PQRS Quick Sheet

The below guide is meant to serve as an abbreviated information guide for PQRS in TRAKnet.

2015 PQRS Quick Sheet

The PQRS Quick Sheet is a list of the recommended measures from TRAKnet, their related codes, and the denominator criteria.

1. NQF 0059: Diabetes: HbA1c Poor Control

  • Denominator: Patients with a diagnoses of 250.XX, age 18-75 and with an E&M.
  • Codes:
    • 3046F: HbA1c > 9
    • 3046F with modifier 8P: Not Performed
    • 3044F: HbA1c < 7
    • 3045F: HbA1c 7 -9

2. NQF 0041: Screening for Influenza

  • Denominator: All patients aged 6 months and older seen for a visit between October 1 and March 31 with an E&M.
  • Codes:
    • G8482: Influenza administered or previously recorded
    • G8483: Not administered: Patient allergy or decline
    • G8484: Not administered: No reason

3. NQF 0043: Pneumonia Vaccine

  • Denominator: Patients 65 years of age and older with a visit during the measurement period and E&M.
  • Codes:
    • 4040F: Pneumonia vaccine administered or previously recorded
    • 4040F with modifier 8P: Not administered with no reason

4. NQF 0421: BMI Screening and F/U

  • Denominator: All patients 18 years old and older with an E&M during the reporting period.
  • Codes:
    • G8420: BMI within normal limits and no follow up
    • G8419: BMI outside of normal limits and no follow up
    • G8418: BMI below normal limits and follow up plan made with doctor
    • G8417: BMI above normal limits and follow up plan made with doctor
    • G8422: BMI not documented: patient not eligible
    • G8938: BMI documented outside normal limits: patient not eligible
    • G8421: BMI not documented with no reason given

5. NQF 0419: Document Current Medications

  • Denominator: All visits with an E&M code for patients aged 18 years and older.
  • Codes:
    • G8427: Patient medications have been reviewed
    • G8430: Patient not eligible
    • G8428: Patient medications not documented

6. NQF 0420: Pain Assessment

  • Denominator: All visits with an E&M code for patients aged 18 years and older.
  • Codes:
    • G8730: Pain (+) and a follow up has been documented
    • G8731: Pain negative and a follow up is not required
    • G8442: Pain not documented
    • G8939: Pain (+) and no follow up documented, patient not eligible
    • G8732: No pain documented, no reason
    • G8509: Pain (+), follow up not documented

7. NQF 0097: Medication Reconciliation

  • Denominator: All patients 18 years of age and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care and E&M.
  • Codes:
    • 1111F: Medication Reconciliation Completed
    • 1111F with modifier 8P: Medication Reconciliation not Completed

8. NQF 0028: Preventative Care and Screening: Tobacco Use

  • Denominator: All patients aged 18 years older and E&M.
  • Codes:
    • 4004F: Patient screened for tobacco use AND received tobacco cessation intervention
    • 1036F: Nonuser
    • 4004F with modifier 8P: Tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified

9. NQF 0101: Fall Risk Assessment

  • Denominator: All patients aged 65 years and older who have a history of falls (history of falls is defined as 2 or more falls in the past year or any fall with injury in the past year). Documentation of patient reported history of falls is sufficient. And E&M codes.
  • Codes:
    • 3288F and 1100F: Fall Risk Assessment documented and patient screened for future fall risk, documentation of two or more falls in the past year and any fall with injury in the past year
    • 3288F with modifier 1P and 1100F: Not completed for medical reason and documented in chart, history of fall in the past year
    • 3288F with modifier 1P and 1100F with modifier 8P: Not completed, no history of fall documented
    • 3288F with modifier 8P and 1100F: Not completed, documentation of falls in chart
    • 1101F: Patient screened for future fall risk; documentation of no falls in the past year or only one fall without injury in the past year
    • 1101F with modifier 8P: No documentation of falls status

10. Preventative Care and Screening: Screening for High Blood Pressure and Follow-Up

  • Denominator: All patients aged 18 years and older and E&M codes.
  • Codes:
    • G8783: BP within normal limits, no follow-up required
    • G8950: Pre-Hypertensive or Hypertensive BP reading documented, AND the indicated follow-up is documented
    • G8784: BP reading not documented, documentation that the patient is not eligible
    • G8785: BP reading not documented, no reason given
    • G8952: Pre-Hypertensive or Hypertensive BP reading documented, indicated follow-up not documented, reason not given
    • G8951: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, documentation that the patient is not eligible

11. Diabetes: Foot Exam

  • Denominator: Patients 18 – 75 years of age who had a diagnoses if diabetes with a visit during the measurement period, Dx of 250.XX, and E&M.
  • Codes:
    • G9226: Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam – report when all of the 3 components are completed)
    • G9225: Foot exam was not performed, reason not given

Disclaimer

Disclaimer: Please note that the above measures are recommendations only. For more information about choosing the measures which best suite your practice, please visit the CMS website.

Related Pages

PQRS
PQRS Guide

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