American Speech-Language-Hearing Association

Reporting Audiology Quality Measures: A Step-by-Step Guide

Medicare Part B Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System (PQRS) is a program through the Centers for Medicare and Medicaid Services (CMS) designed to improve the quality of care to Medicare beneficiaries and track practice patterns.

The following step-by-step guide was developed by the Audiology Quality Consortium (AQC) for audiologists reporting on PQRS measures.

See also: Reporting Audiology Quality Measures: An Overview

Step One: 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 (and effective October 1, 2014, the ICD-10-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 perfomed on the patient.
    • Represent the measures' denominator (the eligible patients for a measure) in conjunction with ICD-9-CM codes.
  • G-Codes
    • Represent the measures' numerator (action required 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).

Eligible PQRS Measures for Audiologists

Further detailed specifications with applicable codes are available on the CMS website (under "Downloads," select "2014 PQRS Measures Specification Manual").

Measures in Detail

Measure #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness

Note: This measure should be reported once per year, per patient

Reporting Criteria

Patients of any age with the following procedure codes and associated diagnosis codes

CPT Codes

92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92575

ICD-9 Codes

780.4, 386.11

G-Codes

G8856 Referral to a physician for otologic evaluation performed.
G8857

Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)

G8858

Referral to a physician for an otologic evaluation not performed, reason not specified

How do I report on this measure? Find out using this easy-to-follow flow chart [PDF].

Measure #130: Documentation of Current Medications in the Medical Record

Note: This measure should be reported for every patient visit.

Reporting Criteria

Patients 18 years or older with the following procedure codes

CPT Codes

92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, 92626

ICD-9 Codes

No specific ICD-9 codes are included for this measure

G-Codes

G8427

List of current medications (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) documented by the provider, including drug name, dosage, frequency, and route.

G8430

Provider documentation that patient is not eligible for medication assessment.

A patient is not eligible if 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.

G8428

Current medications (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified.

How do I report on this measure? Find out using this easy-to-follow flow chart [PDF].

 

Measure #134: Preventative Care and Screening - Screening for Clinical Depression and Follow-Up Plan

Note: This measure should be reported once per-year-per-patient.

Reporting Criteria

Patients 12 years or older with the following procedure codes

CPT Codes

92557, 92567, 92568, 92625, 92626

ICD-9 Codes

No specific ICD-9 codes are included for this measure

G-Codes

G8431

Positive screen for clinical depression using an age appropriate standardized tool and a follow-up plan documented.

G8510

Negative screen for clinical depression using an age appropriate standardized tool, follow-up not required.

G8433

Screening for clinical depression using an age appropriate standardized tool not documented, patient not eligible/appropriate.

G8432 No documentation of clinical depression screening using an age appropriate standardized tool.
G8511 Positive screen for clinical depression using an age appropriate standardized tool documented, follow-up plan not documented, reason not specified.

How do I report on this measure? Find out using this easy-to-follow flow chart [PDF].

 

Step Two: 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 (pg. 26) of its 2014 PQRS 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
  • The NPI of the reporting audiologist is placed in Box 24J

Step Three: Make Sure You Meet CMS' Minimum Reporting Requirements

To obtain the 0.5% PQRS incentive payment, CMS requires that eligible professionals report on at least nine (9) quality measures in 2014 for at least 50% of eligible patient visits. Eligible patient visits are a professional's Part B patients for whom the measure applies according to the measure frequency specification. If less than nine measures are available for reporting, such as is the case for audiologists, CMS will permit a professional to report on fewer than nine measures for at least 50% of eligible patient visits. The Measures Applicability Validation (MAV) process applies to audiologists who have less than nine measures. Audiologists will still have the opportunity to qualify for the payment incentive in its last year by reporting on as many applicable claims-based measures that are available in the reporting period of January 1, 2014 to December 31, 2014. For more information about the MAV process that applies to audiologists, see the CMS PQRS Analysis and Payment page.

Example for Measure Reporting

A patient presents with a referral from internal medicine with a diagnosis of 780.4 (dizziness and giddiness). The audiologist performs, among other tests, a comprehensive audiology evaluation (CPT 92557). 

Review the patient eligibility and codes for each measure:

  • CPT code 92557 is included in all three measures:
    • Measure #261: Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
    • Measure #130: Documentation and Verification of Current Medications in the Medical Record
    • Measure #134: Screening for Clinical Depression and Follow-Up Plan
  • The ICD-9-CM code 780.4 is included in Measure #261, so you must report the G-code that best matches the action you took on the date of service:
    • G8856, referral to a physician for otologic evaluation performed, if you are referring this patient to an otorhinolaryngologist, or
    • G8857, patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness), if you are referring back to the internal medicine physician that referred to you, or
    • G8858, referral to a physician for an otologic evaluation not performed, reason not specified
  • Measure #130 only includes CPT codes, so you may also report on one of the G-codes that best matches the action you took on that date of service:
    • G8427, if the patient is not on medication, or they brought their current medications list, including the name of the medication(s), the dosage of each medication, the frequency of when they take any medication9s), and the method of the drug’s administrations (e.g., oral, intravenous, injection) and you documented it in the medical record or acknowledged review (if already in the medical record) and documented any changes, or
    • G8428, if you did not document or acknowledge a medication review in the medical record, or their medication list is missing one or more of these requirements, or
    • G8430, if you saw the patient in an emergent situation that did not allow for a medication review
  • If you performed a standardized screening tool to evaluate for possible depression, you can consider reporting Measure #134 according to the specifications in the 2014 PQRS Measures Specification Manual.

CMS Resources

Questions?

CMS PQRS Help Desk (available 8:00 a.m.–8:00 p.m. Eastern)
Phone: 1-866-288-8912
E-mail: gnetsupport@sdps.org

Lisa Satterfield, MS, CCC-A
Director, Health Care Regulatory Advocacy
American Speech-Language-Hearing Association
lsatterfield@asha.org

Paul K. Farrell, AuD, CCC-A
Associate Director, Audiology Professional Practices
American Speech-Language-Hearing Association
pfarrell@asha.org

Kim Cavitt, AuD
Academy of Doctors of Audiology
kim.cavitt@audiologyresources.com

Debbie Abel, AuD
Senior Educational Specialist, Business Practices
American Academy of Audiology
dabel@audiology.org

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