Quality Claims

This page will explain how to perform the suggested Quality measures for claims-based reporting in TRAKnet. Click here for more information about Quality, and here for more information about MIPS.

NQF 0059: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Measure #001
Details: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
Denominator Criteria: Diagnoses of Diabetes Mellitus (E10, E11, E13 or O24). age 18-75, E&M.
Numerator Criteria: Patients whose most recent HbA1c level (performed during the measurement period) is > 9.0%.
Performance Met:
3046F HbA1c > 9
3046F w/ modifier 8P not performed
Performance Not Met:
3044F HbA1c < 7
3045F HbA1c 7 – 9
Exclusion (excluded from measure calculations):
G9687 hospice services provided to patient any time during the measurement period
Reporting Instructions: This must be reported once per reporting period.

A tutorial of this measure is found at 1:27 of the below tutorial video.

NQF 0326: Care Plan

Measure #047
Details: Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
Denominator Criteria: Age 65+, E&M.
Numerator Criteria: Patients who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
Performance Met:
1123F advance care plan or surrogate decision maker documented in medical record
1124F patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan
Performance Not Met:
1123F w/ modifier 8P not performed
Exclusion (excluded from measure calculations):
G9692 hospice services received by patient any time during the measurement period
Reporting Instructions: This must be reported once per reporting period.

A tutorial of this measure is found at 3:17 of the below tutorial video.

NQF 0041: Preventative Care and Screening: Influenza Immunization

Measure #110
Details: 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.
Denominator Criteria: Age 6+ months, two E&M between October 1 and March 31 excluding telehealth modifiers (GQ, GT).
Numerator Criteria: Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization.
Performance Met:
G8482 influenza administered or previously recorded
Performance Not Met:
G8484 not administered: No reason
Exception (included in measure calculations but doesn't count against performance rates):
G8483 not administered: Patient allergy or declined
Reporting Instructions: This must be reported once per reporting period.

A tutorial of this measure is found at 5:18 of the below tutorial video.

NQF 0043: Pneumococcal Vaccination Status for Older Adults

Measure #111
Details: Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.
Denominator Criteria: Age 65+, E&M.
Numerator Criteria: Patients who have ever received a pneumococcal vaccination.
Performance Met:
4040F Pneumonia vaccine administered or previously recorded
Performance Not Met:
4040F w/ modifier 8P Not administered with no reason
Exclusion (excluded from measure calculations):
G9707 hospice services received by patient any time during the measurement period
Reporting Instructions: This must be done a minimum of once per reporting period.

A tutorial of this measure is found at 7:28 of the below tutorial video.

NQF 0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Measure #128
Details: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter. Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 kg/m2; Age 18 – 64 years BMI ≥ 18.5 and < 25 kg/m2.
Denominator Criteria: Age 18+, E&M excluding telehealth modifiers (GQ, GT).
Numerator Criteria: Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.
Performance Met:
G8420 BMI within normal limits and no follow-up
G8417 BMI above normal limits and follow-up plan made with doctor
G8418 BMI below normal limits and follow-up plan made with doctor
Performance Not Met:
G8421 BMI not documented with no reason given
G8419 BMI outside of normal limits and no follow-up
Exception (included in measure calculations but doesn't count against performance rates):
G9716 not documented for documented reason
Exclusion (excluded from measure calculations):
G8422 BMI not documented: patient not eligible
G8938 BMI documented outside normal limits: patient not eligible
Reporting Instructions: This must be reported once per reporting period.

A tutorial of this measure is found at 9:26 of the below tutorial video.

NQF 0419: Document Current Medications

Measure #130
Details: Documentation of Current Medications in the Medical Record: Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional)supplements AND must contain the medications’ name, dosage, frequency and route of administration.
Denominator Criteria: Age 18+, E&M.
Numerator Criteria: Eligible professional attests to documenting, updating or reviewing a patient’s current medications using all immediate resources available on the date of encounter. This list must include ALL known prescriptions, over-the counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosages, frequency and route of administration.
Performance Met:
G8427 patient medications have been reviewed
Performance Not Met:
G8428 patient medications not documented
Exception (included in measure calculations but doesn't count against performance rates):
G8430 patient not eligible
Reporting Instructions: This must be reported for each visit during the reporting period.

A tutorial of this measure is found at 11:23 of the below tutorial video.

NQF 0420: Pain Assessment and Follow-Up

Measure #131
Details: Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present.
Denominator Criteria: Age 18+, E&M excluding telehealth modifiers (GQ, GT).
Numerator Criteria: Patient visits with a documented pain assessment using a standardized tool(s) AND documentation of a follow-up plan when pain is present.
Performance Met:
G8730 positive pain assessment documented and follow-up plan made with doctor
G8731 negative pain assessment and no follow-up required
Performance Not Met:
G8732 pain assessment not documented with no reason given
G8509 positive pain assessment documented and no follow-up
Exception (included in measure calculations but doesn't count against performance rates):
G8442 pain assessment not documented, patient not eligible for assessment
G8939 positive pain assessment, patient not eligible for follow-up
Reporting Instructions: This must be reported for each visit during the reporting period.

A tutorial of this measure is found at 13:30 of the below tutorial video.

NQF 0028: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Measure #226
Details: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: 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.
Denominator Criteria: Age 18+, E&M excluding telehealth modifiers (GQ, GT).
Numerator Criteria: Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user.
Performance Met:
4004F patient screened for tobacco use AND received tobacco cessation intervention
1036F non-user
Performance Not Met:
4004F w/ modifier 8P tobacco screening OR tobacco cessation intervention not performed, reason not otherwise specified
Exception (included in measure calculations but doesn't count against performance rates):
4004F w/ modifier 1P documentation of medical reason(s) for not screening for tobacco use
Reporting Instructions: This must be reported once per reporting period.

A tutorial of this measure is found at 15:28 of the below tutorial video.

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Measure #317
Details: 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.
Denominator Criteria: Age 18+, E&M excluding telehealth modifiers (GQ, GT).
Numerator Criteria: Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive.
Performance Met:
G8783 BP within normal limits, no follow-up required
G8950 pre-Hypertensive or Hypertensive BP reading documented, AND the indicated follow-up is documented
Performance Not Met:
G8785 BP reading not documented, no reason given
G8952 Pre-Hypertensive or Hypertensive BP reading documented, indicated follow-up not documented, reason not given
Exception (included in measure calculations but doesn't count against performance rates):
G9745 screening not performed for documented reason
Exclusion (excluded from measure calculations):
G9744 not eligible due to active diagnosis of hypertension
Reporting Instructions: This measure is to be reported a minimum of once per reporting period. This measure may be reported by eligible professionals who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The documented follow-up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management”.

A tutorial of this measure is found at 17:27 of the below tutorial video.

NQF 0101: Falls: Risk Assessment

Measure #154
Details: Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months.
Denominator Criteria: Age 65+, E&M
Numerator Criteria: Patients who had a risk assessment for falls completed within 12 months. (Numerator Note: The correct combination of numerator code(s) must be reported on the claim form in order to properly report this measure. The “correct combination” of codes may require the submission of multiple numerator codes.)
Performance Met:
3288F Falls risk assessment documented AND 1100F Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year
Performance Not Met:
3288F w/ modifier 8P Falls risk assessment not completed, reason not otherwise specified AND 1100F Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year
Exception (included in measure calculations but doesn't count against performance rates):
3288F with 1P Documentation of medical reason(s) for not completing a risk assessment for falls (i.e., patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair AND 1100F Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year
Exclusion (excluded from measure calculations):
G9718 Hospice services for patient provided any time during the measurement period
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 w/ modifier 8P No documentation of falls status
Reporting Instructions: This measure is to be reported a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure is appropriate for use in all non-acute settings (excludes emergency departments and acute care hospitals). This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NQF 0101: Falls: Plan of Care

Measure #155
Details: Percentage of patients aged 65 years and older with a history of falls that had a plan of care for falls documented within 12 months.
Denominator Criteria: Age 65+, E&M, 1100F CPT code reported in the numerator for Measure #154 (Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year)
Numerator Criteria: Patients with a plan of care for falls documented within 12 months.
Performance Met:
0518F Falls plan of care documented
Performance Not Met:
0518F w/ modifier 8P Plan of care not documented, reason not otherwise specified
Exception (included in measure calculations but doesn't count against performance rates):
0518F w/ modifier 1P Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair
Exclusion (excluded from measure calculations):
G9720 Hospice services for patient occurred any time during the measurement period
Reporting Instructions: This measure is to be reported a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure is appropriate for use in all non-acute settings (excludes emergency departments and acute care hospitals). This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Quality - Claims Tutorial Video

For more information on how to fulfill each objective in TRAKnet, see the video below:

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