Clinical Quality Measures MeaningFul Use
Core Clinical Measures
1:- Adult Weight Screening and Follow-Up
(a) Numerator : The patient’s age should be between 18 and 64. The patient must also have BMI in Vital signs chart. BMI must be recorded in the past 6 months to the encounter. Normal BMI - (BMI >= 18.5 or <25) and Abnormal BMI (BMI >= 25 or <18.5). If Patient has an Abnormal BMI then its latest encounter should contain one of the CPT Codes (G8417 or G8418 or S9470) OR select Counseling for Nutrition & physical activity in Measurement therapy. (In Followup tab) [ :CPT Group name - BMI ]
Denominator: No of Patients that were between the ages of 18 and 64. The patient must have one encounter within the period.
(b) Numerator : The patient’s age should be 65 and older. The patient must also have BMI in Vital signs chart. BMI must be recorded in the past 6 months to the encounter. Normal BMI (BMI >= 22 or <30) and Abnormal BMI (BMI >= 30 or <22). If patient has an Abnormal BMI then its latest encounter should contain one of the CPT Codes (G8417 or G8418 or S9470) OR select Counseling for Nutrition & physical activity in Measurement therapy. (In Followup tab) [ :: CPT Group name - BMI ]
Denominator: No of Patients that were at least 65 and older. Patient must have one encounter within the period.
2:- Hypertension: Blood Pressure Measurement
Numerator: The number of patients in the denominator that have at least once BP recorded.
Denominator: No of Patients that were ages at least 18 years old or older. Patient must have 2 encounters within the period and should have one of the ICD Codes: (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, and 404.93).
3:- Preventive Care and Screening Measure Pair
a. Tobacco Use Assessment.
b. Tobacco Cessation Intervention
(a) Numerator: The number of patient’s in the denominator are of tobacco users and who have accomplished by having Smoking Status OR documentation of Smoking in one of the CPT Codes (1000F, 1034F, G8455, 1035F, G8456, 1036F, G8457) [ :: CPT Group name – Smoking Documentation ]
Denominator: The number of Patient’s must be at least 18 years old or older and must have at least 2 encounters within the period.
(b) Numerator: The number of patient’s in the denominator were of tobacco users have documentation of Smoking cessation intervention either in one of the CPT Codes (4000F or 4001F.) OR selecting the “Smoking Cessation Intervention” in management therapy. (In Followup Tab) [ :: CPT Group name – Smoking Cessation ]
Denominator: The number of patient’s must be at least 18 years old or older and must have at least 2 encounters within the period and has being a tobacco user: Those were accomplished by the presence of Smoking status OR ICD code 305.1 or 305.10 OR CPT 1034F or 1035F. [ :: CPT Group name – Smoking Documentation ]
Alternate Clinical Measures
1:- Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Yrs Old
Numerator: The number of patients in the denominator that have influenza vaccine 111 (influenza virus vaccine, live, attenuated, fo) or 140 (Influenza, seasonal, injectable, preservative) and the documentations of CPTs (90656, 90658, 90660, G0008, G8482, 4037F). [ :: CPT Group name – Influenza Vaccine ]
Denominator: The number of patient’s that were 50 years old or older and have at least one encounter within the period of September to February of next year.
2:- Weight Assessment and Counseling for Children and Adolescents
Numerator: The number of patients in the denominator that have BMI reading in Vital signs and for the documentations of counseling use either weight counseling (CPT S9451) and nutrition counseling (CPT G0270, GG0271, S9449, S9452, S9470, 97802, 97803, or 97804) OR selecting Nutrition and physical activity in measurement therapy. [ :: CPT Group name – Weight Counseling and Nutrition Counseling ]
Denominator: The number of patient’s that were between 2 - 17 years and have at least one encounter within the period.
3:- Childhood Immunization Status
(a) Numerator1: The number of patients in the denominator that have
four DTaP;
three polio (IPV),
one (MMR);
two H influenza type B (HiB);
three hepatitis B (Hep B);
one chicken pox (VZV);
four pneumococcal conjugate (PCV);
two hepatitis A (Hep A);
two or three rotavirus (RV);
two influenza (flu) vaccines.
(b) Numerator2: The number of patients in the denominator that have at least four DTaP.
(c) Numerator3: The number of patients in the denominator that have at least three IPV.
(d) Numerator4: The number of patients in the denominator that have at least one MMR.
(e) Numerator5: The number of patients in the denominator that have at least two HiB.
(f) Numerator6: The number of patients in the denominator that have at least three Hep B.
(g) Numerator7: The number of patients in the denominator that have at least one Pox.
(h) Numerator8: The number of patients in the denominator that have at least four Pneumococcal conjugate.
(i) Numerator9: The number of patients in the denominator that have at least two Hep A.
(j) Numerator10: The number of patients in the denominator that have at least two rotavirus.
(k) Numerator11: The number of patients in the denominator that have at least two influenza.
Denominator: The number of patients that were below 2 years and have at least one encounter within the period.
Optional Clinical Measures
1:- Smoking and Tobacco Use Cessation, Medical assistance:
a.Advising Smokers and Tobacco Users to Quit.
a.Advising Smokers and Tobacco Users to Quit.
c.Discussing Smoking and Tobacco Use Cessation Strategies.
Numerator: The number of patient’s in the denominator that have one of the CPT Codes (G8402, S9075, S4995, G0376, S9453, G0375, G9016, 99406 or 99407) OR selecting “Smoking Cessation Intervention” in Management Therapy. (In Followup Tab) [ :: CPT Group name – Smoking Counseling ]
Denominator: The number of patient’s that were 18 years old or older and have at least one encounter within the period and has one of the Diagnosis of (305.1 or 305.10.10 OR has one of the CPTs 1034F or 1035F. OR Tobacco user. [ :: CPT Group name – Smoking Documentation ]
2:- Diabetes: Blood Pressure Management
Numerator: The number of patients in the denominator whose last BP was < 140/90
Denominator: The number of patient’s that were between the ages of 18 and 75 and have at least one encounter within the period and has Diagnosis of ICD Codes are recorded. Acceptable ICD codes: 250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.10, 250.11, 250.12, 250.13, 250.20, 250.21, 250.22, 250.23, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.50, 250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93, 357.2, 362.0, 362.01, 362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41, 648.0, 648.00, 648.01, 648.02, 648.03, 648.04
3:- Breast Cancer Screening
Numerator: The patients in the denominator who had mammogram at least once in the period OR CPTs need to be present: 77055, 77056, 77057, G0202, G0204, G0206, 3014F, 77052. [ :: CPT Group name – Mammogram ]
Denominator: The patients must be Female aged 40 - 69 and have at least one encounter within the period.