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
- 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
Audiologists are also eligible and encouraged to report on the following measures:
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 "2013 PQRS Measures Specification Manual").
Measures in Detail
Reporting Condition
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Patients of any age with the following procedure codes and associated diagnosis codes
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CPT Codes
|
92550, 92557, 92567, 92568, 92570, 92575
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ICD-9 Codes
|
380.00, 380.01, 380.02, 380.03, 380.10, 380.30, 380.31, 380.32, 380.39, 380.51, 380.81, 380.89, 380.9, 744.01, 744.02, 744.03, 744.09
|
G-Codes
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| G8556 |
Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation.
|
| G8557 |
Patient is not eligible for the referral for otologic evaluation measure (e.g. for 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 past 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).
|
| G8558 |
Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified.
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How do I report on this measure? Find out using this easy-to-follow flow chart [PDF].
|
Reporting Criteria
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Patients of any age with the following procedure codes and associated diagnosis codes
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CPT Codes
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92540, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92575
|
ICD-9 Codes
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| 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].
|
Reporting this measure qualifies to avoid the penalty assess in 2015 and may result in the incentive bonus for 2013 if reported on 50% of all eligible patients at each visit.
Reporting Criteria
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Patients 18 years or older with the following procedure codes
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CPT Codes
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92541, 92542, 92543, 92544, 92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585, 92588, 92626
|
ICD-9 Codes
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No specific ICD-9 codes are included for this measure
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G-Codes
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| 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.
By reporting G8427, the eligible professional is attesting the documented medication information is current, accurate, and complete to the best of his/her knowledge and ability at the time of the patient encounter. This code should also be reported if the eligible professional documented that the patient is not currently taking any medications. Eligible professionals reporting this measure may document medication information received from the patient, authorized representative(s), caregiver(s) or other available health care resources by acknowledging in the medical record the medication has been reviewed and by documenting any changes reported by the patient or authorized representative(s).
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| 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.
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| 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.
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How do I report on this measure? Find out using this easy-to-follow flow chart [PDF].
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This measure should only be reported if a standardized screening tool for clinical depression is routinely performed in your office. If it is not routinely performed, you do not need to report and you will not be penalized for non-reporting. If you routinely perform the required clinical depression screenings in your office, you will need to report on this measure for a minimum of 50% of eligible patients, with the standardized screening tools recommended in the measure. Visit the CMS PQRS website, How to Get Started, and download the 2013 PQRS Measures Specification Manual for more information.
Reporting Criteria
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Patients 12 years or older with the following procedure codes
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CPT Codes
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92557, 92567, 92568, 92625, 92626
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ICD-9 Codes
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No specific ICD-9 codes are included for this measure
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G-Codes
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| 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.
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| G8433 |
Screening for clinical depression using an age appropriate standardized tool not documented, patient not eligible/appropriate.
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| 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].
|
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 2013 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
For realizing the incentive payment, CMS requires that PQRS participants report on at least three on 50% of the patients they see that would fit into an individual measure. To avoid the 1.5% deduction of claims in 2015, reporting must occur on at least one measure during the 2013 reporting period.
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 four measures:
- Measure #188: Referral for Otologic Evaluation for Patients with Congenital or Traumatic Deformity of the Ear
- 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 code 780.4 is not included in Measure #188, so you would not report on this measure and you will not be penalized.
- Because 780.4 is included in Measure #261, you 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 2013 PQRS Measures Specification Manual.
See also: additional reporting examples [PDF]
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