Reporting Audiology Quality Measures: A Step-by-Step Guide
Audiologists that bill Medicare Part B have the opportunity to participate in the Medicare Physician Quality Reporting System (PQRS) program. There are four measures that audiologists can report on, addressed below.
The measures are reportable via the CMS 1500 claim form. A step-by-step process for reporting on the measures is outlined below.
Step One: Review the Measures
The three measures are:
Each measure has a numerator, a denominator, and denominator exclusions.
- The numerator describes the action required by the measure for reporting and performance.
- A denominator describes all the eligible patients for a measure.
- Denominator exclusions are those patients that fit in the denominator but are not eligible for the measure for specific reasons.
The specifications of the measures are available on the Audiology Quality Consortium (AQC) website under the "Quality Measures" section. Further detailed specifications with applicable codes are available on the CMS website (under "Downloads," select "2012 Physician Quality Reporting System Measure List and Implementation Guide").
Step Two: Review the Codes for Each Measure
Each measure is reportable via the CMS 1500 claim form using the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) codes, Current Procedural Terminology (CPT) codes, and G-codes.
- ICD-9-CM codes
- Indicate the diagnosis of the patient.
- Represent the measures' denominator (the eligible patients for a measure) in conjunction with CPT codes.
- CPT Codes
- Indicate the procedure performed on the patient.
- Represents the measures' denominator (the eligible patients for a measure) in conjunction with the ICD-9-CM codes.
- G-Codes
- Represents the measures' numerator (action required by the measure for reporting and performance) as well as when the action does not occur because the patient fits into the denominator exclusion (patient that fits into the denominator but is not eligible for the measure).
- Some measures have CPT Category II codes to represent the numerator as well as when the action does not occur because the patient fits into the denominator exclusion. When there are no CPT Category II codes for a measure, CMS creates temporary G-codes.
Codes for Congenital or Traumatic Deformity of the Ear
| Codes |
What the Code Represents
|
ICD-9 Codes
|
| 744.01, 744.02, 744.03, 744.09, 380.0, 380.02, 380.03, 380.10, 380.30, 380.31, 380.32, 380.39, 380.51, 380.81, 380.89, 380.9 |
Patients that have any of these ICD-9-CM codes (as well as CPT codes below) fit into the measure's denominator (the eligible patients for a measure) |
CPT Codes
|
| 92557, 92567, 92568, 92575 |
Patients that have any of these CPT codes (as well as the ICD-9-CM codes above) fit into the measure's denominator (the eligible patients for a measure) |
G-Codes
|
| G8556 |
Represents the measure's numerator (action required): Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
|
| G8557 |
Also part of the measure's numerator: Referral not performed because patient is not eligible (denominator exclusion) (e.g., patients for whom an assessment of the congenital or traumatic deformity of the ear has been performed by a physician (preferably a physician with training in disorders of the ear) within the last 6 months, patients who are already under the care of a physician (preferably a physician with training in disorders of the ear) for congenital or traumatic deformity of the ear, etc. |
| G8558 |
Also part of the measure's numerator: Referral not performed, but reason not specified. |
Codes for History of Active Drainage from the Ear within the Previous 90 Days
| Codes |
What the Code Represents
|
ICD-9 Codes
|
| 381.01, 382.00, 382.01, 382.02, 382.1, 382.2, 382.3, 382.4, 382.9, 388.60. 388.61, 388.69 |
Patients that have any of these ICD-9-CM codes (as well as CPT codes below) fit into the measure's denominator (the eligible patients for a measure) |
CPT Codes
|
| 92557, 92567, 92568, 92575 |
Patients that have any of these CPT codes (as well as the ICD-9-CM codes above) fit into the measure's denominator (the eligible patients for a measure) |
G-Codes
|
| G8559 |
Represents the measure's numerator (action required): Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
- Must be reported with G8560
|
| G8560 |
Represents part of the measure's numerator (action required): Patient has a history of active drainage from ear within the previous 90 days.
|
| G8561 |
Also part of the measure's numerator: Referral not performed because patient is not eligible (denominator exclusion) (e.g., patients who are already under the care of a physician [preferably a physician with training in disorders of the ear] for active ear drainage)
- Must be reported with G8560
|
| G8562 |
Also part of the measure's numerator: Patient is not eligible for this measure because there is no history of active drainage
|
| G8563 |
Also part of the measure's numerator: Referral not performed, but reason not specified.
- Must be reported with G8560
|
Codes for History of Sudden or Rapidly Progressing Hearing Loss
| Codes |
What the Code Represents
|
ICD-9 Codes
|
| 389.00, 389.01, 389.02, 389.03, 389.04, 389.05, 389.06, 389.08, 389.10, 389.11, 389.12, 389.13, 389.14, 389.15, 389.16, 389.17, 389.18, 389.20, 389.21, 389.22; 389.8, 389.9 |
Patients that have any of these ICD-9-CM codes (as well as CPT codes below) fit into the measure's denominator (the eligible patients for a measure) |
CPT Codes
|
| 92557, 92567, 92568, 92575 |
Patients that have any of these CPT codes (as well as the ICD-9-CM codes above) fit into the measure's denominator (the eligible patients for a measure) |
G-Codes
|
| G8564 |
Represents the measure's numerator (action required): Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
- Must be reported with G8565
|
| G8565 |
Represents part of the measure's numerator (action required): Verification and documentation of sudden or rapidly progressive hearing loss
|
| G8566 |
Also part of the measure's numerator: Referral not performed because patient is not eligible (denominator exclusion) (e.g., patients who are already under the care of a physician [preferably a physician with training in disorders of the ear] for sudden or rapidly progressive hearing loss)
- Must be reported with G8565
|
| G8567 |
Also part of the measure's numerator: Patient is not eligible for this measure because patient does not have verification or documentation of sudden or rapidly progressive hearing loss
|
| G8568 |
Also part of the measure's numerator: Referral not performed, but reason not specified.
- Must be reported with G8565
|
Codes for Acute or Chronic Dizziness
| Codes |
What the Code Represents
|
ICD-9 Codes
|
| 780.4, 386.11 |
Patients that have any of these ICD-9-CM codes (as well as CPT codes below) fit into the measure's denominator (the eligible patients for a measure) |
CPT Codes
|
| 92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92575 |
Patients that have any of these CPT codes (as well as the ICD-9-CM codes above) fit into the measure's denominator (the eligible patients for a measure) |
G-Codes
|
| G8856 |
Represents the measure's numerator (action required): Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation
|
| G8857 |
Also part of the measure's numerator: Referral not performed because patient is not eligible (denominator exclusion) (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
|
| G8858 |
Also part of the measure's numerator: Referral not performed, but reason not specified
|
Step Three: Fill Out the CMS-1500 Claim Form
A sample 1500 claim form [PDF] is available on the Centers for Medicare & Medicaid Services (CMS) website. CMS also has a sample claim form filled out for PQRS in Appendix D of its 2012 Physician Quality Reporting Initiative Implementation Guide [ZIP].
- ICD-9 codes are placed in box 21
- CPT codes are placed in box 24D
- G-codes are placed in box 24D
Step Four: Make Sure You Meet CMS' Minimum Reporting Requirements
CMS requires that PQRS participants report on at least three measures. For each measure, PQRS participants have to report on 80% of the patients they see that would fit into that measure.