PQRS Measures – 2016

CMS has released the PQRS specifications for the 2016 reporting period and as expected, they are full of changes. Since inception, the Physician Quality Reporting System, has greatly changed the coding and documentation landscape for Eligible Professionals and Group Practices.

Reporting on quality measures has become a way of life for the practicing physician. Most of the reporting options now available, for Eligible Professionals or the Group Practice, require reporting for at least 9 measures across 3 of the National Quality Strategy domains.

This page lists the 2016 updates for Claims-based PQRS measures.

Visit the CMS website for all authorized information CMS PQRS Measure Codes


Measures Retired – Claims-Based = 3

Measure # Title
40 Osteoporosis: Management Following Fracture of Hip, Spine or Distal Radius for Men and Woman Aged 50 Years and Older
172 Hemodialysis Vascular Access Decision-Making by Surgeon to Maximize Placement of Autogenous Arterial Venous (AV) Fistula
193 Perioperative Temperature Management

 

Measure Switched from Claims-Based to Registry = 5

Measure # Title
44 Coronary Artery Bypass Graft (CABG): Pre-Operative Beta-Blocker in Patients with Isolatedt CABG Surgery
119 Diabetes: Medical Attention for Nephropathy
163 Diabetes: Foot Exam
262 Image Confirmation of Successful Excision of Image-Localized Breast Lesion
263 Preoperative Diagnosis of Breast Cancer

 

Active Measures Claims-Based = 79

Measure # Title
1 Diabetes: Hemoglobin A1c Poor Control
12 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation
14 Age-Related Macular Degeneration (AMD): Dilated Macular Examination
19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care
21 Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin
22 Perioperative Care: Discontinuation of Prophylactic Parenteral Antibiotics (Non-Cardiac Procedures)
23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
24 Osteoporosis: Communication with the Physician Managing Ongoing Care Post Fracture of Hip, Spine or Distal Radius for Men and Women Aged 50 Years and Older
32 Stroke and Stroke Rehabilitation: Discharged on Antithrombotic Therapy
39 Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older
41 Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older
46 Medication Reconciliation Post Discharge
47 Advance Care Plan
48 Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older
50 Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older
51 Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation
52 Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy
54 Emergency Medicine: 12-Lead Electrocardiogram (ECG) Performed for Non-Traumatic Chest Pain
71 Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer
72 Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients
76 Prevention of Central Venous Catheter (CVC) Related Bloodstream Infections
91 Acute Otitis Externa (AOE): Topical Therapy
93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use
99 Breast Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN category (Regional Lymph Nodes) with Histologic Grade
100 Colorectal Cancer Resection Pathology Reporting: pT Category (Primary Tumor) and pN category (Regional Lymph Nodes) with Histologic Grade
109 Osteoarthritis (OA): Function and Pain Assessment
110 Preventive Care and Screening: Influenza Immunization
111 Pneumonia Vaccination Status for Older Adults
112 Breast Cancer Screening
113 Colorectal Cancer Screening
117 Diabetes: Eye Exam
128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
130 Documentation and Verification of Current Medications in the Medical Record
131 Pain Assessment and Follow-Up
134 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
140 Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement
141 Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15PCT OR Documentation of a Plan of Care
145 Radiology: Exposure Time Reported for Procedures Using Flouroscopy
146 Radiology: Inappropriate Use of Probably Benign Assessment Category in Mammography Screening
147 Nuclear Medicine: Correlation with Existing Imaging studies for All Patients Undergoing Bone Scintigraphy
154 Falls: Risk Assessment
155 Falls: Plan of Care
156 Oncology: Radiation Dose Limits to Normal Tissues
181 Elder Maltreatment Screen and Follow-up Plan
182 Functional Outcome Assessment
185 Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use
195 Radiology: Stenosis Measurement in Carotid Imaging Reports
204 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
225 Radiology: Reminder System for Screening Mammograms
226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
236 Controlling High Blood Pressure
249 Barretts Esophagus
250 Radical Prostatectomy Pathology Reporting
251 Immunohistochemical (IHC) Evaluation of Human Epidermal Growth Factor Receptor 2 Testing (HER2) for Breast Cancer Patients
254 Ultrasound Determination fo Pregnancy Location for Pregnant Patients with Abdominal Pain
255 Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure
261 Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
268 Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy
317 Preventive Care and Screening Screening for High Blood Pressure
320 Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients
326 Atrial Fibrillation and Atrial Flutter: Chronic Antocoagulation Therapy
395 Lung Cancer Reporting (Biopsy Cytology Specimens) National Quality Strategy Domain: Communication and Care Coordination
396 Lung Cancer Reporting (Resection Specimens) National Quality Strategy Domain: Communication and Care Coordination
397 Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination
405 Appropriate Follow-up Imaging for Incidental Abdominal Lesions
406 Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients
407 Appropriate Treatment of MSSA Bacteremia
410 Psoriasis: Clinical Response to Oral Systemic or Biologic Medications
415 Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older
416 Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 through 17 Years
418 Osteoporosis Management in Women Who Had a Fracture
419 Overuse Of Neuroimaging For Patients With Primary Headache And A Normal Neurological Examination
422 Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury
423 Perioperative Anti-platelet Therapy for Patients Undergoing Carotid Endarterectomy
425 Photodocumentation of Cecal Intubation
429 Pelvic Organ Prolapse: Preoperative Screening for Uterine Malignancy
435 Quality of Life Assessment For Patients With Primary Headache Disorders
436 Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques
437 Rate of Surgical Conversion from Lower Extremity Endovascular Revascularization Procedure