2018 stage 1 & 2 medicaid meaningful use guide€¦ · how to run a meaningful use report all...

2018 Stage 1 & 2 Medicaid Meaningful

Use Guide

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CONTENTS MEANINGFUL USE INTRODUCTION.............................................................................. 3

USING THIS GUIDE ...................................................................................................... 5

OBJECTIVES, MEASURES, CRITERIA & REQUIRED ANCILLARY SERVICES ....................... 6

HOW TO RUN A MEANINGFUL USE REPORT……………………………...……...………..…….…..….9

HOW TO RUN A CLINICAL QUALITY REPORT ……………………………………………….….………..12

HOW TO RUN THE PATIENT BY VOLUME REPORT FOR MEANINGFUL USE…..…………….15

TAKING SCREENSHOTS ...............................................................................................18

OBJECTIVE #1: PROTECT PATIENT HEALTH INFORMATION .........................................19

OBJECTIVE #2: CLINICAL DECISION SUPPORT .............................................................20

OBJECTIVE #3: CPOE ................................................................................................. 28

OBJECTIVE #4: ELECTRONIC PRESCRIBING ................................................................. 32

OBJECTIVE #5: HEALTH INFORMATION EXCHANGE ................................................... 36

OBJECTIVE #6: PATIENT SPECIFIC EDUCATION ...........................................................49

OBJECTIVE#7: MEDICATION RECONCILIATION ...........................................................51

OBJECTIVE #8: PATIENT ELECTRONIC ACCESS ............................................................ 53

OBJECTIVE #9: SECURE MESSAGING .......................................................................... 56

OBJECTIVE #10: PUBLIC HEALTH REPORTING .............................................................59

CLINICAL QUALITY MEASURES..........................................................................................64

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MEANINGFUL USE INTRODUCTION

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as

part of the American Recovery and Reinvestment Act (ARRA) of 2009, promotes the adoption

and Meaningful Use of health information technology. One of its specific goals is to encourage

physicians to adopt Electronic Health Record (EHR) software. The HITECH and ARRA acts include

incentive payments to physicians who demonstrate ‘Meaningful Use’ of a certified EHR

application. One of its specific goals is to increase physician adoption of EHR applications to 90

percent by 2019. Participation in the Medicare EHR incentive program began in 2011.

To receive incentive payments for EHR adoption, physicians must demonstrate that they are

using a certified EHR in the manner proscribed by The Department of Health and Human

Services as Meaningful Use.

Pediatricians must have at minimum 20% Medicaid patient volume

• Check with your state requirements as some states require 30% for Pediatricians.

Non-Pediatrician providers must have at minimum 30% Medicaid patient volume

The Department of Health and Human Services’ (HHS) definition of Meaningful Use expands

over three stages:

STAGE 1 – Data capturing and sharing

STAGE 2 – Advanced clinical processes

STAGE 3 – Improved outcomes

PROGRAM PENALTIES FOR NON-PARTICIPATION For Medicaid there are no program penalties.

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EHR INCENTIVE PAYMENT SCHEDULE: MEDICAID

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USING THIS GUIDE This guide provides a general introduction to using Aprima® PRM 2015 or 2016 for Meaningful

Use Stage 1 and 2 reporting in the 2018 calendar year for the Medicaid EHR Incentive Program.

THIS DOCUMENT: Provides an in depth contextual explanation of each objective.

Comes complete with screen shots of Aprima® accompanied by easy to follow step-by-

step instructions of how to meet each objective.

Describes each Clinical Quality Measure supported by Aprima® and how to successfully

document these measures.

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OBJECTIVES, MEASURES, CRITERIA & REQUIRED ANCILLARY SERVICES To demonstrate Meaningful Use for Stage 1 and Stage 2, you must report on:

10 core measure objectives

Six clinical quality measures

REQUIREMENTS: (For both MU and CQM reporting)

Provider tax identification number (ETIN)

Provider National Provider Identification number (NPI)

Provider Information: first and last name, specialty, phone number

Patient Information: First name, last name, gender, date of birth, race, ethnicity,

language

Provide Patient Volume information to prove Medicaid Volume

OBJECTIVES: Protect Patient Health Information (security risk analysis)

Clinical Decision Support (must implement five rules as well as turn on drug formulary

checks)

Computerized Provider Order Entry (provider must order their own prescriptions, labs

and radiology orders)

Electronic Prescribing (medications being sent electronically)

Health Information Exchange (direct mail, HISP)

Patient Specific Education (education forms)

Medication Reconciliation

Patient Electronic Access (patient portal)

Secure Messaging (communication via patient portal)

Public Health Reporting (immunization registry, syndromic surveillance reporting,

specialized registry reporting)

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CLINICAL QUALITY MEASURES Clinical quality measures must be selected from at least three of the six key health care policy

domains defined by the Department of Health and Human Services’ National Quality Strategy.

The health care policy domains are:

Patient and Family Engagement

Patient Safety

Care Coordination

Population and Public Health

Efficient Use of Healthcare Resources

Clinical Processes/Effectiveness

ANCILLARY SERVICES Ancillary Services are required for successful Meaningful Use attestation. These ancillary

services are provided at an additional cost and include:

Aprima® Patient Portal

Direct Secure Mail

Surescripts® electronic pharmacy clearinghouse

Interface with an immunization registry or immunization information systems (if

applicable)

Interface with public health agency

Interface with specialized registry, other than for immunizations, syndromic surveillance

or cancer

INACTIVE ITEMS (Before October 1, 2015)

Record Demographics

Record Vital Signs

Record Smoking Status

Clinical Summaries

Structured Lab Results

Patient List

Patient Reminders

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Summary of Care

Measure 1—Any Method

Measure 3—Test

Electronic Notes

Imaging Results

Family Health History

REPORTING PERIOD 2018 For all new participants, the EHR reporting period is a minimum of any continuous 90

days between January 1 and December 31, 2018.

For the 2018 EHR reporting period, the attestation deadline is February 28, 2019.

ATTESTATION WEBSITE When you are ready to attest, you will access your state Medicaid website. If you need to

modify your registration this can be done on the Medicare & Medicaid EHR Incentive Program

Registration and Attestation System.

To access this system please log on to

https://ehrincentives.cms.gov/hitech/loginCredentials.action using your username and

password for the National Plan and Provider Enumeration System (NPPES).

https://ehrincentives.cms.gov/hitech/loginCredentials.action

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HOW TO RUN A MEANINGFUL USE REPORT

All reports are to be obtained from your Aprima® software for reporting purposes. To obtain a

report please proceed to the report icon on your desktop.

STEP BY STEP INSTRUCTIONS

From your Aprima® desktop, select the Reports icon.

In the View Report window, select the Meaningful Use Stage 2 2015 report from the

Clinical Quality menu. All providers regardless of stage will run this report as it shows

you the list of measures based on the final rule released by the CMS in October 2015.

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In the Filter Attributes select the provider you wish to run the report for and then select the reporting period. When checking your provider’s status for the 2017 reporting period be sure to run it for the entire year. Select View to display the report.

• Leave the Provider Option on Billing Provider. If you are generating a report for a midlevel provider for their Medicaid attestation and they bill under a different provider, select Rendering Provider.

The report will then appear. To print the report, select the Print button. You may also export the report as a PDF, Word or Excel document using the floppy disk with a green arrow icon.

• If a measure has an N/A in the numerator/denominator column this means that the system was not able to calculate the data due to no data being entered or due to the measure being a Yes/No attestation instead of a threshold.

• To view more details about the measure, select the plus sign next to Measure Details. This will show you all of the patients who have been applied to the measure. You may select the patients name to access their chart from the report.

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HOW TO RUN A CLINICAL QUALITY MEASURE REPORT FOR MEANINGFUL USE OBJECTIVE

Allow the user to understand how to run the CQM report for Meaningful Use from the Reports

icon.



In the View Report window, select the CQM 2015 report from the Clinical Quality menu.

All providers regardless of stage will run this report as it shows you the list of measures

based on the final rule released by the CMS in October 2015.

For the Filter Attributes

• Select search next to your Filter Name to pull in a filter if you have created one. If you do not have a filter please proceed with the following items.

• The CQM Version to use for 2018 is currently CQM 2016.

• The Description field is left blank. The CMS Program radio button should be on ‘Meaningful Use Only’.

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• The Payer field for both a Medicare and Medicaid provider will be left blank to

pull in all insurance carriers.

• Search for and select the provider name the report is for in the Provider field.

• Leave the Provider Option on Billing Provider unless the provider the report is

for is never the billing provider then select Rendering Provider.

• The Measure Date is for the entire reporting period (i.e. the entire year or 90

day reporting period as designated by your Meaningful Use Stage or by the

CMS).

• Select the six (or more) measures that you have predetermined.

• Leave the Financial Center and Service Site fields blank to include all visits and

select VIEW.

The QRDA Calculated Summary Report will display. The eMeasure Identifier (MAT) is

what you will use to identify the measure in the EHR Incentive Program reporting

website. You will then use the Denominator, Numerator, Performance Rate, Exclusions

and Exceptions when reporting the data. Select the blue printer icon to print the report.

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Should you have difficulty displaying the report, please contact your Account Manager.

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HOW TO RUN THE PATIENT BY VOLUME REPORT FOR MEANINGFUL USE OBJECTIVE

Allow the user to understand how to run the Patient by Volume for Meaningful Use report from

the Reports icon for Medicaid Meaningful Use providers only.



Select the Patient Volume for Meaningful Use report from the Clinical Quality menu.

For the Filter Attributes:

• Leave the provider option on billing provider unless the provider the report is

for is never a billing provider.

• Pull in the provider’s name in the Provider field you wish to run the report for.

(If you are running the report for the group volume numbers, leave this field

blank.)

• If needed, select a specific Financial Center or Service Site.

• For the Render Option, select Insurance Payer.

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• Leave the Patient Account Type blank.

• Select all Medicaid payers in the Insurance Payer field.

• For the Visit Date, select the 90 period you will be using.

• Under Insurance Option chose to use Primary Insurance Only or to Include Secondary.

• You can choose to Group by Provider if you are using separate volumes for each provider.

• For the Insurance Payment option, you will typically leave it on All Visits.

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When the report generates you can choose to select the payer to view the names of the

patients included in the payer group or simply select the Print button to print the report.

Select the back arrow to return to the main screen of the report.

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TAKING SCREENSHOTS

OBJECTIVE Inform physician on how to take appropriate screenshots for measures that are a Yes/No.

STEP BY STEP INSTRUCTIONS For those measures requiring screen shots, you can accomplish this in two different

ways:

• If a whole screen is necessary, simply use the Print Screen, [Prt Sc], button on

your keyboard. This will copy the entire contents of your viewable monitor. If

you have multiple monitors, this will capture both screens.

• If you need to capture a smaller section or an individual window, you can also

use a combination of the [Alt] key and [Prt Sc] key. To use this combination, you

will just need to make sure that the window that you intend to capture is

selected as your main focus. This is done by simply using your mouse and

clicking on the window intended for capture and then pressing the [Alt] and [Prt

Sc] keys together.

Once you have taken your screen shot it may appear that nothing has happened, but a

copy of your screen has been saved to your clipboard.

• To retrieve your image, you will want to open any program that will allow you to

paste an image. Once you have this program opened, you will want to use the

Paste command by either right clicking in blank space on your document and

selecting ‘Paste’, or by using the command [Ctrl] [V].

• Save the document you have created with the name of the measure and the

date the screen shot was taken for easy identification.

The measures necessary to screenshot are:

Objective 2 Measure 1- Clinical Decision Support

Objective 2 Measure 2- Drug Screening

Objective 9- Patient Portal Messaging

Objective 10 Measure 1- Immunization Registry (if applicable)

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OBJECTIVE #1: PROTECT ELECTRONIC HEALTH INFORMATION OBJECTIVE Allow provider to understand how to protect electronic information.

CONTEXT Provers should protect electronic health information created or maintained by the certified EHR

technology (CEHRT) through the implementation of appropriate technical capabilities.

Conduct or review a Security Risk Analysis in accordance with the requirements under 45 CFR

164.308(a)(1), including addressing the security (to include encryption) of ePHI created and

maintained by Certified EHR Technology (CEHRT) in accordance with requirements in 45 CFR

164.312 (a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and

correct identified security deficiencies as part of the provider’s risk management process for

EPs.

EXCLUSION None

STEP BY STEP INSTRUCTIONS No data entry is required to report on this measure. To meet the measure’s goal, you

must attest Yes to having conducted or reviewed a security risk analysis in accordance

with the requirements under 45 CFR 164.308 (a) (1) prior or during the EHR reporting

period.

You may complete your Security Risk Analysis by using DAS Health’s SRA services

(consult your Account Manager). DAS’ services reduce your required staff time, ensures

completion of all requirements, and provides all necessary documentation.

Alternatively, The Office of the National Coordinator for Health Information Technology

has made available a downloadable Security Risk Analysis Tool (requires manual

completion without support) that can be accessed from their website:

https://www.healthit.gov/providers-professionals/security-risk-assessment-tool

https://dashealth.com/solutions/security-risk-assessment

https://dashealth.com/solutions/security-risk-assessment

https://www.healthit.gov/providers-professionals/security-risk-assessment-tool

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OBJECTIVE #2: CLINICAL DECISION SUPPORT RULE OBJECTIVE Allow provider to understand how to use Clinical Decision Support Rules, formally known as

Health Maintenance Rules.

CONTEXT STAGE 1: Use clinical decision support to improve performance on high-priority health conditions.

Measure 1: Implement one clinical decision support rule relevant to specialty or high

clinical priority, along with the ability to track compliance with that rule.

STAGE 2: Use clinical decision support to improve performance on high-priority health conditions.

Measure 1: Implement five clinical decision support interventions related to four or

more clinical quality measures at a relevant point in patient care for the entire EHR

reporting period. Absent four clinical quality measures related to an EP’s scope of

practice or patient population, the clinical decision support interventions must be

related to high-priority health conditions.

Measure 2: The EP has enabled and implemented the functionality for drug-drug and

drug-allergy interaction checks for the entire EHR reporting period.

EXCLUSIONS None

STEP BY STEP INSTRUCTIONS Measure 1: Create 1 Clinical Decision Support Rule for Stage 1 or 5 Clinical Decision

Support Rules for Stage 2. For Stage 2, the Clinical Decision Support Rules must be

associated with 4 Clinical Quality Measures from three different domains.

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• Start from the Aprima Desktop, go to List Editor, click on Clinical, then Clinical

Decision Support Rules. Create the rule using the three tabs: General, Criteria

and Care Team.

The New Clinical Decision Support window will open to the General tab:

• Type the name of the rule in the Name field. Example: Well Woman Exam

• Place a check in the box if this rule is to "Report as Preventative Follow-up"

• Place a check in the box for "Procedures to be Completed" this will active the

rest of the fields.

• In the Recurrence fields define how often you wish for the rule to occur for all

patients. In this example it is occurring once a year (Every 1 to 1 years).

• To limit the recurrences, check the box next to Limit Recurrence and specify in

the number in the Max Recurrence box.

• If an advanced warning is desired specify the time frame such as a 30-day

warning before the due date.

• Specify the procedures to be completed in the Procedures find box.

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Select the Criteria tab:

• Define the age range for which the rule is applicable, such as 3 to 6 months or

40 to 65 years.

• Define Gender. This choice is multi-select, so you can select Male and Female for

any tests that are not gender specific.

• Define Patient Medical History. This field is multi-select, so you can add all

medical history to which the rule will apply.

• Define the drug or drug class. These are multi-select fields, so you can add all

the medications to which the rule will apply. However, you can only select by

either drug or drug class; you cannot select by both drug and drug class.

Define the lab result criteria:

• In the LOINC field, select the code for the laboratory test you want to associate

with the health maintenance rule.

• In the Result Is field, select the operator for the value. For example, select the

‘>’ operator if you are interested in results greater than a certain value.

• In the Value field, enter the lab result value.

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Define observation criteria if appropriate.

• Select the Edit Observation Criteria button. This accesses the Edit Observation

Criteria window, where you can define an equation for observation values. You

may want to write down your equation before you start to enter it.

• To enter a clause, select the open parentheses ( ) button.

• Select the desired Observation item.

• Select the Not button if appropriate.

• Select a comparison operator (=, <, >, like, etc.).

• Enter the literal value for the observation.

• Select the Insert button to add the criteria to the equation. Your criteria will

display in the Current Observation Criteria area.

• To close a clause, select the close parentheses ( ) button.

• If needed, select the ‘and’ or ‘or’ buttons to begin another clause. Then repeat

sub steps to enter the next clause.

• To edit the equation, select the << button to backspace through the equation.

• When finished, select the OK button to save the observation equation and

return to the Clinical Decision Support window. Your equation displays in the

Observation Criteria area.

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Select the Care Team tab:

• Select the Care Team.

• Select the Msg (message) Recipient(s) for the rule. When a rule becomes due, a

message is sent to the message recipients to alert them of the rule. The

message recipients do not need to be members of the care team; they can be

other users, such as front desk staff.

• Select which providers, if any, wish to opt out, that is do not wish to be

associated with the rule.

• Repeat the sub steps for each care team that will use the rule.

Within the Full Note Composer, access the CDS Slider > slide bar to far right > click action

on the appropriate rule group. Action CDS by selecting either HM Hx, SO, SP, Plan or

Declined. This will then trigger the next appropriate rule date.

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Measure 2: From the Aprima Desktop, click on the Tools drop down menu > select

Configure Practice Settings > Drug Screening. Make sure the box for Drug to Drug

Interaction box is checked.

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This measure is suggested to have screen shots for supporting documentation. The

following are examples of the suggested screen shots to support the measures.

• Measure 1 Screenshot #1: Screenshot of CDS Rules being tracked in a patient’s

chart. Include the date and time in the screenshot.

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Measure 1 Screenshot #2: Screenshot of list of CDS rules from List Editor. Include the

date and time in the screenshot.

Measure 2 Screenshot: Screenshot of Drug Screening Configuration from Configure

Practice Settings located in the Tools menu. Include the date and time in the screenshot.

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OBJECTIVE #3: COMPUTERIZED PROVIDER ORDER ENTRY (CPOE)

OBJECTIVE

Allow provider to understand Computerized Provider Order Entry.

CONTEXT

Use computerized provider order entry (CPOE) for medication, laboratory, and radiology orders

directly entered by any licensed healthcare professional who can enter orders into the medical

record per state, local and professional guidelines.

Stage 1:

Providers use CPOE to document orders.

Measure 1: More than 30 percent of all unique patients with at least one medication in

their medication list seen by the EP during the EHR reporting period have at least one

medication order entered using CPOE;

Or more than 30 percent of medication orders created by the EP during the reporting

period during the EHR reporting period, are recorded using computerized provider order

entry.

Stage 2:

Providers use CPOE to document orders.

Measure 1: More than 60 percent of medication orders created by the EP during the

EHR reporting period are recorded using computerized provider order entry.

Measure 2: More than 30 percent of laboratory orders created by the EP during the EHR

reporting period are recorded using computerized provider order entry.

Measure 3: More than 30 percent of radiology orders created by the EP during the EHR

reporting period are recorded using computerized provider order entry.

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EXCLUSIONS

Providers scheduled to be Stage 1 in 2016 may claim an exclusion for measure two (laboratory

orders) and for measure three (radiology orders) of Stage 2 CPOE objective for an EHR reporting

period in 2016. There are no exclusions for Stage 2 providers.

Providers who write fewer than 100 medications, laboratory or radiology orders during the

reporting period may exclude from this measure.


For medication ordering: create a Full Note Composer, navigate to RX Tab and enter

desired medication. This medication can be printed or e-prescribed to calculate.

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For laboratory ordering: create a Full Note Composer, navigate to either the SO or SP

Tab and enter desired laboratory order using a CPT code in the range of 80000.

For radiology ordering: create a Full Note Composer, navigate to either the SO or SP Tab

and enter desired radiology order using a CPT code in the code range of 70000.

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If someone other than the provider is entering prescriptions, laboratory orders, or

radiology orders they must be a Licensed Healthcare Professional. It is recommended to

have a copy of their license on file in case of an audit.

To mark a user as a Licensed Healthcare Professional, access the User option from the

System menu of List Editor, search for the user and select Modify.

From the Modify User window, select the Settings tab. Here you will check the box for

Licensed Healthcare Professional and then click the OK button.

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OBJECTIVE #4: ELECTRONIC PRESCRIBING

OBJECTIVE Allow provider an understanding of how to generate and transmit permissible prescriptions

electronically (eRx).

CONTEXT STAGE 1:

Providers in 2016 only, more than 40 percent of all permissible prescriptions written by

the EP are transmitted electronically using CEHRT.

STAGE 2: Generate and transmit permissible prescriptions electronically (eRx). More than 50

percent of all permissible prescriptions written by the EP are queried for a drug

formulary and transmitted electronically using CEHRT.

Please Note: This measure only applies to permissible medications; it does not apply to

controlled substances. Prescriptions which are faxed to a pharmacy using a fax service do not

meet requirements for this measure.

EXCLUSION Any provider who:

Writes fewer than 100 prescriptions during the EHR reporting period OR

Does not have a pharmacy within their organization and there are no pharmacies that

accept electronic prescriptions within 10 miles of the practice location at the start of the

reporting period.

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STEP BY STEP INSTRUCTIONS Initiate the download of drug formulary through the patient’s demographics window.

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View the patient formulary on the RX tab in the Full Note Composer.

From the RX tab search for and write a new RX or Refill an existing medication.

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In the SIG writer window make sure the Dosage, Form, Route, Frequency, Dose, Refills in

needed, Quantity and Unit of Measure (UOM) are filled out or the prescription will not

go successfully.

Make sure that the patients pharmacy pulls into the pharmacy field. If it does not, then

you need to select one before sending the prescription. It will then go electronically to

the pharmacy.

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OBJECTIVE #5: HEALTH INFORMATION EXCHANGE OBJECTIVE Allow provider to understand how to create a summary of care record for each referral order or

transition of care.

CONTEXT The EP who transitions their patient to another setting of care or provider of care or refers their

patient to another provider of care (1) uses CEHRT to create a summary of care record; and (2)

electronically transmits such summary to a receiving provider for more than 10 percent of

transitions of care and referrals.

EXCLUSION Any provider who transfers a patient to another setting or refers a patient to another provider

less than 100 times during the EHR reporting period may exclude from this measure.

STEP BY STEP INSTRUCTIONS First, the practice must add the providers Direct Mail address to the Referring Provider

list in Aprima®.

To access this list, go to List Editor > System > Provider > then select the check box

Include External Providers. *Please note- you must obtain the providers Direct Mail

address by contacting the provider directly.

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From the search window, find the provider whose Direct Mail address you would like to

add and then select Modify. To add the address, find the tab called Direct Message and

place the address in the To Address field and close the Provider window. The Direct Mail

address has been added.

GENERATING THE DIRECT SECURE MESSAGE Within the Full Note Composer, place a referral order by selecting the Referral Order

from the SO Tab then click on the blue procedure note box to left of order and complete

procedure note. Must enter Provider, Providers Role, Disclosure Reason, PPT Status, and

CDA Section.

If the provider is not sending the Direct Mail, please select Assign To and assign the

referral order message to a staff member who will complete the order.

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Once the provider completes their note, the Unified Summary window will appear. The

provider must then select the Formatting Model “C-CDA” then click OK.

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Next, the Send Documents window will appear. Pull in the sending providers Direct Mail

Address (From) and type a message in the Message field if desired. Once all necessary

fields are complete, select the Direct button at the bottom of the screen. The Direct Mail

Message will then be sent.

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If the provider will not be sending the Direct Mail but an office staff member will be,

have the provider select the referral using the SO Referral Order in the Full Note

Composer and complete the procedure box with the appropriate Assigned to.

Once the note is closed, have the staff member open the Referral Order Message. The

provider will not have the Unified Summary Window appear. *Please note- staff

member must have security for Direct Mail access. This is located in List Editor under

Provider > Clinical Delegate Security.

Open the Referral Order Message in your message center by clicking on the date and

time.

Next, associate the necessary fields such as “Provider’s Role”, “Role Active”, and

“Default Formatting Model”. Once this is complete, click the Generate Document icon at

the top of the message.

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From the Document Generation Window, complete the necessary fields by first selecting

“Related Patient Referral” then associate the “Visit Date”, and finally choose the

appropriate formatting model by selecting “Use Formatting Model” and find CCDA.

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The Send Document screen will appear. Pull in the sending providers Direct Mail Address

and type a message in the Message filter if desired. Press Direct, then your mail will then

be sent.

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RECEIVING THE DIRECT MAIL MESSAGE When a practice sends you a Direct Mail Message, it will appear in your Attachment

Approval message filter if the patient is already built in your database, or, it will appear

in Document Linking under the Direct Mail folder if the patient is not built in your

database. From the C-CDA, only the patient’s medication list, allergies, and past medical

history can be imported as discrete data.

From the Attachment Approval message, click the date and time to open the message.

You can then Approve Attachment or Reject Attachment. If you Reject Attachment, it will

be sent to the Reject Folder in Document Linking for re-attachment.

You can also import medication, allergies and problems from this message by clicking on

the Import buttons at the top of the CCD document. Once you click an Import button,

the Modify Import window appears. Here you can select the boxes to the left of the

items you wish to import, then select Add to HX at the top. This will pull the selected

items into the patient’s chart. Once all desired items are reviewed and imported,

complete the message to remove it from your inbox.

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To import patient information from Document Linking, click the Document Linking icon

from the Aprima® desktop then select the Direct Mail folder. *Please note- no message

is generated when a C-CDA is sent to Document Linking. Please have staff members

check this folder regularly.

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Drag the desired CCDA to the Document Linking window and attach to the desired

patient. *Please note- this patient may need to be built, this can be completed from the

Patient Name window in Document Linking.

Select the document Type “CCD for DataExchange Export”. Name the document per

practice desire.

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Once all fields are complete, click Apply to link the document and OK to close the

window. Proceed to Find Patient then click on Attachments to view linked C-CDA.

Click the document name to open the C-CDA. From here, you can import medications,

allergies and problems using the same method as above. Once all items have been

imported, click close to exit the C-CDA.

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VERIFYING DSM TRANSMISSION

In order to track Direct Mail transmissions, please go to Interface Data Details from the Aprima

desktop. Here, you will select the Logged From dates and select Search. A list of sent items will

appear, you can then filter the Partner by Direct Message. A successful status indicates the

Direct Mail was sent to Nitor.

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OBJECTIVE #6: PATIENT SPECIFIC EDUCATION

OBJECTIVE

Allow provider an understanding of how to attach appropriate education form to patient visit

note.

CONTEXT

Use clinically relevant information from Certified EHR Technology to identify patient-specific

education resources and provide those resources to the patient.

Patient-specific education resources identified by Certified EHR Technology are provided to

patients for more than 10 percent of all unique patients with office visits seen by the EP during

the EHR reporting period.

EXCLUSION

None


Within the Full Note Composer, access the Education Slider. Click Add located at the

bottom left corner > click Search to see available education forms > Select appropriate

education form and click OK. The education form has now been attached to the

patient’s visit.

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OBJECTIVE #7: MEDICATION RECONCILIATION

OBJECTIVE

Allow provider to understand how to reconcile medication history for patients.

CONTEXT

The EP who receives a patient from another setting of care or provider of care or believes an

encounter is relevant should perform medication reconciliation.

The EP who performs medication reconciliation for more than 50 percent of transitions of care

in which the patient is transitioned into the care of the EP.

EXCLUSION

Any provider who was not the recipient of any transitions of care during the EHR reporting

period.

Stage 1 providers who did not intend to select Stage 1 Medication Reconciliation menu objective

may exclude from this measure.


To report on this measure, you must identify the patient as transitioning by selecting the

“Transition Of Care” checkbox in Medication History category of the Hx tab of the Full

Note Composer or other patient visit note window as well as check the box next to the

Medication History category indicating that the Medication History was reviewed with

the patient.

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OBJECTIVE #8: PATIENT ELECTRONIC ACCESS

OBJECTIVE Allow the provider to understand how to provide electronic health information to patients.

CONTEXT Provide patients the ability to view online, download and transmit their health information

within four business days of the information being available to the EP.

Measure 1: More than 50 percent of all unique patients seen by the EP during the EHR

reporting period are provided timely (available to the patient within four business days

after the information is available to the EP) online access to their health information.

Measure 2: For more than 5 percent of patient’s seen by the EP during the EHR

reporting period (or their authorized representatives) view, download, or transmit to a

third party their health information.

EXCLUSION Stage 1 providers can claim an exclusion to the second measure as Stage 1 does not have an

equivalent measure.

STEP BY STEP INSTRUCTIONS Measure 1: In the demographic window, enter patient’s email address. Then go to the

Questionnaire tab and Create Web Account.

54

Measure 2: Provide patient user name and password for Patient Portal. Have patient log

in and view, download, or transmit Clinical Summary. The patient may also transmit a

CCDA to another provider.

55

Their Clinical Summary will the download. They can select the double arrow to choose

an option of Printing their Summary or Downloading it. When they are done, they can

select the Close button at the bottom.

56

OBJECTIVE #9: SECURE ELECTRONIC MESSAGING

OBJECTIVE Allow provider to understand secure messaging between provider and patient via Aprima® and

the Patient Portal.

CONTEXT Use secure electronic messaging to communicate with patients on relevant health information.

For at least 5 percent of patient’s seen by the EP during the reporting period, a secure message

was sent using the electronic secure messaging function of CEHRT to the patient or in response

to a message sent by the patient. The message must be sent by the provider for a patient seen

during the reporting period for an E&M visit.

EXCLUSION Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50

percent or more of his or her patient encounters in a county that does not have 50 percent or

more of its housing units with 4 Mbps broadband availability, according to the latest information

available from the FCC on the first day of the EHR reporting period.

An EP may claim exclusion for the measure if for an EHR reporting period in 2015 they were

scheduled to demonstrate Stage 1, which does not have an equivalent measure.

STEP BY STEP INSTRUCTIONS Provide patient user name and password to Patient Portal. The patient must have an

email address entered to be able to send them a message. The clinician then needs to

send the patient a message from their chart in Aprima®.

• To send the patient a message from their chart select the New drop-down menu

and select New Patient Portal or Email.

57

The New Message window will open. Select a Sub-Type for the message.

58

The Reason for the message will automatically populate. Then type the message in the

large box. Select the OK button when you are ready to send the message.

The provider can also respond to a message sent from a patient’s portal account for this

measure. Type the reply in the white box and then select the reply button. Once you are

finished with this select the complete button.

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OBJECTIVE #10: PUBLIC HEALTH AND CLINICAL DATA REGISTRY REPORTING

EXCLUSIONS If the EP qualifies for multiple exclusions and the remaining number of measures available to the

EP is less than 2 (for Stage 2), the EP can meet the objective by meeting the one remaining

measure available to them and claiming applicable exclusions.

If no measures remain available, the EP can meet the objective by claiming applicable exclusions

for all measures.

MEASURE 1: IMMUNIZATION REGISTRY REPORTING

OBJECTIVE Allow provider to understand how to send immunization information electronically to state

immunization registry.

CONTEXT The EP is in active engagement with a public health agency to submit immunization data.

EXCLUSION An EP may exclude from this measure if they do not administer any immunizations to any of the

populations for which data is collected by its jurisdiction's immunization registry or

immunization information system during the EHR reporting period.

An EP may exclude from this measure is they operate in a jurisdiction for which no immunization

registry or immunization information system is capable or declared readiness to receive

immunization data using the specific standards required to meet the CEHRT definition at the

start of the reporting period.

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STEP BY STEP INSTRUCTIONS Within the Full Note Composer or Order Note, select desired immunization to administer

through the SP Tab > save the note using the floppy disk icon > access the Vaccine

Administration Record icon and document administration accordingly. Upon completion

of note, vaccine gets sent electronically to the interfaced state registry.

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This measure requires screen shots for supporting documentation. The following is an

example of the suggested screen shots to support the measures.

• From the Desktop menu select Integration Data Detail. Fill in the Partner field to

say the name of your state immunization registry, Message Type to say the

specific immunization registry message, and the Message Status of Successful

and then select the search button. Click on the Partner link to open the New

Interface Data Detail window to take your screenshot.

MEASURE 1 SCREENSHOT

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MEASURE 2: SYNDROMIC SURVEILLANCE REPORTING

OBJECTIVE Allow provider to understand submission of syndromic surveillance data to public health agency.

CONTEXT The EP is in active engagement with a public health agency to submit syndromic surveillance

data.

EXCLUSION An EP meeting one or more of the following criteria may exclude from this measure:

Is in a category of providers from which ambulatory syndromic surveillance data is

collected by their jurisdiction's syndromic surveillance system;

Operates in a jurisdiction for which no public health agency is capable of receiving

electronic syndromic surveillance data from EPs in the specific standards required to

meet the CEHRT definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no public health agency has declared readiness to

receive syndromic surveillance data from EPs at the start of the EHR reporting period.

STEP BY STEP INSTRUCTIONS *Check with your state health department to determine if your state is capable of reporting this

measure. If they are capable, please contact your Account Manager for further instructions.

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MEASURE 3: SPECIALIZED REGISTRY REPORTING OBJECTIVE Allow provider to understand how to report to a specialized registry.

CONTEXT The EP is in active engagement to submit data to a specialized registry.

EXCLUSION Any EP meeting at least one of the following criteria may be excluded from the specialized

registry reporting measure if the EP:

Does not diagnose or directly treat any disease or condition associated with, or collect

relevant data that is collected by, a specialized registry in their jurisdiction during the

EHR reporting period;

Operates in a jurisdiction for which no specialized registry is capable of accepting

electronic registry transactions in the specific standards required to meet the CEHRT

definition at the start of the EHR reporting period; or

Operates in a jurisdiction where no specialized registry for which the EP is eligible has

declared readiness to receive electronic registry transactions at the beginning of the

EHR reporting period.

STEP BY STEP INSTRUCTIONS *Check with your specialty societies and your state health department to determine their

capability to meet this measure.

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CLINICAL QUALITY MEASURES

INTRODUCTION Each provider must perform six of the available clinical quality measures (CQMs). The six

selected measures must cover three of the six domains. Aprima® PRM 2015 is certified for 56

of the 58 CMS clinical quality measures. You must select measures for which the Aprima

application is certified.

The provider’s performance on the CQMs are not evaluated for Meaningful Use, they simply

need to report the percentage for each measure selected.

All clinical quality measures have a denominator and numerator patient population. The

denominator is the total qualifying patient population for the measure. The numerator is the

patient populations for whom you have provided the service specified for the measure.

Beginning in 2017, you must attest to six CQM’s that cover at least three of the six NQS

areas/domains.

DOMAINS

Patient and Family Engagement

Efficient Use of Healthcare Resources

Clinical Processes/Effectiveness

Patient Safety

Population and Health

Care Coordination

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CMS 2; NQF 0418; PQRS 134 PREVENTIVE CARE AND SCREENING: SCREENING FOR CLINICAL DEPRESSION AND FOLLOW-UP PLAN DOMAIN Population/Public Health

MEASURE Percentage of patients aged 12 years and older screened for clinical depression on the date of

the encounter using an age appropriate standardized depression screening tool AND if positive,

a follow-up plan is documented on the date of the positive screen.

EXCLUSIONS OR EXCEPTIONS Patient Reason(s): Patient refuses to participate.

Medical Reason(s): Patient is in an urgent or emergent situation where time is of the

essence and to delay treatment would jeopardize the patient’s health status.

Situations where the patient’s functional capacity or motivation to improve may impact

the accuracy of results of standardized depression assessment tools. For example:

certain court appointed cases or cases of delirium.

ENTERING DENOMINATOR DATA The patient must be 12 years and older at the beginning of the measurement period. The

patient must have at least one eligible visit during the measurement period.

ENTERING NUMERATOR DATA There are two numerators for this measure. The first numerator requires an appropriate

depression screening. To chart the screening, you must enter a procedure code that is

associated with a qualifying SNOMED code. You may enter the procedure code in either the SP

or the SO tab of Full Note Composer or other clinical note type window.

SNOMED CODES FOR THE SCREENING 10197000, 10997001, 29657007, 38756009, 45392008, 79094001, 90407005, 165171009,

165190001, 171207006, 225337009, 370803007, 428151000124107, 428161000124109,

428171000124102, 428181000124104

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The second numerator applies when the screening result is positive, and you diagnose the

patient. Enter the diagnosis with a qualifying ICD-9 or ICD-10 code or a diagnosis code

associated with a qualifying SNOMED code for depression in the Dx tab of Full Note Composer

or other clinical note type window.

ICD-9

290.13, 290.21, 290.43, 296.2, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.3,296.31,

296.32, 296.33, 296.34, 296.36, 296.82, 298.0, 300.4, 301.12, 309.0, 309.1,309.28, 311

ICD-10

F31.1, F31.11, F31.12, F31.13, F31.2, F31.73, F31.74, F31.9, F01.51, F03, F32.0, F32.1, F32.2,

F32.3, F32.4, F32.5, F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.42, F33.9, F34.1, F43.21, F43.23

SNOMED

162004, 832007, 1196001, 1499003, 2506003, 2618002, 3109008, 3530005, 4441000, 5703000,

9340000, 10875004, 10981006, 13313007, 13581000, 13746004, 14183003, 14495005,

15193003, 15639000, 16295005, 16506000, 17782008, 18818009, 19300006, 19527009,

19694002, 20250007, 20960007, 21900002, 22121000, 22407005, 25922000, 26203008,

26530004, 28475009, 28663008, 28884001, 29929003, 30520009, 30687003, 30935000,

31446002, 33078009, 33380008, 34315001, 35481005, 35489007, 35846004, 36170009,

36474008, 36583000, 36923009, 38368003, 38451003, 38694004, 39809009, 40379007,

40568001, 40926005, 41552001, 41832009, 41836007, 42925002, 43568002, 43769008,

45479006, 46229002, 48589009, 48937005, 49468007, 49512000, 51637008, 53049002,

53607008, 54761006, 55516002, 59617007, 61403008, 63249007, 63778009, 64731001,

65042007, 66344007, 66631006, 67711008, 68569003, 69392006, 70546001, 71294008,

71336009, 71984005, 73471000, 73867007, 74686005, 75084000, 75360000, 75752004,

75837004, 76441001, 77486005, 77911002, 78269000, 78640000, 78667006, 79298009,

79584002, 81319007, 81319007, 82998009, 83176005, 83225003, 84760002, 85080004,

85248005, 86058007, 87203005, 87512008, 87950005, 111485001, 191610000, 191611001,

191613003, 191616006, 191618007, 191620005, 191621009, 191623007, 191625000,

191627008, 191629006, 191630001, 191632009, 191634005, 191636007, 191638008,

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191639000, 191641004, 191643001, 191659001, 192080009, 192362008, 231444002,

231504006, 231542000, 268621008, 319768000, 320751009, 370143000, 371596008,

371599001, 371600003, 371604007, 430852001, 44205700

You must establish a follow up plan, which may include medication, an additional screening, or a

referral to another qualifying medical services provider. To chart the screening, you must enter

a procedure code that is associated with a qualifying SNOMED code. You may enter the in either

the SP or the SO tab of Full Note Composer or other clinical note type window.

SNOMED CODES FOR THE FOLLOW UP PLAN

5694008, 5694008, 88848003, 88848003, 91310009, 91310009, 372067001, 372067001,

385721005, 385721005, 385724002, 385724002, 385725001, 385725001, 385726000,

385726000, 385727009, 385727009, 385887004, 385887004, 385889001, 385889001,

385890005, 385890005, 401277000, 401277000, 410223002, 410223002, 410224008,

410224008, 410225009, 410225009, 410226005, 410226005, 410227001, 410227001,

410228006, 410228006, 410229003, 410229003, 410230008, 410230008, 410231007,

410231007, 410232000, 410232000, 410233005, 410233005, 410234004, 410234004,

425604002, 425604002, 439141002, 4391410

To use a referral as the follow-up plan, you must order the referral by entering a procedure code

that is associated with a qualifying SNOMED code.

SNOMED CODES FOR DEPRESSION REFERRAL

183524004, 183583007, 183851006, 183866009, 305922005, 306136006, 306137002,

306226009, 306227000, 306252003, 306291008, 306294000, 308459004, 308477009,

309627007, 390866009, 401174001, 429387009, 61801003, 14129001, 183524004,

183528001, 183583007, 183866009, 305922005, 306136006, 306137002, 306138007,

306204008, 306226009, 306227000, 306252003, 306294000, 308459004, 308477009,

390866009, 401174001, 408293001, 429387009, 61801003

To use medication as the follow-up plan, you must prescribe a qualifying medication as the follow

up plan. Write the prescription through the SIG Writer window, then print or submit electronically.

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CMS 22 PREVENTIVE CARE AND SCREENING: SCREENING FOR HIGH BLOOD PRESSURE AND FOLLOW-UP DOCUMENTED DOMAIN Population/Public Health

MEASURE Percentage of patients aged 18 years and older seen during the reporting period who were

screened for high blood pressure AND a recommended follow-up plan is documented based on

the current blood pressure (BP) reading as indicated.

EXCLUSIONS OR EXCEPTIONS Patient Reason(s): Patient refuses to participate.

OR

Medical Reason(s): Patient is in an urgent or emergent medical situation where time is

of the essence and to delay treatment would jeopardize the patient’s health status. This

may include but is not limited to severely elevated BP when immediate medical

treatment is indicated.

ENTERING DENOMINATOR DATA Patients must be 18 years old or older before the start of the measurement period. Patients do

not already have an active diagnosis of hypertension.

ENTERING NUMERATOR DATA Patients who were screened for high blood pressure AND a recommended follow-up plan is

documented as indicated if the blood pressure is pre-hypertensive or hypertensive.

To report on this measure, you must enter the patient’s blood pressure (both systolic and

diastolic values) in the Vitals tab of Full Note Composer or other clinical note type window. Use

the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation items

for these blood pressure fields are associated with the appropriate LOIN codes.

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The blood pressure measurement from the most recent visit is used to report on this measure.

When that visit contains more than one blood pressure measurement, then the measurement

with the lowest systolic and diastolic blood pressure is used.

If the patient’s blood pressure is between 120/80 and 140/90, then within one day of the visit,

you must either:

Order referral to another provider, or

Document a plan to retest the blood pressure within a year and document lifestyle

change recommendations that may include diet, exercise, weight loss, and alcohol

consumption.

If the patient’s blood pressure is 140/90 or greater, but has not been high in the year prior to

this visit, then within one day of the visit, you must either:

Order referral to another provider, or

Document a plan to retest the blood pressure within four weeks and document lifestyle


consumption.

If the patient’s blood pressure is 140/90 or greater, and has been high in the year prior to this

visit, then within one day of the visit, you must either:

Order referral to another provider, OR

Document a plan to retest the blood pressure within four weeks and document lifestyle


consumption, and either

• Write a prescription for medication, OR

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• Order a screening or test, such as a comprehensive metabolic panel or an

electrocardiogram. To chart a referral to another provider, you must order the

referral by entering a procedure code that is associated with a qualifying

SNOMED code. The system-defined Referral Order procedure code is associated

with SNOMED code 306253008. You may associate other procedure codes with

more specific qualifying SNOMED codes as needed. Enter the procedure code in

either the SP or the SO tab of Full Note Composer or other clinical note type

window.

SNOMED 134403003, 183516009, 183561008, 183856001, 306206005, 306253008, or 308470006

You may also create the referral from Patient/Provider Tracking. When you create the referral in

this way, you must create the referral within one day of the visit date and associate it with the

visit.

To chart that you plan to retest the blood pressure, you must one or more custom procedure

codes and associate them with a qualifying SNOMED code that indicates the timeframe for the

follow up test. Enter the procedure in the SP tab of Full Note Composer or other clinical note

type window. Please note that simply entering the referral in Referral Tracking or Patient

Provider Tracking will not count for this measure.

SNOMED codes for retest within 4 weeks

183617005, 183618000, 183619008,183620002, 183621003, 183622005, 183623000

SNOMED codes for retest within 1 year

61342007, 183617005, 183618000, 183619008, 183620002, 183621003, 183622005,

183623000, 183624006, 183625007, 183626008, 183627004, 183628009, 300042001

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For diet, exercise, weight loss, or alcohol consumption recommendations, counseling, or

education, you must chart an appropriate procedure. Select the desired procedure code in the

SP or SO tab of Full Note Composer or other clinical note type window. If the procedure code is

associated with an education form, such as for counseling, then selecting the education form

from the Education Form slider will add the procedure code to the SP tab.

ALCOHOL SNOMED 24165007, 38670004, 390857005, 408947007, 413473000, 417096006, 419822006, 431260004

DIET HCPCS G8417, S9452, S9470

DIET SNOMED 11816003, 14044002, 31002004, 40546006, 54123004, 61310001, 103699006, 169411000,

182922004, 182954008, 182955009, 182956005, 182960008, 183061003, 183065007,

183070000, 183071001, 226164007, 281085002, 284071006, 284352003, 304491008,

305849009, 306163007, 361231003, 370847001, 386464006, 386619000, 386620006,

410114009, 410171007, 410177006, 410270001, 413315001, 418995006, 424753004,

443288003

EXERCISE HCPCS GS9451

EXERCISE SNOMED 281090004, 304507003, 304549008, 386291006, 386292004, 386373004, 386463000,

410289001

LIFESTYLE SNOMED 313204009, 364706004, 39155009, 415510005, 443402002, 60134006

WEIGHT LOSS HCPCS S9449

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WEIGHT LOSS SNOMED 170795002, 266724001, 268523001, 275919002, 401003006, 408289007, 410200000

To use medication as part of the follow-up plan, you must prescribe a qualifying medication as

the follow up plan. Write the prescription through the SIG Writer window, and then either print

it or submit it electronically.

To chart a screening or test, you must enter a procedure code that is associated with a

qualifying SNOMED code. You may enter the in either the SP or the SO tab of Full Note

Composer or other clinical note type window.

CPT 80047, 80048, 80050, 80053, or 80069

SNOMED 2278000, 5540006, 8879006, 15373003, 18207002, 20501000, 27171005, 27260001, 28317006,

36793009, 59573005, 60218003, 68994006, 70901006, 71878006, 73668004, 82912006,

88480006, 102811001, 105362001,113075003, 127800008, 164846002, 167181009,

167182002, 167183007, 167222005, 167470001, 251838003, 259295006, 271000000,

271075006, 271236005, 271240001, 290127004, 301119002, 301120008, 304048005,

312468003, 312472004, 313502007, 313936008, 365616005, 365618006, 365756002,

365757006, 365760004, 390963002, 390964008, 420155008, 444164000, 444275009,

444336003

TROUBLESHOOTING This measure looks at both the systolic and diastolic measures. Both the patient’s systolic

measure and diastolic measure must be equal to or greater than the criteria to move to the next

level. If either measure is less than the criteria, then the patient remains in the lower level

group.

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CMS 50; NQF NA; PQRS 374 CLOSING THE REFERRAL LOOP: RECEIPT OF SPECIALIST REPORT

DOMAIN Care Coordination

MEASURE Percentage of patients with referrals, regardless of age, for which the referring provider receives

a report from the provider to whom the patient was referred.

EXCLUSIONS OR EXCEPTIONS None

ENTERING DENOMINATOR DATA The patient must have at least one visit during the measurement period. You must order the

referral. This can be done in either of the following ways:

In the visit note, enter a procedure code that is associated with a qualifying SNOMED

code.

Create the referral from Patient/Provider Tracking. When you create the referral in this

way, you must associate the referral with the visit.

The system-defined Referral Order procedure code is associated with SNOMED code

306253008. You may associate other procedure codes with more specific qualifying SNOMED

codes as needed. Enter the procedure code in either the SP or the SO tab of Full Note Composer

or other clinical note type window.

REFERRAL SNOMED 54395008, 103697008,103699006,183515008,183517000,183528001, 183529009,

183530004, 183541002, 183555005, 183557002, 183561008,183567007, 183569005,

183591003, 183878008, 183879000, 183880002, 183881003,183882005, 183884006,

183885007, 183886008, 183887004, 183888009, 183889001,183890005, 183891009,

183892002, 183893007, 183894001, 183895000, 183896004,183897008, 183899006,

183900001, 183901002, 183902009, 83903004, 83904005, 183905006, 183906007,

183907003, 183908008, 183909000, 183910005, 183911009,183913007, 183914001,

183915000, 183916004, 266747000, 274410002, 06160005,306161009, 306162002,

306253008, 306254002, 306255001, 306256000, 306257009,306258004, 306259007,

306260002, 306261003, 306262005, 306263000, 306264006,306265007, 306266008,

306267004, 306268009, 306269001, 306270000, 306271001,306272008, 306273003,

306274009, 306275005, 306276006, 306277002, 306278007, 306279004, 306280001,

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306281002, 306282009, 306284005, 306285006, 306286007, 30687003, 306288008,

306289000, 306290009, 306291008, 306293006, 306294000, 306295004, 306296003,

306297007, 306298002, 306299005, 306300002, 306301003, 306302005, 306303000,

306304006, 306305007, 306306008, 306307004, 306308009, 306309001, 306310006,

306311005, 306312003, 306313008, 306314002, 306315001, 306316000, 306317009,

306318004, 306320001, 306338003, 306351008, 306352001, 306353006, 306354000,

306355004, 306356003, 306357007, 306358002, 306359005, 306360000, 306361001,

306736002, 307063001, 307777008, 308447003, 308449000, 308450000, 308451001,

308452008, 308453003, 308465004, 308469005, 308470006, 308471005, 308472003,

308473008, 308474002, 308475001, 308476000, 308477009, 308478004, 308479007,

308480005, 308481009, 308482002, 308483007, 308484001, 308485000, 309046007,

309627007, 309629005, 310515004, 312487009, 312488004, 390807002, 406158007,

406159004, 408285001, 415277000, 416116000, 425971006, 429365000, 428441000124100,

428451000124103, 428461000124101, 428471000124108, 428481000124106,

428491000124109, 428541000124104

ENTERING NUMERATOR DATA When you receive the consultation report from the referred to physician or medical service

provider, you must attach the consultation report to the referral record using Document Linking.

You must use the attachment type Consultation Report when attaching the report to the

referral. The Consultation Report attachment type has the SNOMED code 371530004 in the ID

field.

Please note that referral entries with a status of Historical Reference or of Relationship are not

included.

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CMS 52; NQF 0405; PQRS 160 HIV/AIDS: PNEUMOCYSTIS JIROVECI PNEUMONIA (PCP) PROPHYLAXIS

DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were

prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis.

EXCLUSIONS OR EXCEPTIONS Numerator 1: Patient did not receive PCP prophylaxis because there was a CD4 count

above 200 cells/mm3 during the 3 months after a CD4 count below 200 cells/mm3

Numerator 2: Patient did not receive PCP prophylaxis because there was a CD4 count

above 500 cells/mm3 or CD4 percentage above 15 percent during the three months

after a CD4 count below 500 cells/mm3 or CD4 percentage below 15 percent.

Numerator 3: None

ENTERING DENOMINATOR DATA Denominator 1: All patients aged 6 years and older with a diagnosis of HIV/AIDS and a

CD4 count below 200 cells/mm3 who had at least two visits during the measurement

year, with at least 90 days in between each visit. The test must be performed less than 9

months after the start of the measurement period.

Denominator 2: All patients aged 1-5 years of age with a diagnosis of HIV/AIDS and a

CD4 count below 500 cells/mm3 or a CD4 percentage below 15 percent who had at least

two visits during the measurement year, with at least 90 days in between each visit. The

test must be performed less than 9 months after the start of the measurement period.

Denominator 3: All patients aged 6 weeks to 12 months with a diagnosis of HIV who had

at least two visits during the measurement year, with at least 90 days in between each

visit.

To include a patient in the denominator, you must enter a qualifying diagnosis code or a

diagnosis code associated with a qualifying SNOMED code in the Dx tab of Full Note Composer

or other clinical note type window or enter a problem associated with a qualifying SNOMED

code in the problem history category in either the Hx tab of Full Note Composer or the History

window.

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ICD-9 042, V08

ICD-10 B20, Z21

SNOMED 5810003, 40780007, 48794007, 52079000, 62246005, 62479008, 77070006, 79019005,

86406008, 87117006, 91947003, 111880001, 186706006, 186707002, 186708007, 186709004,

186717007, 186718002, 186719005, 186721000, 186723002, 186725009, 186726005,

230180003, 230201009, 230598008, 235009000, 235726002, 240103002, 276666007,

315019000, 359791000, 397763006, 398329009, 402915006, 402916007

To report on this measure, you must order or perform a CD4+Count or CD4+Percentage test,

and then either enter the test results or receive them through an interface and give them a

status of Resulted or Approved. Test results not received through an interface must be entered

as discrete, quantifiable data. Enter the results in the Patients Results window using a lab

template enabling you to enter the test result value. Results stored in the database as text notes

or image file cannot be used for reporting.

You must associate a LOINC code to the CD4+Count or CD4+Percentagetest item on each lab

template for both manually entered and electronic results.

CD4+Count LOINC: 24467-3, 32515-9, 32532-4, 40898-9, 63450-1

CD4+Percentage LOINC: 17822-8, 32516-7, 32533-2, 40623-1, 43970-3, 51300-2, 8123-2

ENTERING NUMERATOR DATA

Numerator 1: Patients who were prescribed pneumocystis jiroveci pneumonia (PCP)

prophylaxis within 3 months of CD4 count below 200 cells/mm3.

Numerator 2: Patients who were prescribed pneumocystic jiroveci pneumonia (PCP)

prophylaxis within 3 months of CD4 count below 500 cells/ mm3 or a CD4 percentage

below 15%.

Numerator 3: Patients who were prescribed Pneumocystic jiroveci pneumonia (PCP)

prophylaxis at the time of diagnosis of HIV.

77

To report on this measure, you must write a prescription for a Pneumocystic jiroveci pneumonia

(PCP) prophylaxis medication through the SIG Writer window and either print it or submit it

electronically through the Surescripts pharmacy clearinghouse. The prescription counts for the

rendering provider on the visit note, even if another provider enters and submits the

prescription.

For numerators 1 and 2, you must write the prescription within 3 months of performing the CD4

test that had results qualifying for the numerator.

For numerator 3, you must enter the diagnosis of HIV and the prescription in the same visit

note.

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CMS 56; NQF NA; PQRS 376 FUNCTIONAL STATUS ASSESSMENT FOR HIP REPLACEMENT DOMAIN Patient and Family Engagement

MEASURE Percentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who

completed baseline and follow-up (patient-reported) functional status assessments.

EXCLUSIONS OR EXCEPTIONS Patients with multiple trauma at the time of the total hip arthroplasty or patients with severe

cognitive impairment.

ENTERING DENOMINATOR DATA Adults aged 18 and older with a primary total hip arthroplasty (THA) and who had an outpatient

encounter not more than 180 days prior to procedure, and at least 60 days and not more than

180 days after THA procedure.

You must enter a qualifying procedure code or a procedure code associated with a qualifying

SNOMED code for the hip replacement in the surgical history category in the Hx tab of Full Note

Composer or the Patient History window.

HCPCS S2118

CPT 27130

SNOMED 15163009,19954002,33788003, 52734007, 53081006, 55423004, 57589001, 76915002,

179294005, 179304004, 179305003, 265157000, 265160007, 314489006, 314491003,

425443008, 426618001, 426904006, 427728006, 429156003, 443435007

Please note that the system defined hip surgery question in the surgical history does not count

for this measure. This is because that entry may be for any hip surgery; it is not specifically total

hip arthroplasty.

79

ENTERING NUMERATOR DATA Patients with patient reported functional status assessment results (e.g., VR- 12, VR-36,

PROMIS-10- Global Health, PROMIS-29, HOOS) not more than 180 days prior to the primary THA

procedure, and at least 60 days and not more than 180 days after the THA procedure.

To report on this measure, you must have set up an observation item for the score of each

assessment that you use, and put these observation items in an observation template. The

observation item for each assessment’s score must include the appropriate LOINC code for the

functional status assessment.

You must also have a clinical note type defined to include the Observation tab so that you can

use the observation template to chart the assessment. None of the system-defined clinical note

type windows (such as Full Note Composer) include the Observation tab. So, you must use a

custom clinical note type window to chart patient visit notes that will include a functional status

assessment.

Enter the score of the functional status assessment in the observation template on the

Observation tab.

Please note that entries in the Cognitive and Functional Assessment history categories do not

count for this measure.

ACTIVITIES OF DAILY LIVING LOINC CODE 72095-3

HOOS LOINC CODES 72094-6, 72095-3, 72096-1

PROMIS-10 LOINC CODES 71969-0, 71970-8, 71971-6, 71972-4

PROMIS-29 LOINC CODES 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9, 71961-7, 71962-5, 71963-3, 71964-1,

71965-8, 71966-6, 71967-4, 71968-2,71970-8

80

VR12 LOINC CODES 72009-4, 72010-2, 72011-0, 72012-8, 72013-6, 72014-4, 72015-1, 72016-9, 72017-7, 72018-5,

72019-3, 72020-1, 72021-9, 72022-7, 72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4

VR-36 LOINC CODES 71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3,

719831, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2,

71993-0, 719948, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9,

72003-7, 72004-5, 720052, 72006-0, 72007-8, 72008-6

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CMS 65; NQF NA; PQRS 373 HYPERTENSION: IMPROVEMENT IN BLOOD MEASURE This measure requires a reporting period is greater than 6 months. You cannot use this measure

if your reporting period is six months or less. Percentage of patients aged 18-85 years of age

with a diagnosis of hypertension whose blood pressure improved during the measurement

period.

DOMAIN Clinical Process/Effectiveness

EXCLUSIONS OR EXCEPTIONS Exclude from the denominator all patients with evidence of end-stage renal disease (ESRD) on or

prior to December 31 of the measurement year. Documentation of dialysis or renal transplant

also meets the criteria for evidence of ESRD.

Exclude from the denominator all patients with a diagnosis of pregnancy during the

measurement year.

ENTERING DENOMINATOR DATA All patients aged 18-85 years of age, who had at least one outpatient visit in the first 6 months

of the measurement year, who have a diagnosis of hypertension documented during that

outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit.

Enter the hypertension diagnosis with a qualifying diagnosis code or diagnosis code associated

with a SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or

enter a problem associated with a qualifying SNOMED code in the problem history category in

the Hx tab of Full Note Composer or the Patient History window.

82

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, 405.01, 405.09, 405.11, 405.19, 405.91, 405.99

ICD-10 I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I15.1, I15.2, I15.8, I15.9

SNOMED 193003, 1201005, 10725009, 14973001, 19769006, 23130000, 28119000, 31992008, 32916005,

38481006, 39018007, 46481004, 48146000, 49220004, 50490005, 52698002, 56218007,

57684003, 59621000, 59720008, 59997006, 62240004, 62275004, 65443008, 65518004,

66610008, 70272006, 73410007, 74451002, 78544004, 78975002, 81363003, 84094009,

86234004, 89242004, 90493000, 111438007, 123799005, 123800009, 169465000, 194774006,

194783001, 194785008, 194788005, 194791005, 276789009, 371125006, 397748008,

427889009, 428575007, 429198000, 429457004

To report on this measure, you must enter the patient’s blood pressure in the Vitals tab of Full

Note Composer or other clinical note type window. You must enter both systolic and diastolic

values, but this measure is only concerned with the systolic entry.



with the lowest systolic and diastolic blood pressure is used.

Please note that if the patient has a visit in the first six months of the reporting period and their

blood pressure is not high at that time and they do not have a diagnosis or problem of

hypertension, then the patient will not be counted for this measure even if the patient’s blood

press is high in a visit in during the last six months of the year.

83

ENTERING NUMERATOR DATA Patients whose follow-up systolic blood pressure is at least 10 mmHg less than their baseline

blood pressure or is adequately controlled (systolic blood pressure is less than 140 mmHg).

If a follow-up blood pressure reading is not recorded during the measurement year, the

patient’s blood pressure is assumed “not improved.”

To report on this measure, the patient must have a second visit that is at least six months after

the first visit and that is in the reporting period. The visit must include a blood pressure reading.

Enter the patient’s blood pressure in the Vitals tab of Full Note Composer or other clinical note

type window. You must enter both systolic and diastolic values, but this measure is only

concerned with the systolic entry.

Use the system-defined blood pressure fields (Blood Pressure 1, 2, 3, or 4). These observation

items for these blood pressure fields are associated with the appropriate LOINC codes.



with the lowest systolic and diastolic blood pressure is use.

84

CMS 66; NQF NA; PQRS 375 FUNCTIONAL STATUS ASSESSMENT FOR KNEE REPLACEMENT

DOMAIN Patient and Family Engagement

MEASURE Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who

completed baseline and follow-up (patient-reported) functional status assessments.

EXCLUSIONS OR EXCEPTIONS Patients with multiple traumas at the time of the total knee arthroplasty or patients with severe

cognitive impairment.

ENTERING DENOMINATOR DATA Adults, aged 18 and older, with a primary total knee arthroplasty (TKA) and who had an

outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not

more than 180 days after TKA procedure.

You must enter a qualifying procedure code or a procedure code associated with a qualifying

SNOMED code for the knee replacement in the surgical history category in the Hx tab of Full

Note Composer or the Patient History window.

CPT 27447

SNOMED 179344006, 179345007, 179351002, 179352009, 265170009, 265172001, 392237008,

430698003, 443681002, 443682009

ENTERING NUMERATOR DATA Patients with patient reported functional status assessment results (e.g., VR- 12, VR-36,

PROMIS-10 Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA

procedure, and at least 60 days and not more than 180 days after the TKA procedure.

85









assessment.


Observation tab.



ACTIVITIES OF DAILY LIVING LOINC CODE 72100-1

KOOS LOINC CODES 72102-7, 72099-5, 72101-9

PROMIS-10 LOINC CODES 71969-0, 71970-8, 71971-6, 71972-4

PROMIS-29 LOINC CODES 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9, 71961-7, 71962-5, 71963-3, 71964-1,

71965-8, 71966-6, 71967-4, 71968-2, 71970-8

VR12 LOINC CODES 72009-4, 72010-2, 72011-0, 72012-8, 72013-6, 72014-4, 72015-1, 72016-9, 72017-7, 72018-5,

72019-3, 72020-1, 72021-9, 72022-7, 72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4

86

VR-36 LOINC CODES 71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3,

719831, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2,

71993-0, 719948, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9,

72003-7, 72004-5, 72005-2, 72006-0, 72007

87

CMS 68; NQF 0419; PQRS 130 DOCUMENTATION OF CURRENT MEDICATION IN THE MEDICAL RECORD

DOMAIN Patient Safety

MEASURE Percentage of specified visits for patients aged 18 years and older for which the eligible

professional attests to documenting a list of current medications to the best of his/her

knowledge and ability. This list must include ALL prescriptions, over-the-counters, herbals, and

vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name,

dosage, frequency, and route of administration.


ENTERING DENOMINATOR DATA The patient must be 18 years old or older at the beginning before the start of the measurement

period.

ENTERING NUMERATOR DATA To report on this measure, you must either:

Select the checkbox for the Medication History category in the Hx tab of Full Note

Composer or other clinical note type to indicate that you have reviewed the medication

list, or

Create a custom defined procedure code for documenting a list of the patient’s current

medications. This procedure code must be associated to SNOMED code

428191000124101. You must then include this custom procedure code in visit notes for

all patient visits during which you document a list of current medications. You may want

to include your custom-defined procedure code in your SP charge ticket so that it is easy

to select when charting visit notes.

88

CMS 69; NQF 0421; PQRS 128 PREVENTIVE CARE AND SCREENING: BODY MASS INDEX (BMI) SCREENING AND FOLLOW-UP DOMAIN Population/Public Health

MEASURE Percentage of patients aged 18 years and older with an encounter during the reporting period

with a documented calculated BMI during the encounter or during the previous six months, AND

when the BMI is outside of normal parameters, follow-up is documented during the encounter

or during the previous six months of the encounter with the BMI outside of normal parameters.

Normal parameters for patients age 65 years and older is a BMI between ≥23 and <30. Normal

parameters for patients age 18 years to 64 years is a BMI between ≥18.5 and <25.

Denominator 1: All patients aged 65 years and older

Numerator 1: Patients with BMI calculated within the past six months or during the

current visit and a follow-up plan documented if the BMI is outside of parameters.

• Numerator Inclusions: Population Stratification 1: (BMI < 30 kg/m2 and 23

kg/m2)

Denominator 2: All patients aged 18 through 64 years.

• Denominator Inclusions: Population Stratification 2: (Patients aged 18-64)

Numerator 2: Patients with BMI calculated within the past six months or during the

current visit and a follow-up plan documented if the BMI is outside of parameters.

• Numerator Inclusions: Population Stratification 2: (BMI < 25 kg/m2 and 18.5

kg/m2)

EXCLUSIONS OR EXCEPTIONS Patients who are pregnant.

ENTERING DENOMINATOR DATA For denominator 1, the patient must be 65 years of age or older before the beginning of the

measurement period. The patient must have at least one eligible encounter during the

measurement period.

89

For denominator 2, the patient must be between 18 and 64 years old before the beginning of

the measurement period.

For both denominators, the patient must have at least one eligible encounter during the

measurement period. Eligible encounters do not include encounters where the patient is

receiving palliative care, refuses BMI measurement, the patient is in an urgent or emergent

medical situation where time is of the essence and to delay treatment would jeopardize the

patient’s health status, or there is any other reason documented in the medical record by the

provider explaining why BMI measurement was not appropriate.

ENTERING NUMERATOR DATA To report on this measure, you must enter the patient’s height and weight in the Vitals tab of

the patient visit note window. The BMI is calculated automatically from the height and weight

entries, and then displayed on the Vitals tab and charted in the visit note. The application

determines the appropriate LOINC code to associate with the BMI based on the patient’s age.

If there is a medical reason for not calculating the BMI, then you must enter one of the following

HCPCS procedure codes and enter an appropriate negation reason on that procedure.

HCPCS FOR BMI G8938, G8421, G8417, G8418, G8419, G8420, G8422, G8938

If the BMI is out of the established normal range, then you must establish a follow up plan,

which may include medication, procedures, counseling, or a referral to another qualifying

medical services provider.

To document the follow-up plan using a procedure, counseling, or referral, use a procedure

code that is associated with a qualifying SNOMED code. You may enter the procedure code in

either the SP or the SO tab of Full Note Composer or other clinical note type window. If you are

using an ICD-9 procedure code, enter it on the Dx tab of Full Note Composer or other clinical

note type window.

90

If the procedure code you want has been associated with an education form, such as for

counseling, then selecting the education form from the Education Form slider will add the

procedure code to the SP tab.

The education form assigned to the patient must be associated with a patient communication

type of Overweight or Underweight. Please note that since only one patient communication

type can be associated with an education form, you must have separate forms for these

conditions. If you use an education form on a general topic, such as nutrition, for both

underweight and overweight, then you must have two copies of education form in your

database.

Above Normal Follow Up

CPT 43644, 43645, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848,

97804, 98960, 99078

HCPCS G8417, S9449, S9451, S9452, S9470

ICD-9 V65.3, V65.41

SNOMED 304549008, 307818003, 361231003, 370847001, 386291006, 386292004, 386373004,

386463000, 386464006, 401003006, 410177006, 413315001, 418995006, 424753004,

443288003

Above Normal Referral

SNOMED 103698003, 103699006, 183515008, 183524004, 183583007, 185359002, 305922005,

306136006, 306163007, 306164001, 306165000, 306166004, 306167008, 306168003,

91

306226009, 306227000, 306252003, 306344004, 306353006, 306354000, 308459004,

308470006, 308477009, 390864007, 390866009, 390893007, 408289007, 410160006,

416790000, 424203006, 91251008

Below Normal Follow Up

HCPCS G8418, S9449, S9452, S9470

ICD-9 V65.3

SNOMED 386464006, 404923009, 410177006, 413315001, 418995006, 424753004, 429095004,

443288003

Below Normal Referral

SNOMED 91251008, 103698003, 103699006, 183515008, 183524004, 183583007, 185359002,

305922005, 306136006, 306163007, 306164001, 306165000, 306166004, 306167008,

306168003, 306226009, 306227000, 306252003, 306344004, 306353006, 306354000,

308459004, 308470006, 308477009, 390866009, 390893007, 408289007, 410160006,

416790000, 424203006

To document the follow-up plan using a medication, write a prescription for an appropriate

medication using the SIG Writer window. Then print or electronically submit the prescription.

92

CMS 74; NQF NA; PQRS 379 PRIMARY CARIES PREVENTION INTERVENTION AS OFFERED BY PRIMARY CARE PROVIDERS, INCLUDING DENTISTS DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of children, age 0-20 years, who received a fluoride varnish application during the

measurement period.


ENTERING DENOMINATOR DATA Children, age 0-20 years, with a visit during the measurement period.

ENTERING NUMERATOR DATA Children who receive a fluoride varnish application.

To report on this measure, you must enter a qualifying procedure code or a procedure code

associated with a qualifying SNOMED code for a fluoride varnish application.

HCPCS D1203, D1206

SNOMED 35889000, 70468009, 234723000, 313042009

93

CMS 75; NQF NA; PQRS 378 CHILDREN WHO HAVE DENTAL DECAY OR CAVITIES DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of children, age 0 through 20 years, who have had tooth decay or cavities during the

measurement period.


ENTERING DENOMINATOR DATA The patient must be 0 through 20 years old, and must have at least one visit during the

measurement period.

ENTERING NUMERATOR DATA To report on this measure, you must enter the diagnosis code in the Dx tab of Full Note


ICD-9 CODES 521.00, 521.01, 521.02, 521.03, 521.04, 521.05, 521.06, 521.07, 521.08, 521.09

ICD-10 K02.3, K02.51, K02.52, K02.53, K02.61, K02.62, K02.63, K02.7, K02.9

94

CMS 82; NQF 1401; PQRS 372 MATERNAL DEPRESSION SCREENING

DOMAIN Population/Public Health

MEASURE The percentage of children who turned 6 months of age during the measurement year, who had

a face-to-face visit between the clinician and the child during child’s first 6 months, and who had

a maternal depression screening for the mother at least once between 0 and 6 months of life.


ENTERING DENOMINATOR DATA Children with a visit who turned 6 months of age in the measurement period.

ENTERING NUMERATOR DATA Children with documentation of maternal screening or treatment for postpartum depression for

the mother.

Enter the mother’s screening using a procedure code associated with the SNOMED code

428221000124108 in the SP tab of Full Note Composer or other clinical note type.

Enter the mother’s treatment using a procedure code associated with the SNOMED code

428231000124106 in the SP tab of Full Note Composer or other clinical note type.

If you use the same procedure when screening or treating patients, then you may need to

associate the procedure with two different SNOMED codes, one that indicates patient screening

or treatment and one that indicates maternal screening or treatment. Or you can create custom

procedure codes for the maternal screening and treatment and associate those custom

procedure codes with the appropriate SNOMED codes.

95

CMS 90; NQF NA; PQRS 377 FUNCTIONAL STATUS ASSESSMENT FOR COMPLEX CHRONIC CONDITIONS DOMAIN Patient and Family Engagement

MEASURE Percentage of patients aged 65 years and older with heart failure who completed initial and

follow-up patient-reported functional status assessments.

EXCLUSIONS OR EXCEPTIONS Patients with severe cognitive impairment or patients with an active diagnosis of cancer.

ENTERING DENOMINATOR DATA The patient must be 65 years old or older. The patient must have an active diagnosis of heart

failure.

ICD-9 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20,

428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9

ICD-10 I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22, I50.23, I50.30, I50.31, I50.32, I50.33, I50.40,

I50.41, I50.42, I50.43, I50.9

SNOMED 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007,

43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003,

77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007,

92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005,

195112003, 195114002, 206586007, 233924009, 277639002, 314206003, 359617009,

96

359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001,

426263006, 426611007, 441481004, 441530006

This measure requires at least two patient visits. The first visit must be within the first 185 days

of the measurement period (January 1 through July 4). The second visit must be within the

assessment period and must be at least 30 days after and not more than 180 days after the first

visit. The assessment must be done during or within two weeks prior to each of these two visits.

Because of the timing constraints on the first and second visit, this measure is not optimal if

your reporting period is 90 days.

ENTERING NUMERATOR DATA To report on this measure, you must have set up an observation item for the score of each

assessment that you use and put these observation items in an observation template. The



LOINC CODES 71938-5, 71940-1, 71955-9, 71956-7, 71957-5, 71958-3, 71959-1, 71960-9, 71961-7, 71962-5,

71963-3, 71964-1, 71965-8, 71966-6, 71967-4, 71968-2, 71969-0, 71970-8, 71971-6, 71972-4,

71973-2, 71974-0, 71975-7, 71976-5, 71977-3, 71978-1, 71979-9, 71980-7, 71981-5, 71982-3,

71983-1, 71984-9, 71985-6, 71986-4, 71987-2, 71988-0, 71989-8, 71990-6, 71991-4, 71992-2,

71993-0, 71994-8, 71995-5, 71996-3, 71997-1, 71998-9, 71999-7, 72000-3, 72001-1, 72002-9,

72003-7, 72004-5, 72005-2, 72006-0, 72007-8, 72008-6, 72009-4, 72010-2, 72011-0, 72012-8,

72013-6, 72014-4, 72015-1, 72016-9, 72017-7, 72018-5, 72019-3, 72020-1, 72021-9, 72022-7,

72023-5, 72024-3, 72025-0, 72026-8, 72027-6, 72028-4, 72188-6, 72189-4, 72190-2, 72191-0,

72192-8, 72193-6, 72194-4, 72195-1, 72196-9





assessment for a complex chronic condition.

97


Observation tab.



98

CMS 117; NQF 0038; PQRS 240 CHILDHOOD IMMUNIZATION STATUS DOMAIN Population/Public Health

MEASURE Percentage of children two years of age who had four diphtheria, tetanus and acellular pertussis

(DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B

(HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one

hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second

birthday.

Denominator: All patients who turn two years of age during the measurement period.

Numerator: Patients who received four diphtheria, tetanus and acellular pertussis

(DTaP); three polio (IPV); one measles, mumps, rubella (MMR); three 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.


ENTERING DENOMINATOR DATA The patient must turn two years old during the measurement period. The patient must have at

least one visit during the measurement period.

ENTERING NUMERATOR DATA To report on this measure, document the administration of the each of the required vaccines.

To document an immunization, enter the appropriate CPT code for that immunization and enter

the vaccination details in the Vaccine Administration Record. This can be done in the patient

visit note or in the Patient History, Immunization History category. The vaccine type for the

vaccination must be associated with the appropriate CVX code.

All vaccinations must be given according to the recommended schedule for the vaccine. The first

DTaP, HIB, IPV, PCV vaccinations must be given when the patient is 42 days old or older.

99

Vaccinations administered prior to 42 days are not counted. Patient refusal is not considered

valid reporting for this measure and will be in denominator.

100

CMS 122; NQF 0059; PQRS 1 DIABETES: HEMOGLOBIN A1C POOR CONTROL DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during


EXCLUSIONS OR EXCEPTIONS Patients with a diagnosis of gestational diabetes during the measurement period.

ENTERING DENOMINATOR DATA Patients 18-75 years of age with diabetes with a visit during the measurement period. Enter the

diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED

code in the Dx tab of Full Note Composer or other clinical note type window or enter a problem

associated with a qualifying SNOMED code in the problem history category in the Hx tab of Full


ICD-9 250.00, 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, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60,

250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90,

250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10 E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339,

E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44,

E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630,

E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29,

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610,

101

E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65,

E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112,

O24.113, O24.119, O24.12, O24.13

SNOMED 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009,

190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001,

199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004,

314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008,

359642000, 359939009

ENTERING NUMERATOR DATA Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%.

Patients who do not have an HbA1c level entered during the measurement period are also

included in the numerator. Please note that for this measure, a low numerator is the desired

outcome.

To report on this measure, you must order or perform an A1c test and then either enter the test

results or receive them through an interface. You must associate the results with the order and

give them a status of Resulted or Approved.

The A1c test results must be entered as discrete, quantifiable data. Enter the results in the

Patients Results window using a lab template enabling you to enter the HGB A1c value. Results

stored in the database as text notes or an image file cannot be used for reporting.

You must associate a LOINC code to the A1C test item on each lab template for both manually

entered and electronic results. LOINC codes for this result are 17855-8, 17856-6, 4548-4.

102

CMS 123; NQF 0056; PQRS 163 DIABETES FOOT EXAM DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18-75 years of age with diabetes who had a foot exam during the

measurement period.


Patients who have had both feet amputated.

ENTERING DENOMINATOR DATA Patients 18-75 years of age with diabetes with a visit during the measurement period.

Enter the diabetes diagnosis with a qualifying diagnosis code or diagnosis code associated with a

SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or enter a

problem associated with a qualifying SNOMED code in the problem history category in the Hx

tab of Full Note Composer or the Patient History window. This diagnosis or problem must be

active.

ICD-9 250.00, 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, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60,

250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90,

250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10 E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339,

E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44,

E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630,

E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29,

103

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610,

E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65,

E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112,

O24.113, O24.119, O24.12, O24.13

SNOMED 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002,76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009,

190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001,

199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004,

314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008,

359642000, 359939009

ENTERING NUMERATOR DATA Patients who received a foot exam during the measurement period. The foot exam must include

a visual inspection and either a sensory exam or a pulse exam.

To report on this measure, you must order or perform a visual foot exam, a sensory exam, and a

pulse exam. You may chart the exams using procedure codes that are associated with the

SNOMED codes for the exams.

PULSE EXAM 91161007

SENSORY EXAM 134388005

VISUAL EXAM 401191002

The procedure codes 2028-F and G9226 are associated with the proper SNOMED codes and

configured to report as a complete foot exam (visual, sensory, and pulse).

104

CMS 124; NQF 0032; PQRS 309 CERVICAL CANCER SCREENING DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of women 21-64 years of age, who received one or more Pap tests to screen for

cervical cancer.

EXCLUSIONS OR EXCEPTIONS Women who had a hysterectomy with no residual cervix.

ENTERING DENOMINATOR DATA Women 24-64 years of age with a visit during the measurement period.

ENTERING NUMERATOR DATA Women with one or more Pap tests during the measurement period or the two years prior to

the measurement period. To report on this measure, you must order or perform a Pap test, and

then either enter the test results or receive them through an interface and give them a status of

Resulted or Approved. To chart the Pap test, to chart the screening, you must enter a procedure

code that is associated with a qualifying LOINC code. You may enter the procedure in either the

SP or the SO tab of Full Note Composer or other clinical note type window.

Pap test results not received through an interface must be entered as discrete, quantifiable

data. Enter the results in the Patients Results window using a lab template enabling you to enter

the test result value. Results stored in the database as text notes or image file cannot be used

for reporting. You must associate a LOINC code to the Chlamydia test item on each lab template

for both manually entered and electronic results.

LOINC CODES 10524-7, 18500-9, 19762-4, 19764-0, 19765-7, 19766-5, 19774-9, 33717-0, 47527-7, 47528-5

105

CMS 125; NQF NA; PQRS 112 BREAST CANCER SCREENING DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of women 40–69 years of age who had a mammogram to screen for breast cancer.

EXCLUSIONS OR EXCEPTIONS Women who had a bilateral mastectomy or for whom there is evidence of two unilateral

mastectomies.

ENTERING DENOMINATOR DATA Women 42–69 years of age with a visit during the measurement period.

ENTERING NUMERATOR DATA Women with one or more mammograms during the measurement period or the year prior to


To report on this measure, you must order or perform the mammography and enter the result.

The mammography may be ordered or performed within 12 months prior to the start of the

measurement period or during the measurement period.

To document the test and its results, order the mammography test using one of the HCPCS

codes below. Then enter and approve the mammography results in the Patient Results window,

and give them a status of Resulted or Approved.

HCPCS CODES G0202, G0204, G0206

LOINC CODES 24604-1, 24605-8, 24606-6, 24610-8, 26175-0, 26176-8, 26177-6, 26287-3, 26289-9, 26291-5,

263467, 26347-5, 26348-3, 26349-1, 26350-9, 26351-7, 36319-2, 36625-2, 36626-0, 36627-8,

36642-7,36962-9, 37005-6, 37006-4, 37016-3, 37017-1, 37028-8, 37029-6, 37030-4, 37037-9,

106

37038-7, 37052-8, 37053-6, 37539-4, 37542-8, 37543-6, 37551-9, 37552-7, 37553-5, 37554-3,

37768-9, 37769-7,37770-5, 37771-3, 37772-1, 37773-9, 37774-7, 37775-4, 38067-5, 38070-9,

38071-7, 38072-5, 380907, 38091-5, 38807-4, 38820-7, 38854-6, 38855-3, 39150-8, 39152-4,

39153-2, 39154-0, 42168-5,42169-3, 42174-3, 42415-0, 42416-8, 46335-6, 46336-4, 46337-2,

46338-0, 46339-8, 46342-2, 46350-5, 46351-3, 46354-7, 46355-4, 46356-2, 46380-2, 48475-8,

48492-3, 69150-1, 69251-7, 69259-0

107

CMS 127; NQF 0043; PQRS 111 PNEUMONIA VACCINATION STATUS FOR OLDER ADULTS DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients 65 years of age and older who have ever received a pneumococcal

vaccine.


ENTERING DENOMINATOR DATA Patients 65 years of age and older with a visit during the measurement period. Please note that

the E&M codes 99211 and 99243 do not count for this measure.

ENTERING NUMERATOR DATA Patients who have ever received a pneumococcal vaccination.

To report on this measure, you must document the administration of the pneumonia vaccine or

document it in the patient’s history. The vaccination may have been given at any time prior to or

during the measurement period. To document the pneumonia immunization, enter the

administration using a procedure code associated to an appropriate SNOMED code. Enter the

procedure in the SP tab of Full Note Composer or other clinical note type window. Then

document the vaccination details in the vaccine administration record.

Enter the vaccination in the vaccination history category in the Hx tab of Full Note Composer or

in the Patient History window. Then, identify the type of vaccine when documenting the vaccine

details in the vaccine administration record. CVX: 33

SNOMED FOR ADMINISTERING THE VACCINATION 12866006, 394678003

108

CMS 128; PQRS 0105; PQRS 9 ANTI-DEPRESSANT MEDICATION MANAGEMENT

*This measure requires a reporting period that is greater than six months. You cannot use this

measure if your reporting period is six months or less.

DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients 18 years of age and older who were diagnosed with major depression

and treated with antidepressant medication, and who remained on antidepressant medication

treatment.

Percentage of patients who remained on an antidepressant medication for at least 84 days (12

weeks).

Percentage of patients who remained on an antidepressant medication for at least 180 days (6

months).

EXCLUSIONS OR EXCEPTIONS Patients who were actively on an antidepressant medication in the 90 days prior to the Index

Prescription Start Date.

ENTERING DENOMINATOR DATA Patients 18 years of age and older with a diagnosis of major depression in the 180 days (6

months) prior to the measurement period or the first 180 days (6 months) of the measurement

period, who were treated with antidepressant medication, and with a visit during the

measurement period.

Enter the diagnosis with a qualifying diagnosis code or diagnosis code associated with a

SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or with a


tab of Full Note Composer or the Patient History window.

109

ICD-9 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34,

296.35, 298.0, 300.4, 309.1, 311

ICD-10 F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9,

F34.1

SNOMED 832007, 2506003, 2618002, 3109008, 14183003, 15193003, 15639000, 18818009, 19694002,

20250007, 25922000, 28475009, 30605009, 33078009, 33135002, 33736005, 36170009,

36474008, 36923009, 38451003, 38694004, 39809009, 40379007, 42810003, 42925002,

60099002, 63778009, 66344007, 67711008, 68019004, 69392006, 70747007, 71336009,

73867007, 75084000, 76441001, 77911002, 78667006, 79298009, 83176005, 83458005,

84788008, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000, 191610000,

191611001, 191613003, 191676002, 192049004, 231499006, 231504006, 268620009,

268621008, 274948002, 300706003, 319768000, 320751009, 321717001, 370143000,

430852001

A prescription for a qualifying antidepressant medication must have been written within 30 days

prior to and 14 days after the visit in which depression was diagnosed. Write the prescription

through the SIG Writer window or prescription refill message and print the prescription or send

it electronically.

ENTERING NUMERATOR DATA Numerator 1: Patients who have received antidepressant medication for at least 84 days

(12 weeks) of continuous treatment during the 114-day period following the Index


Numerator 2: Patients who have received antidepressant medications for at least 180

days (6 months) of continuous treatment during the 231-day period following the Index


110

To report on this measure for acute phase treatment, you must prescribe antidepressant

medication for 84 days (12 weeks) within the 4 months following the new episode of major

depression.

To report on this measure for continuation phase treatment, you must prescribe antidepressant

medication for 180 days (6 months) within 8 months following the new episode of major

depression.

To report the antidepressant therapy, write the prescription through the SIG Writer window or

prescription refill message and print the prescription or send it electronically.

111

CMS 129; NQF 0389; PQRS 102 PROSTATE CANCER: AVOIDANCE OF OVERUSE OF BONE SCAN FOR STAGING LOW RISK PROSTATE CANCER PATIENTS DOMAIN Efficient Use of Healthcare Resources

MEASURE Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of

recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the

prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at

any time since diagnosis of prostate cancer.

EXCLUSIONS OR EXCEPTIONS Documentation of reason(s) for performing a bone scan (including documented pain, salvage

therapy, other medical reasons, bone scan ordered by someone other than reporting physician).

ENTERING DENOMINATOR DATA All patients, regardless of age, with a diagnosis of prostate cancer.

The patient must be male and must have an active diagnosis of prostate cancer before or during

the measurement period with a low risk for prostate cancer recurrence and a PSA test of less

than or equal to 10 ng/mL and a Gleason Score of less than or equal to 6 before or during the

prostate cancer treatment.





ICD-9 185

ICD-10 C61

112

SNOMED 93974005, 94503003, 254900004, 278060005, 314969001, 369485004, 369486003, 396198006,

399068003, 399490008, 399590005, 427492003

You must order the desired lab test using the appropriate procedure code with the procedure

code type Lab. Then either enters the test results or receives them through an interface and

gives them a status of Resulted or Approved.

The test results not received through an interface must be entered as discrete, quantifiable


the result values in a positive/negative or numerical format. The lab test in the template must

be associated with an appropriate LOINC code.

LOINC FOR GLEASON RESULTS 35266-6

LOINC FOR PSA RESULTS 10508-0, 10886-0, 12841-3, 15323-9, 15324-7, 15325-4, 19195-7, 19201-3, 2857-1, 33667-7,

34611-4, 35741-8

You must perform at least one prostate cancer treatment during the measurement period. Enter

an appropriate CPT code or a procedure coded associated with an appropriate SNOMED code on

the SP or SO tab of the patient visit note window.

CPT CODES FOR TREATMENT 55810, 55812, 55815, 55840, 55842, 55845, 55866, 55873, 55875, 55876, 77427, 77776, 77777,

77778, and 77787

SNOMED FOR THERAPY 8782006, 10492003, 14473006, 19149007, 21190008, 21372000, 24242005, 26294005,

27877006, 28579000, 29860002, 30426000, 36253005, 37851009, 38915000, 41371003,

41416003, 57525009, 62867004, 64978007, 65381004, 65551008, 67598001, 68986004,

72388004, 77613002, 81232004, 83154001, 84755001, 85768003, 87795007, 90199006,

113

90470006, 91531008, 113120007, 116244007, 118161009, 118162002, 118163007, 168922004,

169327006, 169328001, 169329009, 169340001, 169349000, 169359004, 169374002,

176106009, 176258007, 176260009, 176261008, 176262001, 176263006, 176267007,

176286004, 176288003, 176319004, 228677009, 228684001, 228688003, 228690002,

228692005, 228693000, 228694006, 228695007, 228697004, 228698009, 228699001,

228701001, 228702008, 236209003, 236211007, 236252003, 265589001, 271291003,

312235007, 314202001, 359922007, 359926005, 384691004, 384692006, 394902000,

394918006, 399124002, 399180008, 399315003, 420529003, 427357007, 427985002,

433224001, 433225000, 440093006, 440094000

ENTERING NUMERATOR DATA Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer.

To report on this measure, you would not have ordered a bone scan for the patient at any time

since diagnosis of prostate cancer. Therefore, you will not have received results for the bone

scan, and none of the following LOINC codes would be in the patient’s chart. To ensure accurate

reporting, one of the following LOINC codes should be associated to all bone scan procedures

performed or ordered by the practice.

LOINC 25031-6, 25032-4, 39627-5, 39812-3, 39813-1, 39814-9, 39815-6, 39816-4, 39817-2, 39818-0,

398198, 39820-6, 39858-6, 39879-2, 39880-0, 39881-8, 39882-6, 39883-4, 39884-2, 39901-4,

39902-2, 39903-0, 39904-8, 39905-5, 41772-5, 41836-8, 42700-5, 44142-8

114

CMS 130; NQF 0034; PQRS 113 COLORECTAL CANCER SCREENING DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.

EXCLUSIONS OR EXCEPTIONS Patients with a diagnosis or past history of total colectomy or colorectal cancer.

ENTERING DENOMINATOR DATA Patients 51-75 years of age with a visit during the measurement period

ENTERING NUMERATOR DATA Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined

by any one of the following criteria below:

Fecal occult blood test (FOBT) during the measurement period.

Flexible sigmoidoscopy during the measurement period or the four years prior to the

measurement period.

Colonoscopy during the measurement period or the nine years prior to the

measurement period.

To report on this measure, you must perform the screening test and enter the results during or

prior to measurement period.

To document the test and its results, chart the performance of the screening test using one of

the procedure codes listed below. Then enter and approve the screening results in the Patient

Results window and give them a status of Resulted or Approved.

Test results not received through an interface must be entered as discrete, quantifiable data.

Enter the results in the Patients Results window using a lab template enabling you to enter the

test result value. Results stored in the database as text notes or image file cannot be used for

reporting.

115

You must associate a LOINC code to the FOBT test item on each lab template for both manually

entered and electronic results.

FOBT

LOINC CODES 12503-9, 12504-7, 14563-1, 14564-9, 14565-6, 2335-8, 27396-1, 27401-9, 27925-7, 27926-5,

29771-3, 56490-6, 56491-4, 57905-2, 58453-2

Flexible Sigmoidoscopy

CPT CODES 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345

HCPCS CODES G0104

SNOMED CODES 44441009, 112870002, 396226005, 425634007

Colonoscopy

CPT CODES 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45355, 45378, 45379, 45380, 45381,

45382, 45383, 45384, 45385, 45386, 45387, 45391, 45392

HCPCS CODES G0105, G0121

SNOMED CODES 8180007, 12350003, 25732003, 34264006, 73761001, 174158000, 174184006, 235150006,

235151005, 303587008, 310634005, 367535003, 418714002, 427459009, 443998000,

444783004, 446521004, 446745002, 447021001

116

CMS 131; NQF 0055; PQRS 117 DIABETIC: EYE EXAM DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam

by an eye care professional during the measurement period or a negative retinal exam (no

evidence of retinopathy) in the 12 months prior to the measurement period.


ENTERING DENOMINATOR DATA Patients 18-75 years of age with diabetes with a visit during the measurement period.





ICD-9 250.00, 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, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60,

250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90,

250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10 E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339,

E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44,

E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630,

E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29,

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610,

E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65,

117

E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112,

O24.113, O24.119, O24.12, O24.13

SNOMED 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009,

190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001,

199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004,

314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008,

359642000, 359939009

ENTERING NUMERATOR DATA Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one

of the following:

A retinal or dilated eye exam by an eye care professional in the measurement period or

A negative retinal exam (no evidence of retinopathy) by an eye care professional in the

year prior to the measurement period.

Please note that the application can only be used to report on the first option for this measure.

The exam must be performed and documented in the visit note. Please also note that the

procedure must be performed by an ophthalmologist or optometrist. Other providers cannot

use this measure.

To report on this measure, you must perform the eye exam and enter it on the SP tab using a

procedure code associated with one of the following SNOMED codes.

SNOMED CODES 6615001, 252779009, 252780007, 252781006, 252782004, 252783009, 252784003, 252788000,

252789008, 252790004, 274795007, 274798009, 308110009, 314971001, 314972008,

410451008, 410452001, 410453006, 410455004, 420213007, 425816006, 427478009

118

CMS 132; NQF 0564; PQRS 192 CATARACTS: COMPLICATIONS WITHIN 30 DAYS FOLLOWING CATARACT SURGERY REQUIRING ADDITIONAL SURGICAL PROCEDURES DOMAIN Patient Safety

MEASURE Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who

had cataract surgery and had any of a specified list of surgical procedures in the 30 days

following cataract surgery which would indicate the occurrence of any of the following major

complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL,

retinal detachment, or wound dehiscence.

EXCLUSIONS OR EXCEPTIONS Patients with any one of a specified list of comorbid conditions that impact the surgical

complication rate.

ENTERING DENOMINATOR DATA All patients aged 18 years and older who had cataract surgery and no significant pre-operative

ocular conditions impacting the surgical complication rate.

Enter the procedure code or a procedure code associated with a SNOMED code for the cataract

surgery in the SP or SO tab of Full Note Composer or other clinical note type or in the surgical

history category of the Hx tab of Full Note Composer or the Patient History window.

CPT 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984

SNOMED 5130002, 9137006, 10178000, 12163000, 31705006, 35717002, 39243005, 46309001,

46426006, 46562009, 50538003, 51839008, 54885007, 65812008, 67760003, 69360005,

74490003, 75814005, 79611007, 82155009, 84149000, 85622008, 88282000, 89153001,

119

110473004, 112963003, 112964009, 231744001, 308694002, 308695001, 313999004,

335636001, 336651000, 361191005, 385468004, 397544007, 404628003, 415089008,

417493007, 418430006, 419767009, 420260004, 420526005, 424945000, 446548003

ENTERING NUMERATOR DATA Patients who had one or more specified operative procedures for any of the following major

complications within 30 days following cataract surgery: retained nuclear fragments,

endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscence.

Enter the procedure code or a procedure code associated with a SNOMED code in the SP or SO

tab of Full Note Composer or other clinical note type or in the surgical history category of the Hx


CPT 65235, 65900, 65920, 65930, 66030, 66250, 66820, 66825, 66830, 66852, 66986, 67005, 67010,

67015, 67025, 67028, 67030, 67031, 67036, 67039, 67041, 67042, 67043, 67101, 67105, 67107,

67108, 67110, 67112, 67141, 67145, 67250, 67255

SNOMED 2536007, 3499006, 3938007, 4143006, 4344007, 4503005, 5671007, 8813000, 8920006,

9137006, 9255007, 10006000, 10807008, 12651006, 12868007, 13767004, 14707009,

18752000, 20647004, 21491001, 22768003, 30113009, 30246007, 31530007, 35552007,

37332006, 37958004, 43908008, 45817009, 46562009, 47470009, 48671003, 48933009,

49789002, 50737005, 51281007, 53570002, 54085006, 54211003, 54362002, 57103007,

58689006, 61220009, 64340000, 65812008, 66134002, 67546003, 68999001, 72199008,

74948004, 75734004, 77950003, 78191003, 78290008, 78362007, 78917001, 84016007,

84077007, 84542000, 85145001, 85231002, 89788006, 89942008, 90997007, 120119003,

172426003, 172451002, 172498005, 172548007, 172574001, 223217009, 224227005,

225184003, 231741009, 231751005, 231752003, 231780001, 287233001, 287236009,

287242008, 296867007, 312705004, 312706003, 312707007, 312714009, 360405005,

360411008, 363726008, 416773006, 417297006, 430833007, 444600006, 445023004,

445024005

120

CMS 133; NQF 0565; PQRS 191 CATARACTS: 20/40 OR BETTER VISUAL ACUITY WITHIN 90 DAYS FOLLOWING CATARACT SURGERY DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who

had cataract surgery and no significant ocular conditions impacting the visual outcome of

surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved

within 90 days following the cataract surgery.

EXCLUSIONS OR EXCEPTIONS Patients with specified comorbid conditions that impact the visual outcome of surgery.

ENTERING DENOMINATOR DATA

All patients aged 18 years and older who had cataract surgery.

Enter the procedure code or a procedure code associated with a SNOMED code for the cataract

surgery in the SP or SO tab of Full Note Composer or other clinical note type or in the surgical

history category of the Hx tab of Full Note Composer or the Patient History window.

CPT 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984

SNOMED 5130002, 9137006, 10178000, 12163000, 31705006, 35717002, 39243005, 46309001,

46426006, 46562009, 50538003, 51839008, 54885007, 65812008, 67760003, 69360005,

74490003, 75814005, 79611007, 82155009, 84149000, 85622008, 88282000, 89153001,

110473004, 112963003, 112964009, 231744001, 308694002, 308695001, 313999004,

335636001, 336651000, 361191005, 385468004, 397544007, 404628003, 415089008,

417493007, 418430006, 419767009, 420260004, 420526005, 424945000, 446548003

121

ENTERING NUMERATOR DATA Patients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved

within 90 days following cataract surgery.

There are two ways you can report on this measure. You can use observation items or you can

use a physical exam item.

To use observations, you must have set up an observation item or items for the visual acuity test

and put these observation items in an observation template. The observation item for must be

associated with a qualifying SNOMED code for the test.

SNOMED 422497000, 423059004, 423862000, 424703005


use the observation template to chart the test. None of the system- defined clinical note type

windows (such as Full Note Composer) include the Observation tab. So, you must use a custom

clinical note type window to chart patient visit notes that will include a functional status

assessment.

Perform the visual acuity test, and enter the results in the observation template on the

Observation tab.

To use a physical exam, you must have set up a visual acuity finding in a physical exam. The

finding must have SNOMED code 419775003 in the ID field of the PE Finding window.

Perform the visual acuity test, and select the finding in the physical exam.

122

CMS 134; NQF 0062; PQRS 119 DIABETES: URINE PROTEIN SCREENING DOMAIN Clinical Process/Effectiveness

MEASURE The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening

test or evidence of nephropathy during the measurement period.


ENTERING DENOMINATOR DATA Patients 18-75 years of age with diabetes with a visit during the measurement period. Enter the

diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code in

the Dx tab of Full Note Composer or other clinical note type window or enter a problem



ICD-9 250.00, 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, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60,

250.61, 250.62, 250.63, 250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82, 250.83, 250.90,

250.91, 250.92, 250.93, 648.01, 648.02, 648.03, 648.04

ICD-10 E10.10, E10.11, E10.21, E10.22, E10.29, E10.311, E10.319, E10.321, E10.329, E10.331, E10.339,

E10.341, E10.349, E10.351, E10.359, E10.36, E10.39, E10.40, E10.41, E10.42, E10.43, E10.44,

E10.49, E10.51, E10.52, E10.59, E10.610, E10.618, E10.620, E10.621, E10.622, E10.628, E10.630,

E10.638, E10.641, E10.649, E10.65, E10.69, E10.8, E10.9, E11.00, E11.01, E11.21, E11.22, E11.29,

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E11.36, E11.39, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.51, E11.52, E11.59, E11.610,

123

E11.618, E11.620, E11.621, E11.622, E11.628, E11.630, E11.638, E11.641, E11.649, E11.65,

E11.69, E11.8, E11.9, O24.011, O24.012, O24.013, O24.019, O24.02, O24.03, O24.111, O24.112,

O24.113, O24.119, O24.12, O24.13

SNOMED 4783006, 9859006, 23045005, 28032008, 44054006, 46635009, 75682002, 76751001,

81531005, 190330002, 190331003, 190368000, 190369008, 190372001, 190389009,

190390000, 199223000, 199225007, 199226008, 199227004, 199228009, 199229001,

199230006, 237599002, 237618001, 237626009, 237627000, 313435000, 313436004,

314771006, 314772004, 314893005, 314894004, 314902007, 314903002, 314904008,

359642000, 359939009

ENTERING NUMERATOR DATA Patients with a screening for nephropathy or evidence of nephropathy during the measurement

period.

To report on this measure, you must either diagnose the patient with nephropathy, or order or

perform urine screening and then enter the results, or order or perform a procedure that

indicates nephropathy. For this measure, a prescription for an ACE inhibitor or ARB medication

is also an indication of nephropathy.

To use the diagnosis, enter the diagnosis code in the Dx tab of Full Note Composer or other

clinical note type window or enter a problem associated with a qualifying SNOMED code in the

problem history category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9 250.40, 250.41, 250.42, 250.43

ICD-10 E08.21, E08.22, E08.29, E09.21, E09.22, E09.29, E10.21, E10.22, E10.29, E11.21, E11.22,

E11.29, E13.21, E13.22, E13.29

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SNOMED 38046004, 127013003, 236499007, 236500003, 401110002, 420514000, 420715001,

421305000, 421986006, 445170001

To use the urine screening, perform the urine screening, and then either enter the test results or

receive them through an interface and give them a status of Resulted or Approved.



urine microalbumin value. Results stored in the database as text notes or image file cannot be

used for reporting.

You must associate a LOINC code to the test item on each lab template for both manually


MICROALBUMIN LOINC 1755-8, 1753- 3, 1754-1, 1757-4, 2887-8, 2888-6, 2889-4, 2890-2, 9318-7, 11218-5, 12842-1,

13705-9, 13801-6, 14585-4, 14956-7, 14957-5, 14958-3, 14959-1, 18373-1, 20621-9, 21059-1,

21482-5, 26801-1, 27298-9, 30003-8, 30000-4, 30001-2, 32209-9, 32294-1, 32551-4, 34366-5,

35663-4, 40486-3, 40662-9, 40663-7, 43605-5, 43606-3, 43607-1, 44292-1, 47558-2, 49023-5,

50949-7, 53121-0, 53532-8, 53530-2, 53531-0, 56553-1, 57369-1, 58448-2, 58992-9, 59159-4,

60678-0, 63474-1

MACROALBUMIN LOINC 1753-3, 24356-8, 24357-6, 39264-7, 50556-0, 50564-4, 50949-7, 57019-2, 57020-0, 58077-9

To use a procedure that indicates nephropathy, you must enter a qualifying procedure code or a

procedure code that is associated with a qualifying SNOMED code. You may enter the procedure

in either the SP or the SO tab of Full Note Composer or other clinical note type window.

DIALYSIS EDUCATION SNOMED 59596005, 66402002, 385972005

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DIALYSIS SERVICES CPT 90920, 90921, 90924, 90925, 90935, 90937, 90940, 90945, 90947

DIALYSIS SERVICES HCPCS 108241001

DIALYSIS SERVICES SNOMED 676002, 10848006, 11932001, 14684005, 34897002, 57274006, 67970008, 68341005,

71192002, 108241001, 180273006, 225230008, 225231007, 233575001, 233576000,

233577009, 233578004, 233579007, 233580005, 233581009, 233582002, 233583007,

233584001, 233585000, 233586004, 233587008, 233588003, 233589006, 233590002,

238316008, 238317004, 238318009, 238319001, 238321006, 238322004, 238323009,

265764009, 288182009, 302497006, 427053002, 428648006, 439278006, 439976001

ESRD MONTHLY OUTPATIENT SERVICES CPT 90957, 90958, 90959, 90960, 90961, 90962, 90965, 90966, 90969, 90970, 90989, 90993, 90997,

90999, 99512

KIDNEY TRANSPLANT CPT 50300, 50320, 50340, 50360, 50365, 50370, 50380

KIDNEY TRANSPLANT SNOMED 12976005, 48994000, 52213001, 70536003, 88930008, 175899003, 175901007, 175902000,

175911000, 236138007, 240325001, 313030004

OTHER SERVICES RELATED TO DIALYSIS SNOMED 3257008, 73257006, 233591003, 385970002, 385971003, 385973000, 406168002

VASCULAR ACCESS FOR DIALYSIS CPT 36145, 36147, 36148, 36800, 36810, 36815, 36818, 36819, 36820, 36821, 36831, 36832, 36833

126

VASCULAR ACCESS FOR DIALYSIS SNOMED 676002, 7459007, 22800003, 34163007, 54817007, 61160002, 61740001, 63421002,

69380006, 79827002, 80634002, 180272001, 180277007, 225892009, 233468004, 233471007,

233472000, 233547003, 238314006, 238315007, 271418008, 426340003, 427992007,

428118009, 431418000, 431440009, 431781000, 432509002, 432654009, 434435000,

438341004, 438342006, 439241008, 439322008, 439349008, 439534001, 443683004,

448591002, 449400003

To use medication as an indicator of nephropathy, enter the prescription for an ACE inhibitor or

ARB medication in the SIG Writer window, and print or electronically submit the prescription.

127

CMS 135; NQF 0081; PQRS 5 HEART FAILURE (HF): ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITOR OR ANGIOTENSIN RECEPTOR BLOCKER (ARB) THERAPY FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD) DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a

current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor

or ARB therapy either within a 12-month period when seen in the outpatient setting OR at each

hospital discharge.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g.,

hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who

have experienced marked azotemia, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g.,

patient declined, other patient reasons).

Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (e.g., other

system reasons).

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of heart failure.


SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or

enter a problem associated with a qualifying SNOMED code in the problem history

category in the Hx tab of Full Note Composer or the Patient History window.

ICD-9 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20,

428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9

128


I50.41, I50.42, I50.43, I50.9

SNOMED 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007,

43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003,

77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007,

92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005,

195112003, 195114002, 206586007, 233924009, 277639002, 314206003, 359617009,

359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001,

426263006, 426611007, 441481004, 441530006

To report on this measure, you must order or perform an LVEF test and enter the result data.

When the LVEF result is equal to or less than 40 percent, then you must prescribe either an ACE

inhibitor or ARB therapy. LVEF test results may be entered as results in a lab template using

LOINC codes, or as observation items in an observation template using SNOMED codes.

To report the LVEF test using a lab template, the results must either be received through an

interface or entered as discrete, quantifiable data in the Patient Results window using a lab

template enabling you to enter the LVEF percentage. The results must be given a status of

Resulted or Approved.




reporting.

You must associate a LOINC code to the LVEF test item on each lab template for both manually


129

LOINC 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9, 18045-5,

18049-7, 18043-0, 18046-3, 18047-1

To report the LVEF test using an observation template, you must have set up an observation

item for the LVEF test, and put the observation item in an observation template. The

observation item must include the appropriate SNOMED code.

SNOMED 134401001, 981000124106, 991000124109


use the observation template to chart the LVEF test. None of the system -defined clinical note

type windows (such as Full Note Composer) include the Observation tab. You must use a custom

clinical note type window to chart patient visit notes that will include the test.

ENTERING NUMERATOR DATA Patients who were prescribed ACE inhibitor or ARB therapy either within a 12-month period

when seen in the outpatient setting or at hospital discharge.

To report the ACE inhibitor or ARB therapy, write the prescription through the SIG Writer

window or prescription refill message and print the prescription or send it electronically.

130

CMS 136; NQF 0108; PQRS 366 FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ATTENTION DEFICIT/ HYPERACTIVITY DISORDER (ADHD) MEDICATION DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of children 6 through 12 years of age and newly dispensed a medication for

attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates

are reported.

Percentage of children who had one follow-up visit with a practitioner with prescribing authority

during the 30-Day Initiation Phase.

Percentage of children who remained on ADHD medication for at least 210 days and who, in

addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a

practitioner within 270 days (nine months) after the Initiation Phase ended.

EXCLUSIONS OR EXCEPTIONS Denominator Exclusion 1:

• Exclude patients diagnosed with narcolepsy at any point in their history or

during the measurement period.

• Exclude patients who had an acute inpatient stay with a principal diagnosis of

mental health or substance abuse during the 30 days after the IPSD.

• Exclude patients who were actively on an ADHD medication in the 120 days

prior to the Index Prescription Start Date.

Denominator Exclusion 2:

• Exclude patients diagnosed with narcolepsy at any point in their history or

during the measurement period.

• Exclude patients who had an acute inpatient stay with a principal diagnosis of

mental health or substance abuse during the 300 days after the IPSD.

• Exclude patients who were actively on an ADHD medication in the 120 days

prior to the Index Prescription Start Date.

131

ENTERING DENOMINATOR DATA The patient must be between 6 and 12 years of age, and must have at least one visit during the

measurement period.

For the first denominator, you must prescribe an ADHD medication for the patient for the first

time will be included in the denominator. (The patient is excluded if already taking an ADHD

medication.) The first prescription must be written between 90 days prior to start of the

measurement period and no later than 60 days from the start of the measurement period.

For the second denominator, the patient must meet the requirements for the first denominator

and must remain on medication for at least 210 of the 300 days following the IPSD.

Write the prescription through the SIG Writer window and print the prescription or send it

electronically.

ENTERING NUMERATOR DATA To include the patient in the numerator for the first part of this measure, you must conduct a

follow-up visit with the patient within 30 of the initial ADHD prescription and within the

measurement period.

A patient must be in the numerator for the first part of this measure in order to be included in

the numerator for the second part.

To be included in the second numerator, you must conduct a second follow-up visit at least 31

days after and no more than 300 days after the initial ADHD prescription. The patient must also

have been on the ADHD medication for at least 210 days. To report the medication, write the

prescriptions and/or refills through the SIG Writer window or prescription refill message and

print the prescription or send it electronically.

132

CMS 137; NQF 0004; PQRS 305 INITIATIONS AND ENGAGEMENT OF ALCOHOL AND OTHER DRUG DEPENDENCE TREATMENT DOMAIN Clinical Process/Effectiveness

MEASURE Percentage of patients 13 years of age and older with a new episode of alcohol and other drug

(AOD) dependence who received the following. Two rates are reported.

Percentage of patients who initiated treatment within 14 days of the diagnosis.

Percentage of patients who initiated treatment and who had two or more additional services

with an AOD diagnosis within 30 days of the initiation visit.

EXCLUSIONS OR EXCEPTIONS Patients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to

the first episode of alcohol or drug dependence.

ENTERING DENOMINATOR DATA Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or

drug dependency during a visit in the first 11 months of the measurement period.

Patients presenting with a subsequent episode of alcohol and other drug (AOD) dependence are

not eligible for this measure.

ICD-9 291.0, 291.1, 291.2, 291.3, 291.4, 291.5, 291.81, 291.82, 291.89, 291.9, 292.0, 292.11, 292.12,

292.2, 292.81, 292.82, 292.83, 292.84, 292.85, 292.89, 292.9, 303.00, 303.01, 303.02, 303.90,

303.91, 303.92, 304.00, 304.01, 304.02, 304.10, 304.11, 304.12, 304.20, 304.21, 304.22, 304.30,

304.31, 304.32, 304.40, 304.41, 304.42, 304.50, 304.51, 304.52, 304.60, 304.61, 304.62, 304.70,

304.71, 304.72, 304.80, 304.81, 304.82, 304.90, 304.91, 304.92, 305.00, 305.01, 305.02, 305.20,

133

305.21, 305.22, 305.30, 305.31, 305.32, 305.40, 305.41, 305.42, 305.50, 305.51, 305.52, 305.60,

305.61, 305.62, 305.70, 305.71, 305.72, 305.80, 305.81, 305.82, 305.90, 305.91, 305.92, 535.30,

535.31, 571.1

ICD-10 F10, F10.10, F10.120, F10.121, F10.129, F10.14, F10.150, F10.151, F10.159, F10.180, F10.181,

F10.182, F10.188, F10.19, F10.20, F10.220, F10.221, F10.229, F10.230, F10.231, F10.232,

F10.239, F10.24, F10.250, F10.251, F10.259, F10.26, F10.27, F10.280, F10.281, F10.282, F10.288,

F10.29 F10.920, F10.921, F10.929, F10.94, F10.950, F10.951, F10.959, F10.96, F10.97, F10.980,

F10.981, F10.982, F10.988, F10.99, F11.10, F11.120, F11.121, F11.122, F11.129, F11.14, F11.150,

F11.151, F11.159, F11.181, F11.182, F11.188, F11.19, F11.20, F11.220, F11.221, F11.222,

F11.229, F11.23, F11.24, F11.250, F11.251, F11.259, F11.281, F11.282, F11.288, F11.29, F11.90,

F11.920, F11.921, F11.922, F11.929, F11.93, F11.94, F11.950, F11.951, F11.959, F11.981,

F11.982, F11.988, F11.99, F12.10, F12.120, F12.121, F12.122, F12.129, F12.150, F12.151,

F12.159, F12.180, F12.188, F12.19, F12.20, F12.220, F12.221, F12.222, F12.229, F12.250,

F12.251, F12.259, F12.280, F12.288, F12.29, F12.90, F12.920, F12.921, F12.922, F12.929,

F12.950, F12.951, F12.959, F12.980, F12.988, F12.99, F13.10, F13.120, F13.121, F13.129, F13.14,

F13.150, F13.151, F13.159, F13.180, F13.181, F13.182, F13.188, F13.19, F13.20, F13.220,

F13.221, F13.229, F13.230, F13.231, F13.232, F13.239, F13.24, F13.250, F13.251, F13.259,

F13.26, F13.27, F13.280, F13.281, F13.282, F13.288, F13.29, F13.90, F13.920, F13.921, F13.929,

F13.930, F13.931, F13.932, F13.939, F13.94, F13.950, F13.951, F13.959, F13.96, F13.97, F13.980,

F13.981, F13.982, F13.988, F13.99, F14.10, F14.120, F14.121, F14.122, F14.129, F14.14, F14.150,

F14.151, F14.159, F14.180, F14.181, F14.182, F14.188, F14.19, F14.20, F14.220, F14.221,

F14.222, F14.229, F14.23, F14.24, F14.250, F14.251, F14.259, F14.280, F14.281, F14.282,

F14.288, F14.29, F14.90, F14.920, F14.921, F14.922, F14.929, F14.94, F14.950, F14.951, F14.959,

F14.980, F14.981, F14.982, F14.988, F14.99, F15.10, F15.120, F15.121, F15.122, F15.129, F15.14,

F15.150, F15.151, F15.159, F15.180, F15.181, F15.182, F15.188, F15.19, F15.20, F15.220,

F15.221, F15.222, F15.229, F15.23, F15.24, F15.250, F15.251, F15.259, F15.280, F15.281,

F15.282, F15.288, F15.29, F15.90, F15.920, F15.921, F15.922, F15.929, F15.93, F15.94, F15.950,

F15.951, F15.959, F15.980, F15.981, F15.982, F15.988, F15.99, F16.10, F16.120, F16.121,

F16.122, F16.129, F16.14, F16.150, F16.151, F16.159, F16.180, F16.183, F16.188, F16.19, F16.20,

F16.220, F16.221, F16.229, F16.24, F16.250, F16.251, F16.259, F16.280, F16.283, F16.288,

134

F16.29, F16.90, F16.920, F16.921, F16.929, F16.94, F16.950, F16.951, F16.959, F16.980, F16.983,

F16.988, F16.99, F18.10, F18.120, F18.121, F18.129, F18.14, F18.150, F18.151, F18.159, F18.17,

F18.180, F18.188, F18.19, F18.20, F18.220, F18.221, F18.229, F18.24, F18.250, F18.251, F18.259,

F18.27, F18.280, F18.288, F18.29, F18.90, F18.920, F18.921, F18.929, F18.94, F18.950, F18.951,

F18.959, F18.97, F18.980, F18.988, F18.99, F19.10, F19.120, F19.121, F19.122, F19.129, F19.14,

F19.150, F19.151, F19.159, F19.16, F19.17, F19.180, F19.181, F19.182, F19.188, F19.19, F19.20,

F19.220, F19.221, F19.222, F19.229, F19.230, F19.231, F19.232, F19.239, F19.24, F19.250,

F19.251, F19.259, F19.26, F19.27, F19.280, F19.281, F19.282, F19.288, F19.29, F19.90, F19.920,

F19.921, F19.922, F19.929, F19.930, F19.931, F19.932, F19.939, F19.94, F19.950, F19.951,

F19.959, F19.96, F19.97, F19.980, F19.981, F19.982, F19.988, F19.99, F55.2, K29.20, K29.21,

K70.10, K70.11

SNOMED 281004, 1383008, 1686006, 1973000, 2403008, 4863002, 5002000, 5444000, 5602001,

6348008, 7052005, 7071007, 7200002, 8635005, 8837000, 10028000,10327003, 11061003,

11387009, 12380008, 14784000, 15167005, 15277004, 18653004, 18689007, 19445006,

20385005, 20876004, 21000000, 21647008, 25508008, 26714005, 27956007, 28368009,

28864000, 29212009, 29733004, 30310000, 30491001, 30871003, 31715000, 31956009,

32009006, 32358001, 32552001, 32875003, 33845003, 33871004, 34938008, 37331004,

37344009, 38247002, 39003006, 39807006, 39951001, 40571009, 41083005, 42344001,

43497001, 46721000, 46975003, 47664006, 50026000, 50320000, 50722006,50933003,

50983008, 51339003, 51443000, 51493001, 52866005, 53050002, 53936005, 55967005,

56194001, 57588009, 58727001, 59651006, 61104008, 61144001, 63649001, 63983005,

64386003, 66590003, 69482004, 70328006, 70340006, 70545002, 70655008, 70932007,

71328000, 73097000, 74851005, 74934004, 75122001, 75544000, 77355000, 78267003,

78358001, 78524005, 79578000, 80868005, 82339009, 83168008, 83367009, 84758004,

85005007, 85561006, 87132004, 89451009, 90755006, 90790003, 95635002, 95661003,

105546006, 105549004,111479008, 111480006, 191471000, 191475009, 191476005,

191477001, 191478006, 191480000, 191483003, 191484009, 191485005, 191486006,

191492000, 191493005, 191494004, 191495003, 191496002, 191802004, 191804003,

191805002, 191811004, 191812006, 191813001, 191816009, 191819002, 191820008,

191825003, 191826002, 191829009, 191831000, 191832007, 191837001, 191838006,

135

191843004, 191844005, 191849000, 191850000, 191853003, 191855005, 191856006,

191865004, 191867007, 191868002, 191871005, 191873008, 191874002, 191877009,

191882002, 191883007, 191891003, 191893000, 191894006, 191899001, 191900006,

191905001, 191906000, 191907009, 191909007, 19912005, 191913000, 191914006,

191916008, 191918009, 191919001, 191920007, 191924003, 191925002, 191928000,

191930003, 191931004, 191939002, 199252002, 199253007, 199254001, 199255000,

226034001, 228371004, 228372006, 228373001, 228375008, 228376009, 228377000,

228378005, 228379002, 228380004, 228381000, 228382007, 228383002, 228384008,

228386005, 228387001, 228388006, 228389003, 230334008, 230443000, 231451006,

231458000, 231459008, 231461004, 231462006, 231467000, 231468005, 231469002,

231470001, 231472009, 231473004, 231474005, 231475006, 231477003, 231478008,

231479000, 231480002, 231481003, 231482005, 236751006, 237228001, 267206008,

268640002, 268641003, 268645007, 268646008, 268647004, 268648009, 268727002,

280982009, 280983004, 280984005, 280986007, 284591009, 301643003, 302507002,

307052004, 309279000, 310202009, 311173003, 312098001, 312936002, 313915006,

361049005, 361150008, 361151007, 363101005, 396344000, 403590001, 414874007,

416073003, 416714005, 417143004, 417360004, 425339005, 425885002, 426001001,

426095000, 426873000, 427205009, 427229002, 427327003, 427975003, 428219007,

428370001, 428406005, 428493006, 428495004, 428623008, 428659002, 428819003,

428823006, 429179002, 429299000, 429512006, 429672007, 429692000, 429782000,

441681009, 442351006, 442406005

ENTERING NUMERATOR DATA Numerator 1: Patients who initiated treatment within 14 days of the diagnosis.

Numerator 2: Patients who initiated treatment and who had two or more additional

services with an AOD diagnosis within 30 days of the initiation visit.

To report on this measure, you must document treatment using either a treatment procedure

code associated with a SNOMED code or a psychotherapy visit procedure code.

You must enter the procedure code in the SP Tab of Full Note Composer or other clinical note

type window.

136

SNOMED FOR TREATMENT 24165007, 60112009, 171047005, 313071005, 370881007, 385989002, 386448003, 386449006,

386450006, 386451005, 408933008, 408934002, 408935001, 408936000, 408941008,

408942001, 408943006, 408944000, 408945004, 408947007, 408948002, 410419007,

413473000, 423416000, 424148004, 424407005, 424589009, 426928008

CPT FOR PSYCHOTHERAPY 90832, 90834, 90837

For numerator 2, the patient must have initiated treatment within 14 days of the diagnosis, and

then had two or more additional visits with treatment or psychotherapy visits within 30 days the

initial encounter.

137

CMS 138; NQF 0028; PQRS 226 PREVENTIVE CARE AND SCREENING: TOBACCO USE - SCREENING AND CESSATION INTERVENTION DOMAIN Public Health

MEASURE Percentage of patients aged 18 years and older who were screened for tobacco use one or more

times within 24 months AND who received cessation counseling intervention if identified as a

tobacco user.

ENTERING DENOMINATOR DATA The patient must be 18 years old or older.

This measure generally requires two office visits during the measurement period. Some types of

office visits require only one during the measurement period.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not screening for tobacco use (eg, limited life

expectancy, other medical reason).

ENTERING NUMERATOR DATA To report on this measure, you must enter the patient’s use or non-use of tobacco in the Hx tab,

Social History category, in the patient visit note. When the patient is a tobacco user, then you

must either:

Enter CPT code 99406 or 99407 or HCPCS code G0436 to document the cessation

counseling, OR

Prescribe an approved cessation medication.

If you have entered the patient’s tobacco use in a prior measurement period and that use has

not changed, then you must select the checkbox for the Social History category indicating that

you have reviewed the patient’s history, including tobacco use.

If you typically use an education form with or for cessation counseling, then you can associate

the appropriate procedure code with the education form so that selecting the education form

138

from the Education Form slider in Full Note Composer or other clinical note type will add the

procedure code to the SP tab. The education form must also be associated with the Smoking

Cessation patient communication type.

Smoking and tobacco use counseling to the patient is reported using CPT code 99406 (smoking

and tobacco cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)

or code 99407 (smoking and tobacco cessation counseling visit; intensive, greater than 10

minutes).

Remember that these CPT codes are E&M codes, so if you use them along with another E&M

code, you must include in the visit note proper documentation supporting the use of the

procedure code. Counseling lasting less than 3 minutes is considered part of an evaluation and

management (E/M) service and is not paid separately. Proper documentation for codes 99406

and 99407 includes the total time spent and what was discussed, including cessation

techniques, resources and follow-up.

The counseling services must be provided by a physician or other qualified health professional

and must be provided face-to-face. Some Medicaid programs have not yet adopted payment for

these codes.

If you are using the optionally licensed Alere education forms, the Alere Smoking Cessation form

is recommended. This education form is associated with HCPCS code G0436. This procedure

code is associated with the SNOMED code 225323000 which qualifies for this measure.

If you not using the Alere education forms, then it is recommended that you associate the

HCPCS code G0436 to the custom-defined education form that you use for this purpose.

Write the prescription through the SIG Writer window, and either print or electronically submit

the prescription.

139

CMS 139; NQF 0101; PQRS 318 SCREENING FOR FUTURE FALL RISK DOMAIN Patient Safety

MEASURE Percentage of patients 65 years of age and older who were screened for future fall risk during


EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not screening for fall risk (e.g., patient is not

ambulatory).

ENTERING DENOMINATOR DATA Patients aged 65 years and older with a visit during the measurement period.

ENTERING NUMERATOR DATA Patients who were screened for future fall risk at least once within the measurement period.

To chart the screening, you must enter a procedure code that is associated with a qualifying

SNOMED code. You may enter the in either the SP or the SO tab of Full Note Composer or other

clinical note type window.

SNOMED 408422004, 408423009, 408589008, 427206005

140

CMS 140; NQF 0387; PQRS 71 BREAST CANCER: HORMONAL THERAPY FOR STAGE IC-III ESTROGEN RECEPTOR/PROGESTERONE RECEPTOR (ER/PR) POSITIVE BREAST CANCER

Please note that Aprima® PRM 2015 is not certified for this measure. Therefore, information

about this measure is not included in this document. This measure cannot be submitted through

Aprima PRM.

141

CMS 141; NQF 0385; PQRS 72 COLON CANCER: CHEMOTHERAPY FOR AJCC STAGE III

COLON CANCER PATIENTS



Aprima PRM.

142

CMS 142; NQF 0089; PQRS 19 DIABETIC RETINOPATHY: COMMUNICATION WITH THE PHYSICIAN MANAGING ONGOING DIABETES CARE DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had

a dilated macular or fundus exam performed with documented communication to the physician

who manages the ongoing care of the patient with diabetes mellitus regarding the findings of

the macular or fundus exam at least once within 12 months.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not communicating the findings of the dilated macular

or fundus exam to the physician who manages the ongoing care of the patient with diabetes.

Documentation of patient reason(s) for not communicating the findings of the dilated macular

or fundus exam to the physician who manages the on-going care of the patient with diabetes.

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of diabetic retinopathy. The patient must

have two or more visits within the measurement period.

Equals Initial Patient Population who had a dilated macular or fundus exam performed during

the first visit.





ICD-9 362.01, 362.02, 362.03, 362.04, 362.05, 362.06

143

ICD-10 E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359,

E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359,

E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359,

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359

SNOMED 4855003, 25412000, 59276001, 193349004, 193350004, 232020009, 232021008, 232022001,

232023006, 311782002, 312903003, 312904009, 312905005, 312906006, 312907002,

312908007, 312909004, 312912001, 314010006, 314011005, 314014002, 314015001,

390834004, 399862001, 399863006, 399864000, 399865004, 399866003, 399868002,

399869005, 399870006, 399871005, 399872003, 399873008, 399874002, 399875001,

399876000, 399877009, 408409007, 408410002, 408411003, 408412005, 408413000,

408414006, 408415007, 408416008, 414892004, 414894003, 414908005, 414910007,

417677008, 420486006, 420789003, 421779007, 422034002

To report on this measure, you must order or perform a dilated macular or fundus exam, and

then either enter the test results or receive them through an interface and give them a status of

Resulted or Approved.




reporting.

You must associate the LOINC code 32451-7 to the test item on each lab template for both

manually entered and electronic results.

144

ENTERING NUMERATOR DATA Patients with documentation, at least once within 12 months, of the findings of the dilated

macular or fundus exam via communication to the physician who manages the patient’s diabetic

care.

To report on this measure, you must define custom procedure codes for reporting this

information to another provider. You will need three custom procedures codes: one for

reporting macular edema findings present, one for reporting macular edema finds absent, and

one for reporting the level of severity of retinopathy. Each of these procedure codes must be

associated with an appropriate SNOMED code.

REPORT MACULAR EDEMA FINDINGS PRESENT 37231002, 193350004, 193387007, 232020009, 312911008, 312912001, 312920004,

312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000,

408415007, 408416008, 414892004, 414908005, 420486006, 421779007, 432789001

REPORT MACULAR EDEMA FINDINGS ABSENT 428341000124108

REPORT LEVEL OF SEVERITY OF RETINOPATHY 193349004, 312903003, 312904009, 312905005, 390834004, 408411003, 408412005

145

CMS 143; NQF 0086; PQRS 12 PRIMARY OPEN ANGLE GLAUCOMA (POAG): OPTIC NERVE ELEVATION DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of POAG who have an optic

nerve head evaluation during one or more office visits within 12 months.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not performing an optic nerve head evaluation.

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of primary open-angle glaucoma. The

patient must have two visits within the measurement period.

The first visit must include the diagnosis. Enter the diagnosis with a qualifying diagnosis code or

diagnosis code associated with a SNOMED code in the Dx tab of Full Note Composer or other

clinical note type window.

ICD-9 365.10, 365.11, 365.12, 365.15

ICD-10 H40.10, H40.11, H40.121, H40.122, H40.123, H40.129, H40.151, H40.152, H40.153, H40.159

SNOMED 48705003, 66990007, 77075001, 81416004, 84494001, 111513000

ENTERING NUMERATOR DATA Patients who have an optic nerve head evaluation during one or more office visits within 12

months.

146

To report on this measure, you must order or perform an optic nerve head evaluation. This

evaluation must include a cup-to-disc ratio and an optic disc exam for structural abnormalities.

Then enter the test results and give them a status of Resulted or Approved.

Test results must be entered as discrete, quantifiable data. Enter the results in the Patients

Results window using a lab template enabling you to enter the test result value. Results stored

in the database as text notes or image file cannot be used for reporting.

You must associate a LOINC code to the test item on each lab template for both manually


CUP-TO-DISC RATIO LOINC 71484-0, 71485-7

OPTIC DISC EXAM FOR STRUCTURAL ABNORMALITIES LOINC 71486-5, 71487-3

147

CMS 144; NQF 0083; PQRS 8 HEART FAILURE (HF): BETA – BLOCKER THERAPY FOR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVSD) DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a

current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker

therapy either within a 12-month period when seen in the outpatient setting OR at each

hospital discharge.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., low blood

pressure, fluid overload, asthma, patients recently treated with an intravenous positive

inotropic agent, allergy, intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient

declined, other patient reasons). Documentation of system reason(s) for not prescribing beta-

blocker therapy (e.g., other reasons attributable to the healthcare system).

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of heart failure, with a current or prior LVEF

< 40%. The patient must have two or more visits during the measurement period.





ICD-9 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20,

428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, 428.9

148


I50.41, I50.42, I50.43, I50.9

SNOMED 364006, 5053004, 5148006, 5375005, 10091002, 10335000, 10633002, 25544003, 42343007,

43736008, 44313006, 46113002, 48447003, 56675007, 60856006, 66989003, 74960003,

77737007, 80479009, 82523003, 83105008, 84114007, 85232009, 88805009, 90727007,

92506005, 111283005, 128404006, 194767001, 194779001, 194781004, 195111005,

195112003, 195114002, 206586007, 233924009, 277639002, 314206003, 359617009,

359620001, 367363000, 410431009, 417996009, 418304008, 424404003, 426012001,

426263006, 426611007, 441481004, 441530006

To include all patients in denominator, you must order or perform an LVEF test and enter the

result data.

The LVEF test results must either be received through an interface or entered as discrete,

quantifiable data in the Patient Results window using a lab template enabling you to enter the

LVEF percentage. The results must be given a status of Resulted or Approved. Enter the results

in the Patients Results window using a lab template enabling you to enter the test result value.

Results stored in the database as text notes or image file cannot be used for reporting.



LOINC 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9, 18045-5,

18049-7, 18043-0, 18046-3, 18047-1

ENTERING NUMERATOR DATA When the LVEF result is equal to or less than 40 percent, then you must prescribe either an ACE

inhibitor or ARB therapy. Patients who were prescribed beta- blocker therapy either within a 12-

month period when seen in the outpatient setting or at hospital discharge.

149

To report the beta-blocker therapy, write the prescription through the SIG Writer window or

prescription refill message and print the prescription or send it electronically.

150

CMS 145; NQF 0070; PQRS 7 CORONARY ARTERY DISEASE (CAD): BETA – BLOCKER THERAPY – PRIOR MYOCARDIAL INFARCTION (MI) OR LEFT VENTRICULAR SYSTOLIC DYSFUNCTION (LVEF <40%) DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen

within a 12-month period who also have a prior MI or a current or prior LVEF <40% who were

prescribed beta-blocker therapy.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy,

intolerance, other medical reasons).

Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient

declined, other patient reasons).

Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons

attributable to the health care system).

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12

month period. The patient must have two visits.

Equals Initial Patient Population who also have prior MI or a current or prior LVEF <40%.

Please note that this measure produces results for two denominator and numerator

combinations. The denominator information given here is correct for both.


SNOMED code in the Dx tab of Full Note Composer or other clinical note type window or in the

problem enter a problem associated with a qualifying SNOMED code in the problem history

category in the Hx tab of Full Note Composer or the Patient History window.

151

CAD ICD-9 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04,

414.05, 414.06, 414.07, 414.8, 414.9, V45.81, V45.82

CAD ICD-10 I20.0, I20.1, I20.8, I20.9, I24.0, I24.1, I24.8, I24.9, I25.10, I25.110, I25.111, I25.118, I25.119,

I25.5, I25.6, I25.700, I25.701, I25.708, I25.709, I25.710, I25.711, I25.718, I25.719, I25.720,

I25.721, I25.728, I25.729, I25.730, I25.731, I25.738, I25.739, I25.750, I25.751, I25.758, I25.759,

I25.760, I25.761, I25.768, I25.769, I25.790, I25.791, I25.798, I25.799, I25.89, I25.9, Z95.1, Z95.5,

Z98.61

CAD SNOMED 4557003, 10365005, 19057007, 21470009, 28248000, 29899005, 35928006, 41334000,

50570003, 53741008, 59021001, 61490001, 62207008, 63739005, 66189004, 67682002,

74218008, 75398000, 85284003, 87343002, 89323001, 92517006, 123641001, 123642008,

194823009, 194828000, 194842008, 194843003, 233817007, 233819005, 233821000,

233970002, 300995000, 314116003, 315025001, 315348000, 371803003, 371804009,

371805005, 371806006, 371807002, 371808007, 371809004, 371810009, 371811008,

371812001, 398274000, 408546009, 420006002, 421327009, 427919004, 429245005,

429559004

To document a prior MI, enter a problem associated with a SNOMED code in the problem

history category in the Hx tab of Full Note Composer or the Patient History window.

MI ICD-9

410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20, 410.21, 410.22, 410.30, 410.31, 410.32,

410.40, 410.41, 410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62, 410.70, 410.71, 410.72,

410.80, 410.81, 410.82, 410.90, 410.91, 410.92, 412

MI ICD-10 I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I22.0, I22.1, I22.2, I22.8, I22.9,

I24.1, I25.2

152

MI SNOMED 1755008, 10273003, 15990001, 22298006, 30277009, 32574007, 42531007, 52035003,

54329005, 57054005, 58612006, 62695002, 65547006, 70211005, 70422006, 73795002,

79009004, 129574000, 161502000, 161503005, 194798004, 194802003, 194809007,

194856005, 233835003, 233838001, 233839009, 233840006, 233841005, 233842003,

233843008, 275905002, 304914007, 307140009, 308065005, 314207007, 371068009,

394710008, 399211009, 401303003, 401314000, 418044006, 428196007, 428752002

To document cardiac surgery, enter the procedure with a qualifying procedure code or

procedure code associated with a SNOMED code in the SP or SO tab of Full Note Composer or

other clinical note type window. Or enter the surgery in the surgical history category in the Hx

tab of Full Note Composer or the Patient History window. The history question used to enter the

cardiac surgery must be associated with a SNOMED code.

CARDIAC SURGERY CPT 33140, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523,

33533, 33534, 33535, 33536, 92920, 92924, 92928, 92933, 92937, 92941, 92943, 92980, 92981,

92982, 92984, 92995, 92996

CARDIAC SURGERY SNOMED 3546002, 10326007, 15256002, 30670000, 39202005, 39724006, 48431000, 74371005,

81266008, 82247006, 90205004, 119564002, 119565001, 174911007, 175007008, 175008003,

175009006, 175011002, 175021005, 175022003, 175024002, 175025001, 175026000,

175036008, 175037004, 175038009, 175039001, 175040004, 175041000, 175045009,

175047001, 175048006, 175050003, 232717009, 232719007, 232720001, 232721002,

232722009, 232723004, 232724005, 265481001, 275215001, 275216000, 275227003,

275252001, 275253006, 287277008, 309814006

To report on this measure, you must order or perform an LVEF test and enter the result data.

When the LVEF result is equal to or less than 40 percent, then you must prescribe either an ACE

inhibitor or ARB therapy.

153

The LVEF test results must either be received through an interface or entered as discrete,

quantifiable data in the Patient Results window using a lab template enabling you to enter the

LVEF percentage. The results must be given a status of Resulted or Approved.




reporting.



LOINC 8808-8, 8809-6, 8806-2, 8810-4, 8807-0, 8811-2, 8812-0, 10230-1, 18044-8, 18048-9, 18045-5,

18049-7, 18043-0, 18046-3, 18047-1

ENTERING NUMERATOR DATA Patients who were prescribed beta-blocker therapy. To report the beta-blocker therapy, write

the prescription through the SIG Writer window or prescription refill message and print the

prescription or send it electronically.

154

CMS 146; NQF 0002; PQRS 66 APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS DOMAIN Health Resources

MEASURE Percentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an

antibiotic and received a group A streptococcus (strep) test for the episode.

EXCLUSIONS OR EXCEPTIONS Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis.

ENTERING DENOMINATOR DATA Children 2-18 years of age who had an outpatient or emergency department (ED) visit with a

diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three

days after the visit.

You must diagnosis the patient with pharyngitis using one of the diagnosis codes below during a

visit within the measurement period.

ICD-9 034.0, 462, 463

ICD-10 J02.8, J02.9, J03.80, J03.81, J03.90, J03.91

SNOMED 1532007, 17741008, 40766000, 43878008, 55355000, 58031004, 195655000, 195656004,

195657008, 195658003, 195659006, 195660001, 195662009, 195666007, 195667003,

195668008, 195669000, 195670004, 195671000, 195672007, 195673002, 195676005,

195677001, 232399005, 232400003, 302911003, 363746003

You must prescribe an antibiotic within three days following the visit.

155

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and

print the prescription or send it electronically. The antibiotic must be dispensed within three

days after the qualifying visit.


Children with a group A streptococcus test in the seven-day period from three days prior

through three days after the diagnosis of pharyngitis.

To report on this measure, you must prescribe an antibiotic and order a group A streptococcus

(strep) test and enter the test results.

To report the antibiotic, write a prescription for an antibiotic using the SIG writer window and

print the prescription or send it electronically.

To report the strep test, order the test and then either enter the test results or receive them

through an interface and give them a status of Resulted or Approved.

The strep test results not received through an interface must be entered as discrete,

quantifiable data. Enter the results in the Patients Results window using a lab template enabling

you to enter the strep value. Results stored in the database as text notes or image file cannot be

used for reporting.

You must associate a LOINC code to the strep test item on each lab template for both manually

entered and electronic results. LOINC codes for this result are listed below.

LOINC 626-2, 5036-9, 6559-9, 6556-5, 6557-3, 6558-1, 11268-0, 17656-0, 18481-2, 31971-5, 49610-9,

60489-2, 68954-7

156

CMS 147; NQF 0041; PQRS 110 PREVENTATIVE CARE AND SCREENING: INFLUENZA IMMUNIZATION DOMAIN Public Health

MEASURE Percentage of patients aged 6 months and older seen for a visit between October 1 and March

31 who received an influenza immunization OR who reported previous receipt of an influenza

immunization.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not receiving influenza immunization (eg,

patient allergy, other medical reasons).

Documentation of patient reason(s) for not receiving influenza immunization (eg,

patient declined, other patient reasons).

Documentation of system reason(s) for not receiving influenza immunization (eg,

vaccine not available, other system reasons).


Equals Initial Patient Population and seen for a visit between October 1 and March 31.

The patient must have a visit during flu season, which is defined as October of the prior year

through March of the current year.

The patient must also have one, or in some circumstances two, additional visits during the

reporting period.

ENTERING NUMERATOR DATA Patients who received an influenza immunization OR who reported previous receipt of an

influenza immunization.

To report on this measure, you must document the administration of the flu immunization, or

enter it in the vaccine history category. The vaccine must have been administered between

October of the prior year and March of the current year.

157

To document the influenza immunization, enter the vaccination in the vaccine administration

record using one of the following CPT codes or a procedure code associated with a SNOMED

code. Enter the procedure in the SP tab of Full Note Composer or other clinical note type

window. Then document the vaccination details in the vaccine administration record.

You may also document the pneumonia immunization by using a type of vaccine associated with

the qualifying CVX code. Identify the type of vaccine when documenting the vaccine details in

the vaccine administration record.

To document a vaccination given in the past, you must use a type of vaccine associated with the

qualifying CVX code. Enter the vaccination in the vaccination history category in the Hx tab of

Full Note Composer or in the Patient History window. Then, identify the type of vaccine when

documenting the vaccine details in the vaccine administration record. Please note that you must

make this entry in a visit during the flu season.

CPT 90656, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668

SNOMED 86198006, 442333005

CVX 111, 135, 140, 141, 144

158

CMS 149; NQF NA; PQRS 281 DEMENTIA: COGNITIVE ASSESSMENT DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment

of cognition is performed and the results reviewed at least once within a 12-month period.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not assessing cognition (e.g., patient with very

advanced stage dementia, other medical reason).

Documentation of patient reason(s) for not assessing cognition.

ENTERING DENOMINATOR DATA All patients, regardless of age, with a diagnosis of dementia. The patient must have two visits.

ICD-9 094.1, 290.0, 290.10, 290.11, 290.12, 290.13, 290.20, 290.21, 290.3, 290.40, 290.41, 290.42,

290.43, 290.8, 290.9, 294.10, 294.11, 294.20, 294.21, 294.8, 331.0, 331.11, 331.19, 331.82

ICD-10 A52.17, F01.50, F01.51, F02.80, F02.81, F03.90, F03.91, F05, F06.0, F06.8, G30.0, G30.1, G30.8,

G30.9, G31.01, G31.09, G31.83

SNOMED 281004, 4817008, 6475002, 10349009, 10532003, 12348006, 14070001, 15662003, 25772007,

26852004, 32875003, 51928006, 52448006, 54502004, 55009008, 56267009, 59651006,

62239001, 65096006, 66108005, 70936005, 82959004, 90099008, 111480006, 191449005,

191451009, 191452002, 191454001, 191455000, 191457008, 191458003, 191459006,

191461002, 191463004, 191464005, 191465006, 191466007, 191493005, 230270009,

159

230283005, 230286002, 230287006, 230288001, 230290000, 278857002,279982005,

312991009, 371024007, 371026009, 416780008, 420614009, 421023003, 421529006,

425390006, 429998004, 442344002, 428351000124105

ENTERING NUMERATOR DATA Patients for whom an assessment of cognition is performed and the results reviewed at least

once within a 12-month period.

To report on this measure, enter the assessment using a procedure code or a procedure code

associated with a SNOMED code. You may enter the procedure in either the SP or the SO tab of

Full Note Composer or other clinical note type window.

CPT 97003, 97004

SNOMED 4719001, 113024001





LOINC 58151-2, 71492-3, 71493-1, 71722-3, 72106-8, 72172-0, 72173-8





assessment. Enter the score of the functional status assessment in the observation template on

the Observation tab. Please note that entries in the Cognitive and Functional Assessment history

categories do not count for this measure.

160

CMS 153; NQF 0033; PQRS 310 CHLAMYDIA SCREENING FOR WOMEN DOMAIN Public Health

MEASURE Percentage of women 16 through 24 years of age who were identified as sexually active and

who had at least one test for Chlamydia during the measurement period.

EXCLUSIONS OR EXCEPTIONS Women who received a pregnancy test solely as a safety precaution before ordering an x-ray or

specified medications.

ENTERING DENOMINATOR DATA This measure reports for two groups of patients. Those aged 16 to 20, and those aged 21 to 24.

The patient must have at least one visit during the measurement period.

The patient must be identified as sexually active. Patients may identify as sexually active in a

number of ways, including a procedure for a pregnancy test, a diagnosis for pregnancy or

pregnancy related problem, a procedure for a birth, a lab test for or a diagnosis for a sexually

transmitted infection, a prescription for contraceptives, a procedure for a contraceptive device,

and a procedure for infertility treatments. Patients who received a pregnancy test solely as a

safety precaution before ordering an x-ray or specified medications are excluded. However, this

exclusion does not apply to patients who qualify for the initial patient population based on

services other than the pregnancy test alone.

ENTERING NUMERATOR DATA To report on this measure, you must order or perform a Chlamydia test, and then either enter

the test results or receive them through an interface and give them a status of Resulted or

Approved.

Chlamydia test results not received through an interface must be entered as discrete,


161

you to enter the test result value. Results stored in the database as text notes or image file

cannot be used for reporting.

You must associate a LOINC code to the Chlamydia test item on each lab template for both

manually entered and electronic results.

LOINC CODES 4993-2, 5089-8, 5090-6, 5087-2, 5088-0, 6352-9, 6349-5, 6353-7, 6350-3, 6354-5, 6357-8, 6351-

1, 6355-2, 6356-0, 6918-7, 6919- 5, 6920-3, 7824-6, 13220-9, 13217-5, 13221-7, 13218-3, 13219-

1, 14201-8, 14199-4, 14202-6, 14203-4, 14200-0, 14204-2, 14461-8, 14462-6, 14465-9, 14463-4,

14470-9, 14464-2, 14467-5, 14471-7, 14468-3, 14472-5, 14469-1, 14474-1, 14507-8, 14508-6,

14509-4, 14513-6, 14510-2, 14511-0, 16596-9, 16594-4, 16597-7, 16600-9, 16598-5, 16595-1,

16601-7, 16599-3, 18492-9, 18490-3, 18491-1, 21188-8, 21189-6, 21190-4, 21187-0, 21191-2,

21192-0, 21613-5, 22187-9, 22188-7, 22192-9, 22189-5, 22193-7, 22190-3, 22194-5, 22197-8,

22191-1, 22198-6, 22195-2, 22201-8, 22199-4, 22196-0, 22202-6, 22200-0, 23838-6, 26626-2,

26663-5, 26666-8, 26664-3, 26667-6, 26668-4, 26665-0, 26715-3, 27167-6, 27185-8, 27370-6,

27371-4, 27368-0, 28556-9, 28557-7, 28558-5, 30204-2, 31295-9, 31293-4, 31296-7, 31294-2,

31297-5, 31298-3, 31771-9, 31768-5, 31772-7, 31769-3, 31776-8, 31770-1, 31774-3, 1777-6,

31775-0, 32006-9, 32007-7, 32005-1, 33574-5, 33575-2, 33605-7, 33604-0, 34709-6, 34710-4,

36902-5, 36903-3, 38469-3, 40710-6, 40855-9, 40856-7, 40854-2, 41157-9, 42931-6, 43058-7,

43062-9, 43059-5, 43060-3, 43061-1, 43175-9, 43173-4, 43174-2, 43304-5, 43355-7, 43356-5,

43357-3, 43406-8, 43404-3, 43405-0, 43848-1, 44005-7, 44079-2, 44806-8, 44807-6, 44983-5,

44986-8, 44984-3, 44987-6, 44991-8, 44988-4, 44985-0, 44992-6, 44995-9, 44989-2, 44993-4,

44996-7, 44990-0, 44994-2, 44997-5, 45000-7, 44998-3, 45004-9, 45001-5, 44999-1, 45002-3,

45005-6, 45009-8, 45003-1, 45006-4, 45007-2, 45008-0, 45067-6, 45068-4, 45072-6, 45075-9,

45069-2, 45073-4, 45076-7, 45070-0, 45080-9, 45074-2, 45078-3, 45085-8, 45086-6, 45090-8,

45084-1, 45091-6, 45092-4, 45095-7, 45089-0, 45093-2, 45096-5, 45094-0, 45130-2, 45135-1,

46176-4, 46177-2, 46178-0, 47211-8, 47212-6, 47234-0, 47362-9, 49096-1, 50387-0, 51734-2,

53925-4, 53926-2, 57287-5, 57288-3, 64017-7

162

CMS 154; NQF 0069; PQRS 65 APPROPRIATE TREATMENT FOR CHILDREN WITH UPPER RESPIRATORY INFECTION (URI) DOMAIN Health Resources

MEASURE Percentage of children 3 months through 18 years of age who were diagnosed with upper

respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days

after the episode.

Please note that for this measure, the desired outcome is to have the numerator be a low

number.

EXCLUSIONS OR EXCEPTIONS Exclude children who are taking antibiotics in the 30 days prior to the date of the encounter.

Exclude children who had an encounter with a competing diagnosis within three days after the

initial diagnosis.

ENTERING DENOMINATOR DATA The patient must be between 3 months and 18 years of age. The patient must have an

outpatient or emergency department visit with a diagnosis of upper respiratory infection (URI)

during the measurement period. You must diagnosis the patient with an upper respiratory

infection using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab of Full

Note Composer or other clinical note type window.

ICD-9 460, 465.0, 465.8, 465.9

ICD-10 J00, J06.0, J06.9

163

SNOMED 195708003, 281794004, 54150009, 54398005, 55355000, 78337007, 82272006

ENTERING NUMERATOR DATA To report on this measure, you must not write a prescription for an antibiotic on the date of the

visit or within three days of the visit. Patients for whom an antibiotic prescription is written are

included in the denominator, but not in the numerator.

164

CMS 155; NQF 0024; PQRS 239 WEIGHT ASSESSMENT AND COUNSELING FOR NUTRITION AND PHYSICAL ACTIVITY FOR CHILDREN AND ADOLESCENTS DOMAIN Public Health

MEASURE Percentage of patients 3 through 17 years of age who had an outpatient visit with a Primary

Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the

following during the measurement period. Three rates are reported:

Percentage of patients with height, weight, and body mass index (BMI) percentile

documentation

Percentage of patients with counseling for nutrition

Percentage of patients with counseling for physical activity

EXCLUSIONS OR EXCEPTIONS Patients who have a diagnosis of pregnancy during the measurement period.

ENTERING DENOMINATOR DATA The patient must between 3 and 17 years old. The patient must have at least one visit with a

primary care physician or an obstetrician/gynecologist (OB/GYN) during the measurement

period.

ENTERING NUMERATOR DATA This measure has three different numerators.

To be included in the first numerator, you must enter the BMI. To record the BMI percentile,

you must enter the patient’s height and weight in the Vitals tab of the patient visit note. The

application automatically calculates the BMI.

For this measure, you must associate one of the qualifying LOINC codes with the system-defined

BMI observation item. Please note that the LOINC codes appropriate for children and

adolescents are different from the LOINC code for adults. If you are also reporting on CMS 69

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up, you will need

165

to generate your CQM QRDA files twice. You will need to associate the LOINC code for adults to

the BMI observation item, and generate the report to obtain your counts for the CMS 69

measure. Then you will need associate the LOINC code for children to the BMI observation item,

and generate the report to obtain your counts for this measure.

LOINC FOR CHILDREN AND ADOLESCENTS BMI 59574-4, 59575-1, 59576-9

To be included in the second numerator, you must record counseling for nutrition was

performed. You can either enter the ICD-9 procedure code V65.3 in the Dx tab or enter one of

the following.

CPT CODES 97802, 97803, 97804, 98961, 98962, 99078

HCPCS

G0270, G0271, G8417, S9451, S9452, S9449, S9470

To be included in the third numerator, you must record that counseling for physical activity was

performed. You can either enter the ICD-9 procedure code V65.41 in the Dx tab and one of the

following CPT or HCPCS codes in the SP tab of the patient visit note.

CPT 98961, 98962, 99078

HCPCS S9449, S9451, G8417

If you typically use an education form with or for nutrition or physical activity counseling and the

procedure code is associated with the education form, selecting the education form from the

Education Form slider in Full Note Composer or other clinical note type will add the procedure

code to the SP tab. The education form must also be associated with the patient communication

type Nutrition or the patient communication type Physical Activity.

166

CMS 156; NQF 0022; PQRS 238 USE OF HIGH RISK MEDICATIONS IN THE ELDERLY DOMAIN Patient Safety

MEASURE Percentage of patients 66 years of age and older who were ordered high-risk medications. Two

rates are reported.

Percentage of patients who were ordered at least one high-risk medication.

Percentage of patients who were ordered at least two high-risk medications.


ENTERING DENOMINATOR DATA The patient must be 66 years old or older and must have at least one visit during the

measurement period.

ENTERING NUMERATOR DATA To report on this measure, you must write all prescriptions through the SIG Writer window or

prescription refill message and print the prescriptions or send them electronically.

Patients 66 years old or older are counted in the first numerator if there is a prescription for a

high-risk medication. These patients are counted in the second numerator if there are

prescriptions for two or more high-risk medications.

167

CMS 157; NQF 0384; PQRS 143 ONCOLOGY: MEDICAL AND RADIATION – PAIN INTENSITY QUANTIFIED



Aprima PRM.

168

CMS 158; NQF 0608; PQRS 369 PREGNANT WOMEN THAT HAD HBSAG TESTING DOMAIN Clinical Processes and Effectiveness

MEASURE This measure identifies pregnant women who had a HBsAg (hepatitis B) test during their

pregnancy.

EXCLUSIONS OR EXCEPTIONS Patients with current or past Hepatitis B infection.

ENTERING DENOMINATOR DATA All female patients aged 12 and older who had a full-term delivery during the measurement

period.

To chart the delivery, you must enter a procedure code or a procedure code that is associated

with a SNOMED code. You may enter the procedure in either the SP or the SO tab of Full Note


CPT 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622

SNOMED 5556001, 10745001, 11466000, 14119008, 15413009, 16819009, 17860005, 18302006,

18625004, 19390001, 22633006, 25296001, 25828002, 26313002, 29613008, 30476003,

38479009, 40219000, 45718005, 52660002, 54973000, 57271003, 61586001, 62508004,

69162008, 69422002, 71166009, 72492007, 84195007, 85403009, 89053004, 89346004,

89849000, 90438006, 177128002, 177141003, 177142005, 177143000, 177152009, 177157003,

177158008, 177161009, 177162002, 177164001, 177167008, 177168003, 177170007,

177173009, 177174003, 177175002, 177176001, 177179008, 177180006, 177181005,

177184002, 177203002, 182619004, 236973005, 236974004, 236975003, 236976002,

169

236977006, 236978001, 236985002, 236986001, 236989008, 237311001, 265639000,

274128005, 274129002, 274130007, 275168001, 275169009, 287976008, 287977004,

302375005, 302382009, 302383004, 306727001, 315308008, 359940006, 359943008,

384729004, 386622003, 387711001, 398307005, 416055001, 417121007

You may also chart the delivery using a diagnosis code or a diagnosis code associated with a

qualifying SNOMED code. Enter the diagnosis code in the Dx tab of Full Note Composer or other

clinical note type window or in the problem/diagnosis category of the Patient History window.

ICD-9 642.01, 642.02, 642.04, 642.11, 642.12, 642.14, 642.21, 642.22, 642.24, 642.31, 642.32, 642.41,

642.42, 642.44, 642.91, 643.01, 643.11, 643.21, 643.81, 643.91, 645.11, 645.21, 646.01, 646.41,

646.42, 646.51, 646.52, 646.54, 646.71, 646.81, 646.82, 646.91, 647.01, 647.02, 647.11, 647.12,

647.21, 647.22, 647.31, 647.32, 647.41, 647.42, 647.51, 647.52, 647.61, 647.62, 647.81, 647.82,

647.91, 647.92, 648.11, 648.14, 648.21, 648.22, 648.41, 648.42, 648.51, 648.52, 648.61, 648.62,

648.71, 648.72, 648.81, 648.82, 648.84, 648.91, 648.92, 650, 651.01, 651.11, 651.21, 651.31,

651.41, 651.51, 651.61, 651.81, 651.91, 652.01, 652.21, 652.31, 652.41, 652.51, 652.61, 652.81,

653.01, 653.11, 653.21, 653.31, 653.41, 653.51, 653.61, 653.71, 653.81, 653.91, 654.01, 654.02,

654.11, 654.12, 654.14, 654.21, 654.31, 654.32, 654.41, 654.42, 654.71, 654.72, 654.81, 654.82,

654.91, 654.92, 659.41, 659.51, 659.61, 660.01, 660.11, 660.21, 660.31, 660.41, 660.51, 660.91,

661.01, 661.11, 661.21, 661.31, 661.41, 661.91, 662.01, 662.11, 662.21, 662.31, 664.00, 664.01,

664.10, 664.11, 664.20, 664.21, 664.30, 664.31, 664.40, 664.41, 664.50, 664.51, 664.60, 664.61,

664.80, 664.81, 664.90, 664.91, 665.22, 665.24, 665.31, 665.41, 665.51, 665.61, 665.71, 665.81,

665.91, 666.02, 666.12, 666.32, 667.00, 667.02, 667.04, 667.10, 667.12, 667.14, 669.50, 669.51,

669.60, 669.61, 669.70, 669.71, 669.81, 669.91, 671.01, 671.02, 671.11, 671.12, 671.21, 671.22,

V27.0, V27.2, V27.3, V27.5, V27.6, V27.9

ICD-10 F53, O10.02, O10.03, O10.12, O10.13, O10.22, O10.23, O10.32, O10.33, O10.42, O10.43,

O10.92, O10.93, O15.2, O24.02, O24.03, O24.12, O24.13, O24.32, O24.33, O24.420, O24.424,

O24.429, O24.430, O24.434, O24.439, O24.82, O24.83, O24.92, O24.93, O25.2, O25.3, O26.62,

O26.63, O26.72, O26.73, O60.20, O60.22, O60.23, O62.3, O62.4, O62.8, O62.9, O63.0, O63.1,

170

O63.2, O63.9, O64.0XX0, O64.1XX0, O64.2XX0, O64.3XX0, O64.4XX0, O64.5XX0, O64.8XX0,

O64.9XX0, O65.0, O65.1, O65.2, O65.3, O65.4, O65.5, O65.8, O65.9, O66.0, O66.1, O66.2, O66.3,

O66.41, O66.5, O66.6, O66.8, O66.9, O67.0, O67.8, O67.9, O68, O69.0, O69.1, O69.2, O69.3,

O69.4, O69.5, O69.81, O69.82, O69.89, O69.9, O70.0, O70.1, O70.2, O70.3, O70.4, O70.9, O71.2,

O71.3, O71.4, O71.5, O71.6, O71.7, O71.89, O71.9, O72.0, O72.1, O72.2, O73.0, O73.1, O74.0,

O74.1, O74.2, O74.3, O74.4, O74.5, O74.6, O74.7, O74.8, O74.9, O75.0, O75.1, O75.5, O75.81,

O75.89, O75.9, O76, O77.0, O77.1, O77.8, O77.9, O80, O82, O85, O86.81, O86.89, O87.0, O87.1,

O87.2, O87.3, O87.4, O87.8, O87.9, O88.02, O88.03, O88.12, O88.13, O88.22, O88.23, O88.32,

O88.33, O88.82, O88.83, O89.01, O89.09, O89.1, O89.2, O89.3, O89.4, O89.5, O89.6, O89.8,

O89.9, O90.81, O90.89, O90.9, O91.02, O91.12, O91.22, O92.02, O92.12, O92.20, O92.29,

O98.02, O98.03, O98.12, O98.13, O98.22, O98.23, O98.32, O98.33, O98.42, O98.43, O98.52,

O98.53, O98.62, O98.63, O98.72, O98.73, O98.82, O98.83, O98.92, O98.93, O99.02, O99.03,

O99.12, O99.13, O99.214, O99.215, O99.284, O99.285, O99.314, O99.315, O99.324, O99.325,

O99.334, O99.335, O99.344, O99.345, O99.354, O99.355, O99.42, O99.43, O99.52, O99.53,

O99.62, O99.63, O99.72, O99.73, O99.814, O99.815, O99.824, O99.825, O99.834, O99.835,

O99.844, O99.845, O99.89, O9A.12, O9A.13, O9A.22, O9A.23, O9A.32, O9A.33, O9A.42, O9A.43,

O9A.52, O9A.53, Z37.0, Z37.2, Z37.3, Z37.59, Z37.69, Z37.7

SNOMED 4787007, 5740008, 10950002, 14331002, 16574001, 21987001, 22846003, 23885003,

24258008, 28627008, 35347003, 42599006, 46502006, 48782003, 48888007, 49815007,

50968003, 61007003, 64646001, 64954002, 102879009, 106007006, 128077009, 169961004,

198617006, 199063009, 199314001, 199934009, 199935005, 200130005, 200133007,

200138003, 200142000, 200146002, 200148001, 200149009, 200150009, 237313003,

237321009, 237325000, 271368004, 271369007, 271373005, 274127000, 274128005,

274129002, 288209009, 289259007, 302254004, 309469004

ENTERING NUMERATOR DATA Patients who were tested for Hepatitis B surface antigen (HBsAg) during pregnancy within 280

days prior to delivery.

171

To report on this measure, you must order or perform a HBsAg test, and then either enter the

test results or receive them through an interface and give them a status of Resulted or

Approved. Test results not received through an interface must be entered as discrete,


you to enter the test result value. Results stored in the database as text notes or image file

cannot be used for reporting. You must associate a LOINC code to the HBsAg test item on each

lab template for both manually entered and electronic results.

LOINC 5197-9, 5195-3, 5196-1, 7905-3, 10675-7, 10674-0, 24364-2, 58452-4, 63557-3, 65633-0

172

CMS 159; NQF 0710; PQRS 370 DEPRESSION REMISSION AT TWELVE MONTHS DOMAIN Clinical Processes and Effectiveness

MEASURE Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score >

9 who demonstrate remission at twelve months defined as PHQ-9 score less than five. This

measure applies to both patients with newly diagnosed and existing depression whose current

PHQ-9 score indicates a need for treatment.

EXCLUSIONS OR EXCEPTIONS Patients who died.

Patients who received hospice services.

Patients who were permanent nursing home residents (> 1 year).

Patients with a diagnosis of bipolar disorder.

Patients with a diagnosis of personality disorder.


Adults age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9

score greater than nine during an outpatient encounter.





ICD-9 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35,

298.0, 300.4, 309.1, 311

173


F34.1, F34.1

SNOMED 832007, 2506003, 2506003, 2618002, 3109008, 3109008, 14183003, 15193003, 15639000,

18818009, 19694002, 19694002, 20250007, 25922000, 28475009, 30605009, 33078009,

33135002, 33736005, 36170009, 36170009, 36474008, 36923009, 38451003, 38451003,

38694004, 39809009, 40379007, 42810003, 42925002, 60099002, 63778009, 66344007,

67711008, 67711008, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000,

76441001, 77911002, 78667006, 78667006, 79298009, 83176005, 83176005, 83458005,

84788008, 85080004, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000,

191610000, 191611001, 191613003, 191676002, 192049004,231499006, 231504006,

268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001,

370143000, 430852001

To report on this measure, you must have set up an observation item for the PHQ-9

assessment score, and put the observation item in an observation template. The

observation item must include the appropriate LOINC code for the PHQ-9 assessment.

LOINC 44249-1, 44257-4, 44261-6, 54635-8





assessment.

Enter the score of the PHQ-9 assessment in the observation template on the Observation tab.

174

ENTERING NUMERATOR DATA Adults who achieved remission at twelve months as demonstrated by a twelve month (+/- 30

days) PHQ-9 score of less than five. The visit that includes the follow up PHQ-9 assessment must

be at least 11 months after and less than 13 months after the first assessment.

To report on this measure, you must have set up an observation item for the PHQ-9 assessment

score, and put the observation item in an observation template. The observation item must

include the appropriate LOINC code for the PHQ-9 assessment.

LOINC 44249-1, 44257-4, 44261-6, 54635-8





assessment.


175

CMS 160; NQF 0712; PQRS 371 DEPRESSION UTILIZATION OF THE PHQ-9 TOOL

Please note: This measure cannot be reported on if the reporting period is less than one year.

DOMAIN Clinical Processes and Effectiveness

MEASURE Adult patients age 18 and older with the diagnosis of major depression or dysthymia who have a

PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying

visit.

EXCLUSIONS OR EXCEPTIONS Patients who died

Patients who received hospice services

Patients who were permanent nursing home residents (> 1 year)

Patients with a diagnosis of bipolar disorder

Patients with a diagnosis of personality disorder

ENTERING DENOMINATOR DATA Adult patients age 18 and older with an office visit and the diagnosis of major depression or

dysthymia during each four-month period.

Denominator 1: The patient must have an active diagnosis of major depression or

dysthymia during the last 4 months of the measurement year.


dysthymia during the 5th to 8th month of the measurement year.


dysthymia during the first 4 months of the measurement year.





176

ICD-9 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35,

298.0, 300.4, 309.1, 311


F34.1, F34.1

SNOMED 832007, 2506003, 2506003, 2618002, 3109008, 3109008, 14183003, 15193003, 15639000,

18818009, 19694002, 19694002, 20250007, 25922000, 28475009, 30605009, 33078009,

33135002, 33736005, 36170009, 36170009, 36474008, 36923009, 38451003, 38451003,

38694004, 39809009, 40379007, 42810003, 42925002, 60099002, 63778009, 66344007,

67711008, 67711008, 68019004, 69392006, 70747007, 71336009, 73867007, 75084000,

76441001, 77911002, 78667006, 78667006, 79298009, 83176005, 83176005,83458005,

84788008, 85080004, 85080004, 87414006, 87512008, 191601008, 191602001, 191604000,

191610000, 191611001, 191613003, 191676002, 192049004, 231499006, 231504006,

268620009, 268621008, 274948002, 300706003, 319768000, 320751009, 321717001,

370143000, 430852001

ENTERING NUMERATOR DATA Adult patients who have a PHQ-9 tool administered at least once during the four-month period.

Numerator 1: The PHQ-9 assessment must be performed in the last 4 months of the

measurement year.

Numerator 2: The PHQ-9 assessment must be performed in the 5th to 8th months of the

measurement year.

Numerator 3: The PHQ-9 assessment must be performed in the first 4 months of the

measurement year.

To report on this measure, you must have set up an observation item for the PHQ-9 assessment

score, and put the observation item in an observation template. The observation item must

include the appropriate LOINC code for the PHQ-9 assessment.

177

LOINC 44249-1, 44257-4, 44261-6, 54635-8





assessment.


178

CMS 161; NQF 0104; PQRS 107 MAJOR DEPRESSIVE DISORDER (MDD): SUICIDE RISK ASSESSMENT DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of

MDD who had a suicide risk assessment completed at each visit during the measurement

period.


ENTERING DENOMINATOR DATA All patients aged 18 years and older with a new diagnosis or recurrent episode of MDD. Enter

the diagnosis with a qualifying diagnosis code or diagnosis code associated with a SNOMED code

in the Dx tab of Full Note Composer or other clinical note type window or enter a problem



ICD-9 296.20, 296.21, 296.22, 296.23, 296.24, 296.30, 296.31, 296.32, 296.33, 296.34

ICD-10 F32.0, F32.1, F32.2, F32.3, F32.9, F33.0, F33.1, F33.2, F33.3, F33.9,

SNOMED 832007, 2618002, 14183003, 15193003, 15639000, 18818009, 20250007, 25922000, 28475009,

33078009, 33736005, 36474008, 36923009, 38694004, 39809009, 40379007, 42925002,

60099002, 63778009, 66344007, 69392006, 71336009, 73867007, 75084000, 76441001,

77911002, 79298009, 87512008, 191610000, 191611001, 191613003, 268621008, 319768000,

320751009, 370143000, 430852001

179

ENTERING NUMERATOR DATA Patients who had suicide risk assessment completed at each visit. To chart the assessment, you

must enter a procedure code that is associated with the SNOMED code 225337009. Enter the

procedure in the SP tab of Full Note Composer or other clinical note type window.

180

CMS 164; NQF 0068; PQRS 204 ISCHEMIC VASCULAR DISEASE (IVD): USE OF ASPIRIN OR ANOTHER ANTITHROMBIC MEDICATION DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients 18 years of age and older who were discharged alive for acute

myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary

interventions (PCI) in the 12 months prior to the measurement period, or who had an active

diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had

documentation of use of aspirin or another antithrombotic during the measurement period.


ENTERING DENOMINATOR DATA Patients 18 years of age and older with a visit during the measurement period, and an active

diagnosis of ischemic vascular disease (IVD) or who were discharged alive for acute myocardial

infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions

(PCI) in the 12 months prior to the measurement period.

THE PATIENT MUST EITHER Have an active diagnosis of IVD during the measurement period, or

Have an active diagnosis of AMI within 12 months before the start of the measurement

period and still active during the measurement period, or

Have had a PCI performed less than 12 months before the start of the measurement

period, or

Have had CABG performed less than 12 months before the start of the measurement

period.

181





Acute Myocardial Infarction

ICD-9 410.01, 410.11, 410.21, 410.31, 410.41, 410.51, 410.61, 410.71, 410.81, 410.91

ICD-10 I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4

SNOMED 282006, 10273003, 15990001, 30277009, 52035003, 54329005, 57054005, 58612006,

59063002, 2695002, 64627002, 65547006, 70211005, 70422006, 70998009, 73795002,

76593002, 79009004, 194798004, 194802003, 194809007, 233825009, 233826005, 233827001,

233828006, 233829003, 233830008, 233831007, 233832000, 233833005, 233834004,

233835003, 233836002, 233837006, 233838001, 304914007, 307140009, 401303003,

401314000

Ischemic Vascular Disease

ICD-9 411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9, 414.00, 414.01, 414.02, 414.03, 414.04,

414.05, 414.06, 414.07, 414.2, 414.8, 414.9, 429.2, 433.00, 433.01, 433.10, 433.11, 433.20,

433.21, 433.30, 433.31, 433.80, 433.81, 433.90, 433.91, 434.00, 434.01, 434.10, 434.11, 434.90,

434.91, 440.1, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.4, 444.0, 444.1, 444.21,

444.22, 444.81, 444.89, 444.9, 445.01, 445.02, 445.81


I25.5, I25.6, I25.700, I25.701, I25.708, I25.709, I25.710, I25.711, I25.718, I25.719, I25.720,

I25.721, I25.728, I25.729, I25.730, I25.731, I25.738, I25.739, I25.750, I25.751, I25.758, I25.759,

182

I25.760, I25.761, I25.768, I25.769, I25.790, I25.791, I25.798, I25.799, I25.810, I25.811, I25.812,

I25.82, I25.89, I25.9, I63.00, I63.011, I63.012, I63.019, I63.02, I63.031, I63.032, I63.039, I63.09,

I63.10, I63.111, I63.112, I63.119, I63.12, I63.131, I63.132, I63.139, I63.19, I63.20, I63.211,

I63.212, I63.219, I63.22, I63.231, I63.232, I63.239, I63.29, I63.30, I63.311, I63.312, I63.319,

I63.321, I63.322, I63.329, I63.331, I63.332, I63.339, I63.341, I63.342, I63.349, I63.39, I63.40,

I63.411, I63.412, I63.419, I63.421, I63.422, I63.429, I63.431, I63.432, I63.439, I63.441, I63.442,

I63.449, I63.49, I63.50, I63.511, I63.512, I63.519, I63.521, I63.522, I63.529, I63.531, I63.532,

I63.539, I63.541, I63.542, I63.549, I63.59, I63.6, I63.8, I63.9, I65.01, I65.02, I65.03, I65.09, I65.1,

I65.21, I65.22, I65.23, I65.29, I65.8, I65.9, I66.01, I66.02, I66.03, I66.09, I66.11, I66.12, I66.13,

I66.19, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I70.1, I70.201, I70.202, I70.203, I70.208,

I70.209, I70.211, I70.212, I70.213, I70.218, I70.219, I70.221, I70.222, I70.223, I70.228, I70.229,

I70.231, I70.232, I70.233, I70.234, I70.235, I70.238, I70.239, I70.241, I70.242, I70.243, I70.244,

I70.245, I70.248, I70.249, I70.25, I70.261, I70.262, I70.263, I70.268, I70.269, I70.291, I70.292,

I70.293, I70.298, I70.299, I70.92, I74.0, I74.10, I74.11, I74.19, I74.2, I74.3, I74.4, I74.5, I74.8,

I74.9, I75.011, I75.012, I75.013, I75.019, I75.021, I75.022, I75.023, I75.029, I75.81, I75.89

SNOMED 1055001, 4557003, 5534004, 14977000, 19057007, 20059004, 21470009, 23687008, 25106000,

26900001, 28790007, 29899005, 35928006, 39823006, 41334000, 45281005, 48601002,

49176002, 50808002, 51274000, 51677000, 52674009, 53741008, 54519002, 54687002,

55382008, 57357009, 59021001, 59062007, 60989005, 61490001, 63739005, 64586002,

64775002, 65084004, 65198009, 66189004, 67682002, 67992007, 69742007, 71444005,

72092001, 73192008, 75543006, 81817003, 85284003, 87343002, 88174006, 89323001,

90520006, 92517006, 95458005, 95459002, 95580006, 109381003, 111291001, 111296006,

111298007, 111299004, 123641001, 123642008, 129573006, 194823009, 194828000,

194842008, 194843003, 194849004, 195182007, 195183002, 195185009, 195186005,

195189003, 195190007, 195200006, 195206000, 195230003, 195231004, 195232006,

195233001, 195234007, 195235008, 195236009, 195254008, 195317001, 195318006,

195319003, 195320009, 195321008, 195323006, 195324000, 195325004, 195326003,

195327007, 195335005, 195336006, 195337002, 195340002, 195341003, 195342005,

195343000, 225566008, 230692004, 230693009, 230694003, 230695002, 230698000,

230699008, 230700009, 230701008, 230702001, 230703006, 230704000, 230706003,

183

230707007, 230708002, 233817007, 233819005, 233821000, 233823002, 233844002,

233955003, 233956002, 233958001, 233959009, 233960004, 233961000, 233962007,

233964008, 233970002, 233972005, 233973000, 233974006, 236120009, 251024009,

266253001, 266254007, 266262004, 266263009, 274101000, 276219001, 280871000,

281091000, 287731003, 297136002, 297138001, 297141005, 300917007, 300920004,

300995000, 301755001, 302728008, 302904002, 302910002, 302930003, 307363008,

307406004, 307407008, 307408003, 307409006, 307766002, 307767006, 312375001,

312378004, 312822006, 314116003, 315025001, 315348000, 361132001, 361133006,

363340006, 371039008, 371803003, 371804009, 371805005, 371806006, 371807002,

371808007, 371809004, 371810009, 371811008, 371812001, 394659003, 402861007,

408546009, 408665008, 413102000, 413439005, 413444003, 413552002, 413838009,

413844008, 414545008, 414795007, 420006002, 425527003, 426107000, 426651005,

427296003, 427567003, 428196007, 428507003, 429245005, 429559004, 429673002,

431466007, 432083006, 432504007, 441574008, 442224005, 442240008, 442421004,

442439008, 442693003, 442701004, 442735001, 443502000, 443971004, 444855007,

444856008, 446712002

To chart the CABG or PCI, enter a procedure code or a procedure code that is associated with a

qualifying SNOMED code. You may enter the procedure in either the SP or the SO tab of Full

Note Composer or other clinical note type window.

Coronary Artery Bypass Graft

HCPCS S2205, S2206, S2207, S2208, S2209

CPT 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33533,

33534, 33535, 33536

SNOMED 3546002, 10326007, 30670000, 39202005, 39724006, 48431000, 74371005, 82247006,

119564002, 119565001, 175007008, 175008003, 175009006, 175011002, 175021005,

184

175022003, 175024002, 175025001, 175026000, 175029007, 175030002, 175031003,

175032005, 175033000, 175045009, 175047001, 175048006, 175050003, 232717009,

232719007, 232720001, 232721002, 232722009, 232723004, 232724005, 265481001,

275215001, 275216000, 275252001, 275253006, 309814006, 359597003, 359601003,

414088005, 418551006, 419132001

Percutaneous Coronary Interventions

HCPCS G0290

CPT 33140, 92980, 92982, 92995

SNOMED 11101003, 15256002, 75761004, 80762004, 85053006, 91338001, 175066001, 232727003,

232728008, 232729000, 397193006, 397431004, 414089002, 414509005, 415070008,

428488008, 429499003, 429639007, 431759005

ENTERING NUMERATOR DATA Patients who have documentation of use of aspirin or another antithrombotic during the

measurement period.

To report the aspirin or other antithrombotic therapy, write the prescription through the SIG

Writer window or prescription refill message and print the prescription or send it electronically.

185

CMS 165; NQF 0018; PQRS 236 CONTROLLING HIGH BLOOD PRESSURE DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients 18 through 85 years of age who had a diagnosis of hypertension and

whose blood pressure was adequately controlled (<140/90mmHg) during the measurement

period.

EXCLUSIONS OR EXCEPTIONS Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or

during the measurement period. Also exclude patients with a diagnosis of pregnancy during the

measurement period.

ENTERING DENOMINATOR DATA The patient must be between 18 and 85 years old. The patient must have had a diagnosis of

essential hypertension at any time prior to the measurement period or be given this diagnosis

within the first six months of the measurement period. You may enter the diagnosis in the Dx

tab of Full Note Composer or another clinical note type window, or in the Problem/Diagnosis

category in the Hx tab of Full Note Composer or in the Patient History window.

ICD-9 401.0, 401.1, 401.9

ICD-10 I10

SNOMED 1201005, 10725009, 46481004, 48146000, 52698002, 56218007, 59621000, 59720008,

62275004, 65518004, 78975002, 276789009, 371125006, 429198000, 429457004

186


To report on this measure, enter the patient’s blood pressure (both systolic and diastolic values)

in the Vitals tab of Full Note Composer. These observation items for these blood pressure fields

are associated with the appropriate LOIN codes. Patients are included in the numerator if the

blood pressure entered for the most recent visit in the measurement period exceeds the target

blood pressure.

187

CMS 166; NQF 0052; PQRS 312 USE OF IMAGING STUDIES FOR LOW BACK PAIN DOMAIN Health Resources

MEASURE Percentage of patients 18 through 50 years of age with a diagnosis of low back pain who did not

have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.

EXCLUSIONS OR EXCEPTIONS Exclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis

of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to

the outpatient or emergency department visit.

Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or

emergency department visit.

ENTERING DENOMINATOR DATA The patient must be between 18 and 50 years old.

The patient must be given a diagnosis of low back pain during an outpatient or emergency

department visit. This visit must occur prior to the last 28 days of the measurement period (that

is, within the first 337 days of the measurement period). You must diagnosis the patient with

lower back pain using a qualifying ICD-9 or SNOMED code. Enter the diagnosis code in the Dx tab

of Full Note Composer or other clinical note type window.

ICD-9 721.3, 722.10, 722.32, 722.52, 722.93, 724.02, 724.03, 724.2, 724.3, 724.5, 724.6, 724.70, 738.5,

739.3, 739.4, 846.0, 846.1, 846.2, 846.3, 846.8, 846.9, 847.2

ICD-10 M43.27, M43.28, M46.46, M46.47, M47.26, M47.27, M47.28, M47.816, M47.817, M47.818,

M47.896, M47.897, M47.898, M48.06, M48.07, M51.26, M51.27, M51.36, M51.37, M51.46,

M51.47, M51.86, M51.87, M53.2X7, M53.2X8, M53.3, M53.86, M53.87, M53.88, M54.30,

188

M54.31, M54.32, M54.40, M54.41, M54.42, M54.5, M54.89, M54.9, M99.03, M99.04, M99.23,

M99.33, M99.43, M99.53, M99.63, M99.73, S33.6XXA, S33.8XXA, S33.9XXA

SNOMED 161894002, 202794004, 247368002, 267067009, 267982002, 278860009, 278862001,

279039007, 279040009, 279041008, 279042001, 300957005

PATIENTS ARE EXCLUDED FROM THE DENOMINATOR OF THIS MEASURE IF THEY HAVE A diagnosis of cancer any time in their history, or

A diagnosis of trauma, IV drug abuse, or neurologic impairment during the 12-month

period prior to the visit in which lower back pain is diagnosed, or

A diagnosis of low back pain within the 180 days prior to the visit in which lower back

pain is diagnosed.

ENTERING NUMERATOR DATA To report on this measure, the patient would not have a CT scan, MRI, or x-ray of the lower

spine performed within 28 days of diagnosis of low back pain.

To ensure accurate reporting, you must associate the procedure codes for all CT scans, MRIs, x-

rays, and other imaging studies of the lower spine with one of the following LOINC codes.

LOINC CODES 24665-2, 24929-2, 24930-0, 24963-1, 24964-9, 24965-6, 24967-2, 24968-0, 24969-8, 24970-6,

24971-4, 24972-2, 24975-5, 24977-1, 24984-7, 30620-9, 30678-7, 30679-5, 30713-2, 30714-0,

30715-7, 30716-5, 30717-3, 30773-6, 30774-4, 30775-1, 30776-9, 30777-7, 30778-5, 30797-5,

30854-4, 30855-1, 30883-3, 30884-1, 36058-6, 36059-4, 36060-2, 36069-3, 36100-6, 36110-5,

36111-3, 36245-9, 36246-7, 36247-5, 36332-5, 36390-3, 36391-1, 36392-9, 36402-6, 36520-5,

36521-3, 36522-1, 36647-6, 36670-8, 36674-0, 36681-5, 36688-0, 36735-9, 36946-2, 36949-6,

36990-0, 36992-6, 37003-1, 37009-8, 37011-4, 37073-4, 37078-3, 37101-3, 37105-4, 37132-8,

37172-4, 37208-6, 37232-6, 37256-5, 37257-3, 37259-9, 37260-7, 37261-5, 37288-8, 37300-1,

37340-7, 37341-5, 37342-3, 37351-4, 37353-0, 37355-5, 37356-3, 37357-1, 37509-7, 37515-4,

37516-2, 37651-7, 37652-5, 37653-3, 37658-2, 37659-0, 37660-8, 37974-3, 37975-0, 38008-9,

42410-1, 42411-9, 42413-5, 42424-2, 42425-9, 42426-7, 42427-5, 42428-3, 42429-1, 42472-1,

189

42690-8, 42692-4, 42698-1, 43569-3, 43784-8, 43791-3, 44114-7, 44178-2, 44179-0, 44194-9,

44196-4, 44203-8, 44206-1, 46340-6, 47382-7, 47984-0, 48436-0, 48452-7, 48469-1, 48473-3,

69116-2, 69264-0, 69273-1, 70928-7

190

CMS167; NQF 0088; PQRS 18 DIABETIC RETINOPATHY: DOCUMENTATION OF PRESENCE OR ABSENCE OF MACULAR EDEMA AND LEVEL OF SEVERITY OF RETINOPATHY DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had

a dilated macular or fundus exam performed which included documentation of the level of

severity of retinopathy and the presence or absence of macular edema during one or more

office visits within 12 months.

EXCLUSIONS OR EXCEPTIONS Documentation of medical reason(s) for not performing a dilated macular or fundus

examination.

Documentation of patient reason(s) for not performing a dilated macular or fundus

examination.

ENTERING DENOMINATOR DATA All patients aged 18 years and older with a diagnosis of diabetic retinopathy.

ICD-9 362.01, 362.02, 362.03, 362.04, 362.05, 362.06

ICD-10 E08.311, E08.319, E08.321, E08.329, E08.331, E08.339, E08.341, E08.349, E08.351, E08.359,

E09.311, E09.319, E09.321, E09.329, E09.331, E09.339, E09.341, E09.349, E09.351, E09.359,

E10.311, E10.319, E10.321, E10.329, E10.331, E10.339, E10.341, E10.349, E10.351, E10.359,

E11.311, E11.319, E11.321, E11.329, E11.331, E11.339, E11.341, E11.349, E11.351, E11.359,

E13.311, E13.319, E13.321, E13.329, E13.331, E13.339, E13.341, E13.349, E13.351, E13.359

191

SNOMED 4855003, 25412000, 59276001, 193349004, 193350004, 232020009, 232021008, 232022001,

232023006, 311782002, 312903003, 312904009, 312905005, 312906006, 312907002,

312908007, 312909004, 312912001, 314010006, 314011005, 314014002, 314015001,

390834004, 399862001, 399863006, 399864000, 399865004, 399866003, 399868002,

399869005, 399870006, 399871005, 399872003, 399873008, 399874002, 399875001,

399876000, 399877009, 408409007, 408410002, 408411003, 408412005, 408413000,

408414006, 408415007, 408416008, 414892004, 414894003, 414908005, 414910007,

417677008, 420486006, 420789003, 421779007

ENTERING NUMERATOR DATA Patients who had a dilated macular or fundus exam performed which included documentation

of the level of severity of retinopathy AND the presence or absence of macular edema during

one or more office visits within 12-months.

To report on this measure, you must order or perform a dilated macular or fundus exam during

the measurement period. Then you must document the level of severity of retinopathy and the

presence or absence of macular edema as test results.

To chart the dilated macular or fundus exam, you must use a procedure code associated with

the macula findings LOINC code 32451-7. You may enter the procedure in either the SP or the

SO tab of Full Note Composer or other clinical note type window.

Macula test results not received through an interface must be entered as discrete, quantifiable


the test result value. Results stored in the database as text notes or image file cannot be used

for reporting.

You can also enter the findings for macula edema and the severity of retinopathy using a

procedure code associated with one of the following SNOMED codes. Enter the procedure code

in the SP or SO tab of Full Note Composer or other clinical note type window.

192

MACULA EDEMA ABSENT SNOMED 428341000124108

MACULA EDEMA PRESENT SNOMED 37231002, 193350004, 193387007, 232020009, 312911008, 312912001, 312920004,

312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000,

408415007, 408416008, 414892004, 414908005, 420486006, 421779007, 432789001

SEVERITY OF RETINOPATHY SNOMED 193349004, 312903003, 312904009, 312905005, 390834004, 408411003, 408412005

You may also document the severity of retinopathy and the macular edema findings as two

separate items. Here is the code list for these.

SNOMED CODES FOR SEVERITY OF RETINOPATHY 193349004, 312903003, 312904009, 312905005, 390834004, 408411003, 408412005

SNOMED CODES FOR MACULAR EDEMA FINDINGS 37231002, 193350004, 193387007, 232020009, 312911008, 312912001, 312920004,

312921000, 312922007, 314010006, 314011005, 314014002, 314015001, 399864000,

399872003, 408415007, 408416008, 414892004, 414908005, 420486006, 421779007,

432789001, 6971000047100

193

CMS 169; NQF 0110; PQRS 367 BIPOLAR DISORDER AND MAJOR DEPRESSION: APPRAISAL FOR ALCOHOL OR CHEMICAL SUBSTANCE USE DOMAIN Clinical Processes and Effectiveness

MEASURE Percentage of patients with depression or bipolar disorder with evidence of an initial

assessment that includes an appraisal for alcohol or chemical substance use.


ENTERING DENOMINATOR DATA Patients 18 years of age or older at the start of the measurement period.

Patients in the Initial Patient Population with a new diagnosis of unipolar depression or bipolar

disorder during the first 323 days of the measurement period, and evidence of treatment for

unipolar depression or bipolar disorder within 42 days of diagnosis. The existence of a 'new

diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or

bipolar disorder during the 180 days prior to the diagnosis.

Depression or bipolar disorder may be identified by a diagnosis or by procedures for depression

counseling or therapy or antidepressant or mood stabilizer medications.





ICD-9 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15,

296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35,

296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55,

194

296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.7, 296.80, 296.81, 296.82, 296.89, 300.4,

301.13, 311

ICD-10 F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13,

F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70,

F31.71, F31.73, F31.75, F31.77, F31.81, F31.89, F31.9, F34.0, F32.0, F32.1, F32.2, F32.3, F32.4,

F32.8, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.8, F33.9, F34.1

SNOMED 162004, 832007, 1196001, 1499003, 2618002, 4441000, 5703000, 9340000, 10875004,

10981006, 3313007, 13581000, 13746004, 14183003, 14495005, 15193003,15639000,

16295005, 16506000, 17782008, 18818009, 19300006, 19527009, 20250007, 20960007,

21900002, 22407005, 25922000, 26203008, 26530004, 28475009, 28663008, 28884001,

29929003, 30520009, 30605009, 30687003, 31446002, 33078009, 33135002, 33380008,

33736005, 34315001, 35481005, 35489007, 35722002, 35846004, 36474008, 36583000,

36923009, 38694004, 39809009, 40379007, 40926005, 41552001, 41832009, 41932008,

42810003, 42925002, 43568002, 43769008, 45479006, 46229002, 46244001, 48937005,

49468007, 49512000, 51637008, 53049002, 53607008, 54761006, 55516002, 59617007,

60099002, 61403008, 63249007, 63412003, 63778009, 64731001, 65042007, 66344007,

66631006, 67002003, 68019004, 68569003, 69392006, 70546001, 70747007, 71294008,

71336009, 71984005, 73471000, 73867007, 74686005, 75084000, 75360000, 75752004,

76105009, 76441001, 77911002, 78269000, 78640000, 78667006, 79298009, 79584002,

81319007, 82998009, 83225003, 85248005, 86058007, 87203005, 87512008, 87950005,

191583000, 191584006, 191586008, 191590005, 191592002, 191593007, 191595000,

191610000, 191611001, 191613003, 191618007, 191620005, 191621009, 191623007,

191627008, 191629006, 191630001, 191632009, 191636007, 191638008, 191639000,

191641004, 191658009, 192362008, 231444002, 231494001, 231495000, 231496004,

268619003, 268621008, 319768000, 320751009, 370143000, 371596008, 371599001,

371600003, 371604007, 430852001

195

Counseling or therapy for depression is indicated by a qualifying procedure code or procedure

code associated with qualifying SNOMED codes entered in either the SP or SO tab of Full Note


COUNSELING FOR DEPRESSION SNOMED 428201000124103

ELECTROCONVULSIVE THERAPY CPT 90870

ELECTROCONVULSIVE THERAPY SNOMED 11075005, 23835007, 231079005, 231080008, 284468008, 313019002, 313020008

Medication for depression is indicated by a prescription for a qualifying antidepressant or mood

stabilizer medication written through the SIG Writer window, and then either printed or

submitted electronically. Or, by a qualifying medication in the patient’s medication history.

ENTERING NUMERATOR DATA Patients in the denominator with evidence of an assessment for alcohol or other substance use

following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of

treatment for that diagnosis.

Note: the endorsed measure calls for the assessment to be performed prior to discussion of the

treatment plan with the patient, but the current approach was considered more feasible in an

EHR setting. The "Assessment for Alcohol or Other Drug Use" required in the numerator is meant

to capture a provider's assessment of the patient's symptoms of substance use. The essence of

the measure is to avoid treating the patient for unipolar depression or bipolar disorder without

an assessment of their use of alcohol or other drugs.

Enter the assessment using a procedure code or a procedure code that is associated with a

qualifying SNOMED code. Enter the procedure in either the SP tab of Full Note Composer or

other clinical note type window.

196

HCPCS H0001, H0049

CPT 99408, 99409

SNOMED 105355005, 117251007, 171208001, 252170002, 273347006, 408942001, 408946003,

428211000124100

197

CMS 177; NQF 1365; PQRS 382 CHILD AND ADOLESCENT MAJOR DEPRESSIVE DISORDER: SUICIDE RISK ASSESSMENT DOMAIN Patient Safety

MEASURE Percentage of patient visits for those patients aged 6 through 17 years with a diagnosis of major

depressive disorder with an assessment for suicide risk.

Please note that the numerator and denominator counts on this measure are a count of distinct

visits, not of distinct patients. Therefore, on the CQM 2014 report, the denominator and

numerator counts on the summary page will not equal the count of patients in the patient list

accessed through the hyperlink for the denominator or numerator.


ENTERING DENOMINATOR DATA All patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive

disorder.





ICD-9 296.20, 296.21, 296.22, 296.23, 296.24, 296.30, 296.31, 296.32, 296.33, 296.34

ICD-10 F32.0, F32.1, F32.2, F32.3, F32.9, F33.0, F33.1, F33.2, F33.3, F33.9

198

SNOMED 832007, 2618002, 14183003, 15193003, 15639000, 18818009, 20250007, 25922000, 28475009,

33078009, 33736005, 36474008, 36923009, 38694004, 39809009, 40379007, 42925002,

60099002, 63778009, 66344007, 69392006, 71336009, 73867007, 75084000, 76441001,

77911002, 79298009, 87512008, 191610000, 191611001, 191613003, 268621008, 319768000,

320751009, 370143000, 430852001

ENTERING NUMERATOR DATA Patient visits with an assessment for suicide risk.

To chart the assessment, you must enter a procedure code that is associated with the SNOMED

code 225337009. Enter the procedure in the SP tab of Full Note Composer or other clinical note

type window.

199

CMS 179; NQF NA; PQRS 380 ADE PREVENTION AND MONITORING: WARFIN AND TIME IN THERAPEUTIC RANGE



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