI Measurement

ICD-9: V85.5, V85.51, V85.52, V85.53, V85.54

ICD-10: Z68, Z68.1, Z68.5, Z68.51, Z68.52, Z68.53, Z68.54

SNOMED: 162860001, 162861002, 162862009, 162863004, 162864005, 35425004, 408512008, 412768003, 427090001, 48499001,

60621009, 6497000

Numerator 3.2 Patients from the Denominator 3 that have had a Counseling for Nutrition

Procedure: Nutritional Counseling

ICD-9: V65.3

ICD-10: Z00.1, Z00.10, Z00.11, Z00.2, Z00.3, Z00.7, Z00.70, Z00.71, Z00.8, Z72.3, Z72.4CPT: 97802, 97803, 97804

CPT: 97802, 97803, 97804

HCPCS: G0270, G0271, S9449, S9452, S9470

Numerator 3.3 Patients from the Denominator 3 that have had counseling for nutrition.

Procedure: Nutritional Counseling

ICD-9: V65.41

ICD-10: Z71.3

HCPCS: S9451

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0028a Tobacco Use – Smoking Assessment AGE GROUP TARGETED: All patients 18+

Idea Percentage of patients aged 18 years or older who have been seen for at least 2 office visits, who were queried about tobacco use one or more times within 24 months.

Denominator All Patients that are over 18 years of age, , and that have had two or more ENCONTERS during the reporting period.

Numerator Patients from the denominator that have that have a registered response to the smoking status .

Codes Needed to Demonstrate -

Encounter:

CPT - 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 , 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, 90862, 99401, 99402, 99403, 99404,

Chart Talk Notification Actions: N/A - Value in Chart Talk Vitals for Smoking Status

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0028b Tobacco Use – Cessation AGE GROUP TARGETED: All patients 18+

Idea Percentage of patients aged 18 years and older identified as tobacco users within the past 24 months and have been seen for at least 2 office visits, who received cessation intervention.

Denominator All Patients that are over 18 years of age, with a positive smoking status, and that have had two or more ENCONTERS during the reporting period.

Numerator Patients from the denominator that have that have had smoking cessation counseling (99406 or 99407 for example).

Codes Needed to Demonstrate –

Encounter:

CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 , 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90845, 90862, 99401, 99402, 99403, 99404,

Diagnosis :

Positive result for Smoker in the last 24 months

Chart Talk Notification Actions: Default: CPT 99406 – Intermediate tobacco cessation counseling 3-10 minutes in length.

Other: Prescribed cessation medications such as nicotine patch or gum.

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NQF 0041 Preventative Care and Screening Influenza Immunization for patients > 50 Years Old AGE GROUP TARGETED: All patients 50+

Idea Percentage of patients aged 50 years and older who received an influenza immunization during the flu season (September through February).

Denominator All Patients that are over 50 years of age with ENCOUNTERS during the reporting period.

Numerator Patients from the denominator who received an influenza immunization during the flu season (September through February).

Codes Needed to Demonstrate -

Encounter:

CPT:

2 Counts: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 , 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

1 Count: 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99386, 99387, 99396, 99397

Diagnosis : N/A

Chart Talk Notification Actions: N/A – Patients that qualify for the denominator automatically are included in the numerator when an Influenza immunization is given within122 days previous of the measurement period.

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NQF 0052 Low Back Pain: Overuse of imaging studies AGE GROUP TARGETED: All patients 18 - 50

Idea This measure assesses the percentage of patients in a specific age demographic who did not receive an imaging study (i.e., x‐ray, MRI, CT scan) in the 28 days following a new episode of low back pain. Low back pain is the second most frequently listed reason for physician office visits. It is a common cause of lost productivity and absenteeism from work in the United States. The general consensus from literature reviews indicates that nearly half of American adults will experience low back pain in a year, and about two‐thirds will suffer from it in their lifetime. Low back pain is particularly prevalent among men and women between 30 and 50 years of age, and most likely results from aging and an inactive lifestyle. Low back pain has a significant financial impact, costing an average of $8,000 per claim (Atlas, Devo 2001). This measure facilitates efforts toward improved musculoskeletal condition and improved quality of life.

Denominator All Patients that are between 18 and 50 years of age with ENCOUNTERS during the reporting period.

Numerator Patients from the denominator who DID NOT receive an imaging study order in Chart Talk withing 28 days of an initial diagnosis of low back pain unless they were a red flag case (cancer, IV drug user, etc.)

Codes Needed to Demonstrate -

Encounter:

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215 , 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456, 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942

Diagnosis : Low Back Pain

ICD-9: 721.3, 722.10, 722.32, 722.52, 722.93, 724, 724.02, 724.2, 724.3, 724.5, 724.7, 738.5, 739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9

ICD-10: M45.8, M47.817, M51.25, M51.46, M51.86, M53, M53.3, M54.3, M54.4, M54.9, S06.0, S06.2, S06.5, S06.8, S06.9, S26, S27.89, S36, S36.0, S37, S37.0, S38, S38.1, S39.01, S39.012, S39.9, S42.0, S93.0, S93.3, T79

SNOMED: 161894002, 202794004, 247368002, 267067009, 267982002, 278860009, 278862001, 279039007, 279040009, 279041008, 279042001, 300957005

Chart Talk Notification Actions: Various CPT Codes for imaging studies performed include: 72010, 72020, 72052, 72100, 72110, 72114, 72120, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72158, 72200, 72202, 72220

Use the Radiology Order form in CT to log that an imaging study was ordered to demonstrate this measure. Video demonstration available from the Mighty Oak User Group.

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0055 Diabetes Eye Exam

Idea This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who had an eye (retinal) exam performed. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐ altering complications, including glaucoma and blindness. Diabetic retinopathy is the most common diabetic eye disease and causes 21,000–4,000 new cases of blindness annually. The consensus among established clinical guidelines is that patients with both types of diabetes should have an initial dilated and comprehensive eye exam soon after diagnosis (ADA 2009). Guidelines also recommend consultation with an ophthalmologist for treatment options if a patient has any level of macular edema or diabetic retinopathy (proliferative and nonproliferative). This measure facilitates the prevention and long‐term management of retinal‐based complications for patients diagnosed with diabetes.

Denominator All Patients that are between 18 and 75 years of age, with a diagnosis of diabetes, and with ENCOUNTERS during the reporting period.

Numerator Patients from the denominator who received an retinal eye exam in the reporting period.

Codes Needed to Demonstrate - Encounter:

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456, 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, 92014

ICD-9: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

Diagnosis : Diabetes

ICD-9:

250, 250.0, 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,

250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73,

250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06,

362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04

ICD-10:

E10.36, E11.36, E11.9, E13, E13.32, E13.33, E13.34, E13.35, E13.43, O24.42

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SNOMED:

111552007, 111558006, 11530004, 123763000, 127013003, 127014009, 190321005, 190328004, 190330002, 190331003, 190336008,

190353001, 190361006, 190368000, 190369008, 190371008, 190372001, 190383005, 190389009, 190390000, 190392008, 190406000,

190407009, 190410002, 190411003, 190412005, 190416001, 190417004, 190418009, 190419001, 190422004, 193184006, 197605007,

198609003, 199223000, 199227004, 199229001, 199230006, 199231005, 199234002, 201250006, 201251005, 201252003, 23045005,

230572002, 230577008, 237599002, 237600004, 237601000, 237604008, 237613005, 237618001, 237619009, 237627000, 25907005,

26298008, 267379000, 267380002, 2751001, 275918005, 28032008, 28453007, 290002008, 309426007, 310387003, 311366001, 312912001,

313435000, 313436004, 314537004, 314771006, 314772004, 314893005, 314902007, 314903002, 33559001, 34140002, 359611005,

359638003, 359642000, 360546002, 371087003, 38542009, 39058009, 39181008, 408539000, 408540003, 413183008, 414890007,

414906009, 420414003, 420422005, 421750000, 421847006, 421895002, 422183001, 422228004, 422275004, 423263001, 424736006,

424989000, 425159004, 425442003, 426705001, 426875007, 427089005, 428896009, 42954008, 44054006, 4627003, 46635009, 50620007,

51002006, 5368009, 54181000, 57886004, 59079001, 5969009, 70694009, 73211009, 74263009, 75524006, 75682002, 76751001, 81531005,

81830002, 8801005, 91352004, 9859006

Chart Talk Notification Actions: Default ICD-9 CM Code 14.1 other acceptable codes are:

ICD-9-CM: 14.1, 14.2, 14.3, 14.4, 14.5, 14.9, 95.02-95.04, 95.11, 95.12, 95.16, V72.0

HCPCS: S0620, S0621, S0625, S3000

SNOMED: 134395001, 390735007, 390847009, 390855002

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NQF 0056 Diabetes Foot Exam Idea The consensus among established clinical guidelines is that patients with both types of diabetes should have a foot exam soon after diagnosis and annually thereafter (ADA 2009). Comprehensive foot care programs can lower amputation rates by 45%–85%. This measure facilitates the prevention and long‐term management of lower extremity‐based complications for patients diagnosed with diabetes.

Denominator All Patients that are between 18 and 75 years of age, with a diagnosis of diabetes, and with ENCOUNTERS during the reporting period.

Numerator Patients from the denominator who received a foot exam in the reporting period.

Codes Needed to Demonstrate - Encounter:

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291, 99281, 99282, 99283, 99284,

99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456

92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, 92014

ICD-9: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

Diagnosis :

Diabetes

ICD-9:

250, 250.0, 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,

250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73,

250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06,

362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04

ICD-10:

E10.36, E11.36, E11.9, E13, E13.32, E13.33, E13.34, E13.35, E13.43, O24.42

SNOMED:

111552007, 111558006, 11530004, 123763000, 127013003, 127014009, 190321005, 190328004, 190330002, 190331003, 190336008,

190353001, 190361006, 190368000, 190369008, 190371008, 190372001, 190383005, 190389009, 190390000, 190392008, 190406000,

190407009, 190410002, 190411003, 190412005, 190416001, 190417004, 190418009, 190419001, 190422004, 193184006, 197605007,

198609003, 199223000, 199227004, 199229001, 199230006, 199231005, 199234002, 201250006, 201251005, 201252003, 23045005,

230572002, 230577008, 237599002, 237600004, 237601000, 237604008, 237613005, 237618001, 237619009, 237627000, 25907005,

26298008, 267379000, 267380002, 2751001, 275918005, 28032008, 28453007, 290002008, 309426007, 310387003, 311366001, 312912001,

313435000, 313436004, 314537004, 314771006, 314772004, 314893005, 314902007, 314903002, 33559001, 34140002, 359611005,

359638003, 359642000, 360546002, 371087003, 38542009, 39058009, 39181008, 408539000, 408540003, 413183008, 414890007,

414906009, 420414003, 420422005, 421750000, 421847006, 421895002, 422183001, 422228004, 422275004, 423263001, 424736006,

424989000, 425159004, 425442003, 426705001, 426875007, 427089005, 428896009, 42954008, 44054006, 4627003, 46635009, 50620007,

51002006, 5368009, 54181000, 57886004, 59079001, 5969009, 70694009, 73211009, 74263009, 75524006, 75682002, 76751001, 81531005,

81830002, 8801005, 91352004, 9859006

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0061 Diabetes: Blood Pressure Management

Idea This measure evaluates the percentage of patients in a specific age demographic who were diagnosed with type 1 or type 2 diabetes and who sustain adequate blood pressure control. Diabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body’s inability to correctly produce or utilize the hormone insulin It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life‐threatening, life‐ending or life‐altering complications, including poor blood pressure control and subsequent cardiovascular disease of varying severity. Maintaining a healthy blood pressure has been shown to reduce complications due to diabetes, with a 10 mm Hg reduction in systolic blood pressure lowering the risk of complications by 12% It also reduces the chance of cardiovascular disease among patient with diabetes by up to 50% and reduces the chance of other related complications (eye, kidney, nerve) by more than 25% This measure facilitates long‐term management of blood pressure levels for patients diagnosed with diabetes.

Denominator All Patients that are between 18 and 75 years of age, with a diagnosis of diabetes, and with ENCOUNTERS during the reporting period.

Numerator Patients from the denominator who received a blood pressure measurement in the reporting period.

Codes Needed to Demonstrate - Encounter:

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291, 99281, 99282, 99283, 99284,

99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99420, 99429, 99455, 99456, 92002, 92003, 92004, 92005, 92006, 92007, 92008, 92009, 92010, 92011, 92012, 92013, 92014

ICD-9: V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

Diagnosis : Diabetes

ICD-9:

250, 250.0, 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,

250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73,

250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06,

362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04

ICD-10:

E10.36, E11.36, E11.9, E13, E13.32, E13.33, E13.34, E13.35, E13.43, O24.42

SNOMED:

111552007, 111558006, 11530004, 123763000, 127013003, 127014009, 190321005, 190328004, 190330002, 190331003, 190336008,

190353001, 190361006, 190368000, 190369008, 190371008, 190372001, 190383005, 190389009, 190390000, 190392008, 190406000,

190407009, 190410002, 190411003, 190412005, 190416001, 190417004, 190418009, 190419001, 190422004, 193184006, 197605007,

198609003, 199223000, 199227004, 199229001, 199230006, 199231005, 199234002, 201250006, 201251005, 201252003, 23045005,

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Chart Talk2012:Quality Measures MUPhase 1

230572002, 230577008, 237599002, 237600004, 237601000, 237604008, 237613005, 237618001, 237619009, 237627000, 25907005,

26298008, 267379000, 267380002, 2751001, 275918005, 28032008, 28453007, 290002008, 309426007, 310387003, 311366001, 312912001,

313435000, 313436004, 314537004, 314771006, 314772004, 314893005, 314902007, 314903002, 33559001, 34140002, 359611005,

359638003, 359642000, 360546002, 371087003, 38542009, 39058009, 39181008, 408539000, 408540003, 413183008, 414890007,

414906009, 420414003, 420422005, 421750000, 421847006, 421895002, 422183001, 422228004, 422275004, 423263001, 424736006,

424989000, 425159004, 425442003, 426705001, 426875007, 427089005, 428896009, 42954008, 44054006, 4627003, 46635009, 50620007,

51002006, 5368009, 54181000, 57886004, 59079001, 5969009, 70694009, 73211009, 74263009, 75524006, 75682002, 76751001, 81531005,

81830002, 8801005, 91352004, 9859006

Chart Talk Notification Actions: N/A - A positive result for a blood pressure measurement in the reporting period fulfills this requirement.

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0421 Adult Weight Screening and Counseling

Idea – Patients within two age groups (18-64, 65+) that have BMI values outside of the healthy range should be given nutritional counseling and a documented follow up plan should be created.

Denominator (General) All Patients that are over 18 years of age, with a BMI calculated to be out of the healthy range for their age groups, and with AN ENCOUNTER during the reporting period.

Numerator (General) The patients from the denominator who received nutritional counseling.

Denominator 1 All Patients that are over 65 years of age, with a BMI calculated to be out of the healthy range (24-29)for their age groups, and with AN ENCOUNTER during the reporting period.

Numerator 1 Patients from the denominator who received nutritional counseling .

Denominator 2 All Patients that are between 18 and 64 years of age, with a BMI calculated to be out of the healthy range (18-24)for their age groups, and with AN ENCOUNTER during the reporting period.

Numerator 2 Patients from the denominator who received nutritional counseling .

Codes Needed to Demonstrate -

Encounter:

CPT: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 97001, 97003, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205,

99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345,

99347, 99348, 99349, 99350

HCPCS: D7140, D7210, G0101, G0108, G0270

Diagnosis : BMI out of normal range for the applicable age group.

Chart Talk Notification Actions: Default V65.3 – Dietary Counseling and Surveillance

Other Codes for Dietary Counseling and Surveillance:

CPT: 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 97804, 98961, 98962, 99078

HCPCS: G8417, S9449, S9451, S9452, S9470

SNOMED: 169411000, 170795002, 225171007, 268523001, 275919002, 305849009, 307818003, 401003006

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Chart Talk2012:Quality Measures MUPhase 1

NQF 0038 Childhood Immunization Status AGE GROUP TARGETED: 1 – 2 Years of Age

Idea This measure addresses the appropriate series of immunizations given to children between one and two years of age.

The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates.

Denominator All Patients that are between 1 and 2 years of age, with an encounter during the reporting period.

Numerator 1 - DTap Patients from the denominator who have 4 count(s) of DTaP vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 2 - IPV Patients from the denominator who have 3 count(s) of IPV vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 3 –Mumps, Measles, Rubella (MMR) Patients from the denominator who have 1 count(s) of MMR vaccine (or 1 count of Mumps, measles, and rubella vaccine administered separately) occurring >=42 days and <2 years after birth date.

Numerator 4 - Hib Patients from the denominator who have 2 count(s) of HiB vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 5 – Hepatitis B Patients from the denominator who have 3 count(s) of Hepatitis B vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 6 - VZV Patients from the denominator who have 1 count(s) of VZV vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 7 – Pneumoccal Patients from the denominator who have 4 count(s) of pneumoccal vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 8 – Hepatitis A Patients from the denominator who have 2 count(s) of Hepatitis B vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 9 – Rotavirus Patients from the denominator who have 2 count(s) of Rotavirus vaccine different dates, occurring >=42 days and <2 years after birth date.

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Chart Talk2012:Quality Measures MUPhase 1

Numerator 10– Influenza Patients from the denominator who have 2 count(s) of influenza vaccine different dates, occurring >=42 days and <2 years after birth date.

Numerator 11 – Series 1-6 Completed Patients from the denominator who have 4 count(s) of DTaP, 3 count(s) of IPV, 1 count(s) of MMR vaccine (or 1 count of Mumps, measles, and rubella vaccine administered separately), 2 count(s) of HiB, 3 count(s) of Hepatitis B, and 1 count(s) of VZV occurring >=42 days and <2 years after birth date.

Numerator 12 – Series 1-7 Completed Patients from the denominator who have 4 count(s) of DTaP, 3 count(s) of IPV, 1 count(s) of MMR vaccine (or 1 count of Mumps, measles, and rubella vaccine administered separately), 2 count(s) of HiB, 3 count(s) of Hepatitis B, 1 count(s) of VZV, and 4 count(s) of pneumoccal vaccine >=42 days and <2 years after birth date.

Codes Needed to Demonstrate –

Encounter:

ICD-9: V24, V25, V26, V27, V28, V45.5, V61.5, V61.6, V61.7, V69.2, V72.3, V72.4, V70.0, V70.3, V70.5, V70.6, V70.8, V70.9

ICD-10: Z00.1, Z00.10, Z00.11, Z00.2, Z00.3, Z00.7, Z00.70, Z00.71, Z00.8

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244,

99245, 99341, 99342, 99343, 99344, 99345, 99347-99350, 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397, 99401, 99402, 99403,

99404, 99411, 99412, 99420, 99429, 99455, 99456

Immunizations:

DTaP

IPV

MMR (Mumps, Measels, Rubella)

HiB

VZV

Pneumoccal

Hepatitus A

Rotavirus

Influenza

Diagnosis :

Chart Talk Notification Actions: N/A – Patients go into numerator when they receive the proper number of vaccinations within the reporting period.