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pdf2010 EHR Warehouse Measure Specifications
The specifications listed in this document have been updated to reflect clinical practice guidelines and
applicable health informatics standards that are the most current available as of July 31, 2009. These
specifications may be available for potential use in physician quality initiatives, including but not limited to
the Electronic Health Record (EHR) submission under the 2010 Physician Quality Reporting Initiative
(PQRI). A measure’s inclusion in this document does not guarantee that measure will be used in any
specific CMS program in 2010 or any subsequent year.
In the case of measures that have been used in prior initiatives – such as the 2008 and 2009 PQRI EHR
testing projects or the QIO-program's Doctor's Office Quality-Information Technology (DOQ-IT) project
activities – the specifications detailed in this document supersede any specifications which may have been
used in those prior activities.
To determine which measures are included in any specific CMS program or demonstration, interested
parties should refer to the official documentation for that program or demonstration. Please refer to the
Medicare Physician Fee Schedule 2010 Final Rule (to be published in the Federal Register in November,
2009) to identify the measures that will be available for data submission through EHRs under the 2010
PQRI, if an EHR-related program will exist in 2010.
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2010 EHR Warehouse Measure Specifications
The 2010 PQRI program only allows covered services under the Medicare Physician Fee
Schedule (MPFS) for inclusion. The 2010 EHR Warehouse Measure Specifications
incorporates CPT Category I codes to define the denominator population for both covered and
non-covered services (e.g., preventive visits). Non-covered service codes are included to
remain consistent with the measure developer’s EHR specifications. These non-covered
services, identified by the (arrow) symbol, will not be counted in the denominator population
for PQRI reporting calculations.
List of 2010 EHR Measures containing CPT Category I codes for non-covered services from
the PFS:
Diabetes Measures 1, 2 and 3:
CPT E/M: 99385, 99386, 99387, 99395, 99396, 99397, 99401, 99402, 99403, 99404,
99411, 99412, 99420, 99429
NDC Codes: Insulin or oral hypoglycemics/antihyperglycemics
Heart Failure Measure 5:
CPT E/M: 99385, 99386, 99387, 99395, 99396, 99397
Coronary Artery Disease Measure 7:
CPT E/M: 99385, 99386, 99387, 99395, 99396, 99397
Preventive Measures 110, 111, 112 and 113:
CPT E/M: 99386, 99387, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412,
99420, 99429
HIT Measure 124:
CPT E/M: 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393,
99394, 99395, 99396, 99397
Note:
CPT Category II codes will be included in the 2010 EHR Warehouse Measure Specifications only when other
standard coding systems are not available (e.g. medical, patient, system reasons for not performing the
recommended care) as determined appropriate by the measure owners.
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2010 EHR Warehouse Measure Specifications
TABLE OF CONTENTS
TABLE OF CONTENTS ..........................................................................................................................3
ANALYTIC NARRATIVES .....................................................................................................................4
Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus.................... 4
Measure #2: Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus 7
Measure #3: Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus .................... 10
Measure #5: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin
Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) ................... 13
Measure #7: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with
Prior Myocardial Infarction (MI) ...................................................................................................... 17
Measure #110: Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years
........................................................................................................................................................... 22
Measure #111: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years and
Older ................................................................................................................................................. 26
Measure #112: Preventive Care and Screening: Screening Mammography .................................. 30
Measure #113: Preventive Care and Screening: Colorectal Cancer Screening ............................. 34
Measure #124: Health Information Technology (HIT): Adoption/Use of Electronic Health
Records (EHR) .................................................................................................................................. 39
APPENDIX A ...........................................................................................................................................44
Measure #1: .................................................................................................................................... 44
Measure #2: .................................................................................................................................... 45
Measure #3: .................................................................................................................................... 46
Measure #5: ................................................................................................................................... 47
Measure #7: ................................................................................................................................... 49
Measure #110: ............................................................................................................................... 51
Measure #111: ................................................................................................................................ 53
Measure #112: ................................................................................................................................ 54
Measure #113: ................................................................................................................................ 55
Measure #124: ................................................................................................................................ 56
Measure Owner Designation
AMA-PCPI is the measure owner
NCQA is the measure owner
QIP/CMS is the measure owner
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2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #1: Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus
Description: Percentage of patients aged 18 through 75 years with diabetes mellitus who had
most recent hemoglobin A1c greater than 9.0%
Denominator: Patients aged 18 through 75 years with the diagnosis of diabetes
Denominator Inclusions:
All patients with a documented diagnosis of diabetes at any time in the patient’s
medical history and patient is ≥ 18 and ≤ 75 years of age at the beginning of the
measurement period. To be eligible for performance calculations, patients must
have at least two face-to-face office visits with the physician, physician assistant,
or nurse practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and HCPCS
(HCPCS) codes for inclusion:
ENCOUNTER CODE (C4)
92002, 92004, 92012, 92014, 97802, 97803, 97804,
99201, 99202, 99203, 99204, 99205, 99211, 99212,
99213, 99214, 99215, 99217, 99218, 99219, 99220,
99221, 99222, 99223, 99231, 99232, 99233, 99238,
99239, 99241, 99242, 99243, 99244, 99245, 99251,
99252, 99253, 99254, 99255, 99281, 99282, 99283,
99284, 99285, 99291, 99304, 99305, 99306, 99307,
99308, 99309, 99310, 99315, 99316, 99318, 99324,
99325, 99326, 99327, 99328, 99334, 99335, 99336,
99337, 99341, 99342, 99343, 99344, 99345, 99347,
99348, 99349, 99350, 99385
, 99386
, 99387
,
99395
, 99396
, 99397
, 99401
, 99402
,
99403
, 99404
, 99411
, 99412
, 99420
,
99429
, 99455, 99456
OR
ENCOUNTER CODE (HCPCS)
G0270, G0271
AND
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9) codes for
inclusion:
DX CODE (I9)
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, 250.40, 250.41, 250.42, 250.43, 250.50,
250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63,
250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82,
250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01,
362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41,
648.00, 648.01, 648.02, 648.03, 648.04
OR
TOPIC_DRUG_CODES Table lists applicable drug codes for patients who were
prescribed insulin or oral hypoglycemics/antihyperglycemics during the
measurement period on an ambulatory basis and DRUG_EXCLUSION = N.
Numerator: Patients with most recent hemoglobin A1c level > 9.0%
Numerator Inclusions:
Patients with most recent A1c > 9.0% during the measurement period.
TOPIC_EVALUATION_CODES Table lists an applicable CPT (C4) and
LOINC (LN) code for inclusion:
A1C CODE (C4)
83036, 83037
OR
A1C CODE (LN)
4548-4, 4549-2, 17856-6
AND
Documentation of A1c > 9.0%
Denominator Exclusions: (Exclusions only applied if patient did not receive A1c test)
Diabetes patients with a diagnosis of
and/or steroid induced diabetes.
polycystic ovaries, gestational diabetes,
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion:
EXCLUSION CODE (I9)
251.8, 256.4, 648.80, 648.81, 648.82, 648.83, 648.84, 962.0
Diagnosis of polycystic ovaries can occur anytime in the patient’s history
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Rationale:
Intensive therapy of glycosylated hemoglobin (A1c) reduces the risk of microvascular complications.
Clinical Recommendation Statements:
A glycosylated hemoglobin should be performed during an initial assessment and during follow-up
assessments, which should occur at no longer than three-month intervals. (AACE/ACE)
The A1c should be universally adopted as the primary method of assessment of glycemic control. On the
basis of data from multiple interventional trials, the target for attainment of glycemic control should be
A1c values ≤6.5%. (AACE/ACE)
Obtain a glycosylated hemoglobin during an initial assessment and then routinely as part of continuing
care. In the absence of well-controlled studies that suggest a definite testing protocol, expert opinion
recommends glycosylated hemoglobin be obtained at least twice a year in patients who are meeting
treatment goals and who have stable glycemic control and more frequently (quarterly assessment) in
patients whose therapy was changed or who are not meeting glycemic goals. (Level of evidence: E)
(ADA)
Because different assays can give varying glycated hemoglobin values, the ADA recommends that
laboratories only use assay methods that are certified as traceable to the Diabetes Control and
Complications Trial A1c reference method. The ADA’s goal for glycemic control is A1c <7%. (Level of
evidence: B) (ADA)
Monitor and treat hyperglycemia, with a target A1C of 7%, but less stringent goals for therapy may be
appropriate once patient preferences, diabetes severity, life expectancy and functional status have been
considered. (AGS)
— List of Data Elements located in Appendix A
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2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #2: Diabetes Mellitus: Low Density Lipoprotein (LDL-C) Control in Diabetes Mellitus
Description: Percentage of patients aged 18 through 75 years with diabetes mellitus who had
most recent LDL-C level in control (less than 100 mg/dL)
Denominator: Patients aged 18 through 75 years with the diagnosis of diabetes
Denominator Inclusions:
All patients with a documented diagnosis of diabetes at any time in the patient’s
medical history and patient is ≥ 18 and ≤ 75 years of age at the beginning of the
measurement period. To be eligible for performance calculations, patients must
have at least two face-to-face office visits with the physician, physician assistant,
or nurse practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and HCPCS
(HCPCS) codes for inclusion:
ENCOUNTER CODE (C4)
92002, 92004, 92012, 92014, 97802, 97803, 97804,
99201, 99202, 99203, 99204, 99205, 99211, 99212,
99213, 99214, 99215, 99217, 99218, 99219, 99220,
99221, 99222, 99223, 99231, 99232, 99233, 99238,
99239, 99241, 99242, 99243, 99244, 99245, 99251,
99252, 99253, 99254, 99255, 99281, 99282, 99283,
99284, 99285, 99291, 99304, 99305, 99306, 99307,
99308, 99309, 99310, 99315, 99316, 99318, 99324,
99325, 99326, 99327, 99328, 99334, 99335, 99336,
99337, 99341, 99342, 99343, 99344, 99345, 99347,
99348, 99349, 99350, 99385
, 99386
, 99387
,
99395
, 99396
, 99397
, 99401
, 99402
,
99403
, 99404
, 99411
, 99412
, 99420
,
99429
, 99455, 99456
OR
ENCOUNTER CODE (HCPCS)
G0270, G0271
AND
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9) codes for
inclusion:
DX CODE (I9)
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, 250.40, 250.41, 250.42, 250.43, 250.50,
250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63,
250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82,
250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01,
362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41,
648.00, 648.01, 648.02, 648.03, 648.04
OR
TOPIC_DRUG_CODES Table lists applicable drug codes for patients who were
prescribed insulin or oral hypoglycemics/antihyperglycemics during the
measurement period on an ambulatory basis and DRUG_EXCLUSION = N.
Numerator: Patients with most recent LDL-C < 100 mg/dL
Numerator Inclusions:
Patients with most recent LDL-C < 100 mg/dL during the measurement period.
TOPIC_EVALUATION_CODES Table lists an applicable CPT (C4) and LOINC
(LN) code for inclusion:
LDL CODE (C4)
80061, 83700, 83701, 83704, 83721
OR
LDL CODE (LN)
12773-8, 13457-7, 18261-8, 18262-6, 2089-1,
22748-8, 39469-2, 49132-4
AND
Documentation of LDL < 100 mg/dL
Denominator Exclusions: (Exclusions only applied if LDL cholesterol test not obtained)
Diabetes patients with a diagnosis of
and/or steroid induced diabetes.
polycystic ovaries, gestational diabetes,
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion:
EXCLUSION CODE (I9)
251.8, 256.4, 648.80, 648.81, 648.82, 648.83, 648.84, 962.0
Diagnosis of polycystic ovaries can occur anytime in the patient’s history
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Rationale:
Persons with diabetes are at increased risk for coronary heart disease (CHD). Lowering serum
cholesterol levels can reduce the risk for CHD events.
Clinical Recommendation Statements:
A fasting lipid profile should be obtained during an initial assessment, each follow-up assessment, and
annually as part of the cardiac-cerebrovascular-peripheral vascular module. (AACE/ACE)
A fasting lipid profile should be obtained as part of an initial assessment. Adult patients with diabetes
should be tested annually for lipid disorders with fasting serum cholesterol, triglycerides, HDL
cholesterol, and calculated LDL cholesterol measurements. If values fall in lower-risk levels,
assessments may be repeated every two years. (Level of evidence: E) (ADA)
Patients who do not achieve lipid goals with lifestyle modifications require pharmacological therapy.
Lowering LDL cholesterol with a statin is associated with a reduction in cardiovascular events. (Level of
evidence: A)
Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and
morbidity for all patients with known coronary artery disease and type 2 diabetes. (ACP)
Statins should be used for primary prevention against macrovascular complications in patients with type
2 diabetes and other cardiovascular risk factors.
Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least
moderate doses of a statin.
Older persons with diabetes are likely to benefit greatly from cardiovascular risk reduction; therefore,
monitor and treat hypertension and dyslipidemias. (AGS)
— List of Data Elements located in Appendix A
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2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #3: Diabetes Mellitus: High Blood Pressure Control in Diabetes Mellitus
Description: Percentage of patients aged 18 through 75 years with diabetes mellitus who had
most recent blood pressure in control (less than 140/80 mmHg)
Denominator: Patients aged 18 through 75 years with the diagnosis of diabetes
Denominator Inclusions:
All patients with a documented diagnosis of diabetes at any time in the patient’s
medical history and patient is ≥ 18 and ≤ 75 years of age at the beginning of the
measurement period. To be eligible for performance calculations, patients must
have at least two face-to-face office visits with the physician, physician assistant,
or nurse practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and HCPCS
(HCPCS) codes for inclusion:
ENCOUNTER CODE (C4)
92002, 92004, 92012, 92014, 97802, 97803, 97804,
99201, 99202, 99203, 99204, 99205, 99211, 99212,
99213, 99214, 99215, 99217, 99218, 99219, 99220,
99221, 99222, 99223, 99231, 99232, 99233, 99238,
99239, 99241, 99242, 99243, 99244, 99245, 99251,
99252, 99253, 99254, 99255, 99281, 99282, 99283,
99284, 99285, 99291, 99304, 99305, 99306, 99307,
99308, 99309, 99310, 99315, 99316, 99318, 99324,
99325, 99326, 99327, 99328, 99334, 99335, 99336,
99337, 99341, 99342, 99343, 99344, 99345, 99347,
99348, 99349, 99350, 99385
, 99386
, 99387
,
99395
, 99396
, 99397
, 99401
, 99402
,
99403
, 99404
, 99411
, 99412
, 99420
,
99429
, 99455, 99456
OR
ENCOUNTER CODE (HCPCS)
G0270, G0271
AND
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9) codes for
inclusion:
DX CODE (I9)
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, 250.40, 250.41, 250.42, 250.43, 250.50,
250.51, 250.52, 250.53, 250.60, 250.61, 250.62, 250.63,
250.70, 250.71, 250.72, 250.73, 250.80, 250.81, 250.82,
250.83, 250.90, 250.91, 250.92, 250.93, 357.2, 362.01,
362.02, 362.03, 362.04, 362.05, 362.06, 362.07, 366.41,
648.00, 648.01, 648.02, 648.03, 648.04
OR
TOPIC_DRUG_CODES Table lists applicable drug codes for patients who were
prescribed insulin or oral hypoglycemics/antihyperglycemics during the
measurement period on an ambulatory basis and DRUG_EXCLUSION = N.
Numerator: Patients whose most recent blood pressure < 140/80 mmHg
Numerator Inclusions:
Patients with most recent blood pressure measurement <140/80 mmHg during
the measurement period.
Note: Both the systolic and diastolic blood pressure measurements are
required for inclusion. If there are multiple BPs on the same date of service,
use the lowest systolic and lowest diastolic BP on that date as the
representative BP.
TOPIC_EVALUATION_CODES Table lists applicable SNOMED (SNM) codes
for inclusion:
SYSTOLIC CODE (SNM)
271649006, 72313002
AND
Documentation of Systolic BP < 140 mmHg
AND
DIASTOLIC CODE (SNM)
271650006
AND
Documentation of Diastolic BP < 80 mmHg
Denominator Exclusions: (Exclusions only applied if most recent BP not recorded)
Diabetes patients with a diagnosis of
and/or steroid induced diabetes.
polycystic ovaries, gestational diabetes,
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion:
EXCLUSION CODE (I9)
251.8, 256.4, 648.80, 648.81, 648.82, 648.83, 648.84, 962.0
Diagnosis of polycystic ovaries can occur anytime in the patient’s history
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Rationale:
Intensive control of blood pressure in patients with diabetes reduces diabetes complications, diabetesrelated deaths, strokes, heart failure, and microvascular complications.
Clinical Recommendation Statements:
Recommends that a blood pressure determination during the initial evaluation, including orthostatic
evaluation, be included in the initial and every interim physical examination. (AACE/ACE)
Blood pressure control must be a priority in the management of persons with hypertension and type 2
diabetes. (ACP)
Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood
pressure >130 mmHg or diastolic >80 mmHg should have blood pressure confirmed on a separate day.
Orthostatic measurement of blood pressure should be performed to assess for the presence of autonomic
neuropathy. (Level of Evidence: E) (ADA)
Older persons with diabetes are likely to benefit greatly from cardiovascular risk reduction; therefore,
monitor and treat hypertension and dyslipidemias. (AGS)
Measurement of blood pressure in the standing position is indicated periodically, especially in those at
risk for postural hypotension. At least two measurements should be made and the average recorded.
After BP is at goal and stable, follow-up visits can usually be at 3- to 6-month intervals. Comorbidities
such as heart failure, associated diseases such as diabetes, and the need for laboratory tests influence the
frequency of visits. (JNC)
All individuals should be evaluated during health encounters to determine whether they are at increased
risk of having or of developing chronic kidney disease. This evaluation of risk factors should include
blood pressure measurement. (NKF)
— List of Data Elements located in Appendix A
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2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #5: Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin
Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
Description: Percentage of patients aged 18 years and older with a diagnosis of heart failure and
LVSD who were prescribed ACE inhibitor or ARB therapy
Denominator: Heart failure patients aged 18 years and older with LVEF < 40% or with
moderately or severely depressed left ventricular systolic function
Denominator Inclusions:
All patients with a documented diagnosis of heart failure at any time in the
patient’s medical history, patient is ≥ 18 years of age at the beginning of the
measurement period, and who also have LVSD (defined as ejection fraction < 40%
- use most recent value) or with moderately or severely depressed left ventricular
systolic function. To be eligible for performance calculations, patients must have at
least two face-to-face office visits with the physician, physician assistant, or nurse
practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) codes for
inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99238, 99239, 99241, 99242, 99243,
99244, 99245, 99304, 99305, 99306, 99307, 99308,
99309, 99310, 99324, 99325, 99326, 99327, 99328,
99334, 99335, 99336, 99337, 99341, 99342, 99343,
99344, 99345, 99347, 99348, 99349, 99350, 99385
99386
, 99387
, 99395
, 99396
,
, 99397
AND
TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9) codes for
inclusion:
DX CODE (I9)
402.01, 402.11, 402.91, 404.01, 404.03, 404.11,
404.13, 404.91, 404.93, 428.0, 428.1, 428.20,
428.21, 428.22, 428.23, 428.30, 428.31, 428.32,
428.33, 428.40, 428.41, 428.42, 428.43, 428.9
AND
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and SNOMED
(SNM) codes for inclusion:
EJEC FRAC CODE (C4)
78414, 78468, 78472, 78473, 78480, 78494, 93303,
93304, 93306, 93307, 93308, 93312, 93314, 93315,
93317, 93318, 93350, 93543
OR
EJEC FRAC CODE (SNM)
250907009, 250908004, 366188009, 371862006,
41466009, 46258004, 70822001
AND
Documentation of LVEF < 40%
Numerator: Patients who were prescribed ACE inhibitor or ARB therapy
Numerator Inclusions:
TOPIC_DRUG_CODES Table lists applicable drug codes for patients who were
prescribed ACE inhibitor or ARB therapy during the measurement period and
DRUG_EXCLUSION = N.
Denominator Exclusions: (Exclusions only applied if the patient did not receive ACE
inhibitor or ARB therapy)
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion. The EXCLUSION code can occur anytime before
the end of the measurement period.
EXCLUSION CODE (I9)
39.95, 54.98, 277.6, 395.0, 395.2, 396.0, 396.2, 396.8,
403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13,
404.92, 404.93, 425.1, 440.1, 584.5, 584.6, 584.7, 584.8,
584.9, 585.5, 585.6, 586, 747.22, 788.5, V56.0, V56.8
OR
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion. The PREGNANCY codes must occur during the
measurement period.
PREGNANCY CODE (I9)
V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41,
V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84,
V23.85, V23.86, V23.89, V23.9
OR
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TOPIC_MEDICAL_EXCLUSION Table lists applicable SNOMED (SNM) codes
for allergy or intolerance to ACE inhibitor and ARB therapy:
ACE ALLERGY CODE (SNM)
293500009, 295036000, 315364008,
403607004, 407564000, 407578004, 407595007
AND
ARB ALLERGY CODE (SNM)
407579007, 407590002, 407593000
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for medical reason exclusion:
MEDICAL REASON (C4)
4009F-1P
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for patient reason exclusion:
PATIENT REASON (C4)
4009F-2P
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for system reason exclusion:
SYSTEM REASON (C4)
4009F-3P
Version 1.0
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Rationale:
In the absence of contraindications, ACE Inhibitors or ARBs are recommended for all patients with
symptoms of heart failure and reduced left ventricular systolic function, as measured by left ventricular
ejection fraction (LVEF). Both drugs have been shown to decrease mortality and hospitalizations.
Clinical Recommendation Statements:
Angiotensin converting enzyme inhibitors are recommended for all patients with current or prior
symptoms of HF and reduced LVEF, unless contraindicated. (Class I Recommendation, Level of
Evidence: A)(ACC/AHA)
Angiotensin II receptor blockers approved for the treatment of HF are recommended in patients with
current or prior symptoms of HF and reduced LVEF who are ACEI-intolerant. (Class I
Recommendation, Level of Evidence: A) (ACC/AHA)
Angiotensin II receptor blockers are reasonable to use as alternatives to ACEIs as first-line therapy for
patients with mild to moderate HF and reduced LVEF, especially for patients already taking ARBs for
other indications. (Class IIa Recommendation, Level of Evidence: A) (ACC/AHA)
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 16 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #7: Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD Patients with
Prior Myocardial Infarction (MI)
Description: Percentage of patients aged 18 years and older with a diagnosis of coronary artery
disease and prior MI who were prescribed beta-blocker therapy
Denominator: Patients aged 18 years and older with a diagnosis of coronary artery disease who
also have prior myocardial infarction (MI) at any time
Denominator Inclusions:
All patients with a documented diagnosis of CAD at any time in the patient’s
medical history who also had prior MI at any time and patient is ≥ 18 years of age
at the beginning of the measurement period. To be eligible for performance
calculations, patients must have at least two face-to-face office visits with the
physician, physician assistant, or nurse practitioner during the measurement
period.
Note: Eligible patients for this measure require the presence of a prior MI
diagnosis AND at least one E/M code during the measurement period.
Diagnosis codes for Coronary Artery Disease (which include MI diagnosis
codes) may also accompany the MI diagnosis code, but are not required for
inclusion in the measure.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and ICD-9-CM
(I9) codes for inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99238, 99239, 99241, 99242, 99243,
99244, 99245, 99304, 99305, 99306, 99307, 99308,
99309, 99310, 99324, 99325, 99326, 99327, 99328,
99334, 99335, 99336, 99337, 99341, 99342, 99343,
99344, 99345, 99347, 99348, 99349, 99350,
99385
, 99386
, 99387
, 99395
, 99396
, 99397
AND
DX CODE (I9)
411.0, 411.1, 411.81, 411.89, 413.0, 413.1, 413.9,
414.00, 414.01, 414.02, 414.03, 414.04, 414.05,
414.06, 414.07, 414.8, 414.9, V45.81, V45.82,
OR
DX CODE (C4)
33140, 33510, 33511, 33512, 33513, 33514, 33516,
33533, 33534, 33535, 33536, 92980, 92982, 92995
AND
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
Version 1.0
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MI DX CODE (I9)
410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20,
410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41,
410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62,
410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90,
410.91, 410.92, 412
OR
All patients with a documented diagnosis of a prior MI at any time and patient is ≥
18 years of age at the beginning of the measurement period.
Note: Eligible patients for this measure require the presence of a prior MI
diagnosis AND at least one E/M code during the measurement period.
Diagnosis codes for Coronary Artery Disease (which include MI diagnosis
codes) may also accompany the MI diagnosis code, but are not required for
inclusion in the measure.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and ICD-9-CM
(I9) codes for inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99238, 99239, 99241, 99242, 99243,
99244, 99245, 99304, 99305, 99306, 99307, 99308,
99309, 99310, 99324, 99325, 99326, 99327, 99328,
99334, 99335, 99336, 99337, 99341, 99342, 99343,
99344, 99345, 99347, 99348, 99349, 99350,
99385
, 99386
, 99387
, 99395
, 99396
, 99397
AND
MI DX CODE (I9)
410.00, 410.01, 410.02, 410.10, 410.11, 410.12, 410.20,
410.21, 410.22, 410.30, 410.31, 410.32, 410.40, 410.41,
410.42, 410.50, 410.51, 410.52, 410.60, 410.61, 410.62,
410.70, 410.71, 410.72, 410.80, 410.81, 410.82, 410.90,
410.91, 410.92, 412
Numerator: Patients who were prescribed beta-blocker therapy
Numerator Inclusions:
TOPIC_DRUG_CODES Table lists applicable drug codes for patients who were
prescribed beta-blocker therapy during the measurement period and
DRUG_EXCLUSION = N.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
Version 1.0
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Denominator Exclusions: (Exclusions only applied if the patient did not receive beta-blocker
therapy)
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) and
SNOMED (SNM) codes for medical reason exclusion:
EXCLUSION CODE (I9)
427.81, 427.89, 458.0, 458.1, 458.21, 458.29, 458.8,
458.9, 493.00, 493.01, 493.02, 493.10, 493.11, 493.12,
493.20, 493.21, 493.22, 493.81, 493.82, 493.90, 493.91,
493.92
OR
EXCLUSION CODE (SNM)
195100002, 195508000, 195949008, 195972005, 195976008,
207585002, 233681001, 266361008, 28651003, 293963004,
309746001, 36083008, 389145006, 407577009, 407591003,
408667000, 408668005, 42177007, 44602002, 45007003,
48867003, 49044005, 49710005, 60423000,
63088003, 77545000, 91340006
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable SNOMED (SNM)
code for documentation of bradycardia as defined by two consecutive heart rate
readings < 50 bpm that occur during the measurement period for medical reason
exclusion:
HEART RATE CODE (SNM)
364075005
AND
Documentation of two consecutive Heart Rates < 50 bpm
OR
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for history of 2nd or 3rd degree AV block without permanent pacemaker for
medical reason exclusion. An AV_BLOCK_CODE must be present without the
PERM_PACEMAKER_CODE:
AV BLOCK CODE (I9)
426.0, 426.12, 426.13
WITHOUT
PERM PACEMAKER CODE (I9)
V45.01
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for medical reason exclusion:
MEDICAL REASON (C4)
4006F-1P
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for patient reason exclusion:
PATIENT REASON (C4)
4006F-2P
OR
Version 1.0
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TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for system reason exclusion:
SYSTEM REASON (C4)
4006F-3P
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Rationale:
In the absence of contraindications, beta-blocker therapy has been shown to reduce the risk of a
recurrent MI and decrease mortality for those patients with a prior MI.
Clinical Recommendation Statements:
Chronic Stable Angina: Class I – Beta-blockers as initial therapy in the absence of contraindications in
patients with prior MI. Class I – Beta-blockers as initial therapy in the absence of contraindications in
patients without prior MI. (ACC/AHA/ACP-ASIM)
Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction: Class I – Drugs required in the
hospital to control ischemia should be continued after hospital discharge in patients who do not undergo
coronary revascularization, patients with unsuccessful revascularization, or patients with recurrent
symptoms after revascularization. Upward or downward titration of the doses may be required. Class I –
Beta-blockers in the absence of contraindications. (ACC/AHA)
Acute Myocardial Infarction: Class I – All but low-risk patients without a clear contraindication to ßadrenoceptor blocker therapy. Treatment should begin within a few days of the event (if not initiated
acutely) and continue indefinitely. Class IIa – Low-risk patients without a clear contraindication to ßadrenoceptor blocker therapy. Survivors of non-ST-elevation MI. Class IIb – Patients with moderate or
severe LV failure or other relative contraindications to ß-adrenoceptor blocker therapy, provided they
can be monitored closely. (ACC/AHA)
Although no study has determined if long-term ß-adrenoceptor blocker therapy should be administered
to survivors of MI who subsequently have successfully undergone revascularization, there is no reason
to believe that these agents act differently in coronary patients who have undergone revascularization.
(ACC/AHA)
—
List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 21 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #110: Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years
Description: Percentage of patients aged 50 years and older who received an influenza
immunization during the flu season (September through February)
Denominator: All patients aged 50 years and older
Denominator Inclusions:
All patients ≥ 50 years of age at the beginning of the measurement period. To be
eligible for performance calculations, patients must have at least one face-to-face
office visit with the physician, physician assistant, or nurse practitioner during the
measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) codes for
inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99341, 99342, 99343, 99344, 99345,
99347, 99348, 99349, 99350, 99386
, 99387
,
99396
, 99397
, 99401
, 99402
, 99403
,
99404
, 99411
, 99412
, 99420
, 99429
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
Version 1.0
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Numerator: Patients who received an influenza immunization during the flu season (September
through February)
Numerator Inclusions:
Patients who received an influenza vaccination from September through February
of the year prior to the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9), CPT
(C4), HL7 Vaccination (CVX), HCPCS (HCPCS) and SNOMED (SNM) codes
for inclusion:
INFLUENZA CODE (I9)
V04.81, V06.6
OR
INFLUENZA CODE (C4)
90656, 90658, 90660, 90661, 90662, 90663
OR
INFLUENZA CODE (CVX)
15, 16, 88
OR
INFLUENZA CODE (HCPCS)
G0008
OR
INFLUENZA CODE (SNM)
396425006, 46233009, 86198006
Denominator Exclusions: (Exclusions only applied if influenza vaccination not received)
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for medical reason exclusion:
EXCLUSION CODE (I9)
995.68, V15.03
OR
TOPIC_MEDICAL_EXCLUSION Table lists applicable SNOMED (SNM) codes
for allergy or contraindication to influenza immunization:
ALLERGY CODE (SNM)
293112000, 293113005, 294647003,
315631004, 407594006, 91930004
OR
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for adverse effects exclusion where an ADVERSE_EFFECT_1 code must be
accompanied by an ADVERSE_EFFECT_2 code:
ADVERSE EFFECT 1 CODE (I9)
995.0, 995.1, 995.27, 995.29, 999.5
AND
ADVERSE EFFECT 2 CODE (I9)
E949.6
OR
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TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
and SNOMED (SNM) codes for medical reason exclusion:
MEDICAL REASON (C4)
4037F-1P
OR
MEDICAL REASON (SNM)
390796006
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
and SNOMED (SNM) codes for patient reason exclusion:
PATIENT REASON (C4)
4037F-2P
OR
PATIENT REASON (SNM)
315640000
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
codes for system reason exclusion:
SYSTEM REASON (C4)
4037F-3P
Version 1.0
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Page 24 of 56
Rationale:
Influenza vaccination has shown to decrease hospitalizations for influenza, especially for those with risk
factors, however annual influenza vaccination rates remain low.
Clinical Recommendation Statements:
Annual influenza immunization is recommended for all groups who are at increased risk for
complications from influenza including persons aged ≥ 50 years. (CDC, USPSTF)
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 25 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #111: Preventive Care and Screening: Pneumonia Vaccination for Patients 65 Years
and Older
Description: Percentage of patients aged 65 years and older who have ever received a
pneumococcal vaccine
Denominator: All patients 65 years and older
Denominator Inclusions:
All patients ≥ 65 years of age at the beginning of the measurement period. To be
eligible for performance calculations, patients must have at least one face-to-face
office visits with the physician, physician assistant, or nurse practitioner during
the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) codes for
inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99341, 99342, 99343, 99344, 99345,
99347, 99348, 99349, 99350, 99386
, 99387
,
99396
, 99397
, 99401
, 99402
, 99403
,
99404
, 99411
, 99412
, 99420
, 99429
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
Version 1.0
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Numerator: Patients who have ever received a pneumococcal vaccination
Numerator Inclusions:
Patients who received a pneumococcal vaccination before the end of the
measurement period.
TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9), CPT
(C4), HL7 Vaccination (CVX), HCPCS (HCPCS), and SNOMED (SNM) codes
for inclusion:
PNEUMO CODE (I9)
V03.82, V06.6
OR
PNEUMO CODE (C4)
90732
OR
PNEUMO CODE (CVX)
33, 100, 109
OR
PNEUMO CODE (HCPCS)
G0009
OR
PNEUMO CODE (SNM)
12866006, 333598008, 398730001
Denominator Exclusions: (Exclusions only applied if the patient has never received a
pneumococcal vaccination)
TOPIC_MEDICAL_EXCLUSION Table lists applicable SNOMED (SNM) codes
for medical reason exclusion:
ALLERGY CODE (SNM)
293116002, 294652008, 413378005, 414373006
OR
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) codes
for adverse effects exclusion where an ADVERSE_EFFECT_1 code must be
accompanied by an ADVERSE_EFFECT_2 code:
ADVERSE EFFECT 1 CODE (I9)
995.0, 995.1, 995.27, 995.29, 999.5
AND
ADVERSE EFFECT 2 CODE (I9)
E948.8
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
and SNOMED (SNM) code for medical reason exclusion:
MEDICAL REASON (C4)
4040F-1P
OR
MEDICAL REASON (SNM)
390795005
OR
Version 1.0
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TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
and SNOMED (SNM) code for patient reason exclusion:
PATIENT REASON (C4)
4040F-2P
OR
PATIENT REASON (SNM)
401086001
Version 1.0
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Rationale:
The elderly have a much higher mortality from community-acquired pneumonia due to increased risk
factors such as comorbidities, an increase in the number of medications taken and weaknesses or disease
of lung tissue. Pneumonia accounts for an estimated 20 percent of nosocomial infections among the
elderly, second only to urinary tract infections. The disease burden is large for older adults and the
potential for prevention is high. (Ely, E., 1997)
Drugs such as penicillin were once effective in treating these infections; but the disease has become
more resistant, making treatment of pneumococcal infections more difficult. This makes prevention of
the disease through vaccination even more important. (CDC. National Immunization Program—
Pneumococcal Disease., 2005)
Clinical Recommendation Statements:
The U.S. Preventive Services Task Force’s Guide to Clinical Preventive Services recommends
pneumococcal vaccine for all immunocompetent individuals who are 65 and older or otherwise at
increased risk for pneumococcal disease. Routine revaccination is not recommended, but may be
appropriate in immunocompetent individuals at high risk for morbidity and mortality from
pneumococcal disease (e.g., persons ≥ 75 years of age or with severe chronic disease) who were
vaccinated more than five years previously. Medicare Part B fully covers the cost of the vaccine and its
administration every five years. (United States Preventive Services Task Force, 1998)
Pneumococcal infection is a common cause of illness and death in the elderly and persons with certain
underlying conditions. In 1998, an estimated 3,400 adults aged ≥ 65 years died as a result of invasive
pneumococcal disease. Pneumococcal infection accounts for more deaths than any other vaccinepreventable bacterial disease. (CDC, 2002; Pneumococcal Pneumonia, NIAID Fact Sheet, December
2004.)
One of the Healthy People 2010 objectives is to increase pneumococcal immunization levels for the
non-institutionalized, high-risk populations to at least 90 percent (objective no. 14.29). While the
percent of persons 65 years and older receiving the pneumococcal vaccine has increased, it still remains
considerably below the Health People 2010 objective. According to the National Health Interview
Survey (NHIS), which is used to track performance on year 2010 objectives, in 1998 only 46 percent of
adults age 65 years and older report receiving the vaccine. The figure was 45 percent based on the 1997
Behavioral Risk Factor Surveillance System (BRFSS) survey. (National Center for Health Statistics.,
2005; CDC, 1997)
A particular strength of this measure is that it provides an opportunity to compare performance against
national, state and/or regional benchmarks, which are collected through nationally organized and
administered surveys.
At the physician practice level where a patient survey may not be feasible, data collection on pneumonia
vaccination status through chart abstraction is a viable option.
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 29 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #112: Preventive Care and Screening: Screening Mammography
Description: Percentage of women aged 40 through 69 years who had a mammogram to screen
for breast cancer within 24 months
Denominator: All female patients aged 40 through 69 years
Denominator Inclusions:
All female patients ≥ 40 and ≤ 69 years of age at the beginning of the
measurement period. To be eligible for performance calculations, patients must
have at least one face-to-face office visit with the physician, physician assistant, or
nurse practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) codes for
inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212,
99213, 99214, 99215, 99341, 99342, 99343,
99344, 99345, 99347, 99348, 99349, 99350,
99386
, 99387
, 99396
, 99397
, 99401
,
99402
, 99403
, 99404
, 99411
, 99412
,
99420
, 99429
Numerator: Patients who had a mammogram at least once within 24 months
Numerator Inclusions:
Female patients who had a mammogram during the measurement period or year
prior to the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable ICD-9-CM (I9), CPT
(C4), HCPCS (HCPCS), and SNOMED (SNM) codes for inclusion:
MAMMO CODE (I9)
87.36, 87.37, V76.11, V76.12
OR
MAMMO CODE (C4)
77051, 77052, 77055, 77056, 77057
OR
MAMMO CODE (HCPCS)
G0202, G0204, G0206
OR
MAMMO CODE (SNM)
24623002
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR. All measurerelated EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
Version 1.0
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Denominator Exclusions: (Exclusions only applied if mammogram not performed)
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9) and CPT
(C4) codes for medical reason exclusion:
EXCLUSION CODE (I9)
85.41, 85.42, 85.43, 85.44, 85.45, 85.46, 85.47, 85.48
OR
EXCLUSION CODE (C4)
19303, 19304, 19305, 19306, 19307, 19303-50*, 19304-50*,
19305-50*, 19306-50*, 19307-50*
*-50 modifier indicates the procedure was performed bilaterally
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for medical reason exclusion:
MEDICAL REASON (C4)
3014F-1P
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Rationale:
Breast cancer ranks as the second leading cause of death in women. For women 40 to 49 years of age
mammography can reduce mortality by 17 percent. (AMA, 2003)
Clinical Recommendation Statement:
The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or
without clinical breast examination (CBE), every 1-2 years for women aged 40 and older. (USPSTF,
2002)
•
•
•
The USPSTF found fair evidence that mammography screening every 12-33 months
significantly reduces mortality from breast cancer. Evidence is strongest for women aged 50-69,
the age group generally included in screening trials. (USPSTF, 2002)
For women aged 40-49, the evidence that screening mammography reduces mortality from
breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older
women. Most, but not all, studies indicate a mortality benefit for women undergoing
mammography at ages 40-49, but the delay in observed benefit in women younger than 50 makes
it difficult to determine the incremental benefit of beginning screening at age 40 rather than at
age 50. (USPSTF, 2002)
The absolute benefit is smaller because the incidence of breast cancer is lower among women in
their 40s than it is among older women. (USPSTF, 2002)
The USPSTF concluded that the evidence is also generalizable to women aged 70 and older (who face a
higher absolute risk for breast cancer) if their life expectancy is not compromised by comorbid disease.
The absolute probability of benefits of regular mammography increases along a continuum with age,
whereas the likelihood of harms from screening (false-positive results and unnecessary anxiety, biopsies,
and cost) diminishes from ages 40-70. The balance of benefits and potential harms; therefore, grows
more favorable as women age. The precise age at which the potential benefits of mammography justify
the possible harms is a subjective choice. (USPSTF, 2002)
American Cancer Society: Yearly Mammograms starting at age 40 and continuing for as long as a
woman is in good health. (Smith, 2003)
American College of Preventative Medicine (ACPM):
•
Low-risk women (no family history, familial cancer syndrome, or prior cancer). There is
inadequate evidence for or against mammography screening of women under the age of 50.
Women between the ages of 50-69 should have annual or biennial, high-quality, two-view
mammography. Women aged 70 and older should continue undergoing mammography screening
provided their health status permits breast cancer treatment. (Ferrini, 1996)
• Higher-risk women: Women with a family history of pre-menopausal breast cancer in a firstdegree relative or those with a history of breast and/or gynecologic cancer may warrant more
aggressive screening. Women with these histories often begin screening at an earlier age,
although there is no direct evidence of effectiveness to support this practice. The future
availability of genetic screening may define new recommendations for screening high-risk
women. (Ferrini, 1996)
The American Medical Association (AMA), the American College of Obstetricians and Gynecologists
(ACOG), and the American College of Radiology (ACR), all support screening with mammography and
CBE beginning at age 40. (AMA, 1999; ACOG, 2000; Feig, 1998)
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The Canadian Task Force on Preventive Health Care (CTFPHC), and the American Academy of Family
Physicians (AAFP), recommends beginning mammography for average-risk women at age 50.
(Canadian Task Force on the Periodic Health Examination, 1999; AAFP, 2005)
AAFP recommends that mammography in high-risk women begin at age 40, and recommends that all
women aged 40-49 be counseled about the risks and benefits of mammography before making decisions
about screening. (AAFP, 2005)
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 33 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #113: Preventive Care and Screening: Colorectal Cancer Screening
Description: Percentage of patients aged 50 through 80 years who received the appropriate
colorectal cancer screening
Denominator: All patients aged 50 through 80 years
Denominator Inclusions:
All patients ≥ 50 and ≤ 80 years of age at the beginning of the measurement
period. To be eligible for performance calculations, patients must have at least one
face-to-face office visit with the physician, physician assistant, or nurse
practitioner during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) codes for
inclusion:
ENCOUNTER CODE (C4)
99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99341, 99342, 99343, 99344, 99345,
99347, 99348, 99349, 99350, 99386
, 99387
,
99396
, 99397
, 99401
, 99402
, 99403
,
99404
, 99411
, 99412
, 99420
, 99429
The “Percentage of patients…” who meet the criteria for this measure will be calculated by the EHR Warehouse. All
measure-related EHR coding/data should be submitted to the EHR Warehouse to ensure accurate performance rates.
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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Numerator: Patients who had at least one or more screenings for colorectal
cancer during or prior to the reporting period
Numerator Inclusions:
Patients with any of the recommended colorectal cancer screening test(s)
performed.
Current colorectal cancer screening is defined as performing any of the
following:
· Fecal occult blood test during the measurement period
· Flexible sigmoidoscopy during the measurement period or four years prior
· Double contrast barium enema during the measurement period or four
years prior
· Colonoscopy during the measurement period or nine years prior
TOPIC_EVALUATION_CODES Table lists applicable LOINC (LN), CPT (C4),
HCPCS (HCPCS), ICD-9-CM (I9) and SNOMED (SNM) codes for inclusion:
FOBT CODE (LN)
12503-9, 12504-7, 14563-1, 14564-9, 14565-6,
2335-8, 27396-1, 27401-9, 27925-7, 27926-5, 29771-3
OR
FOBT CODE (C4)
82270, 82274
OR
FOBT CODE (HCPCS)
G0328
OR
FOBT CODE (I9)
V76.51
OR
FLEX SIG CODE (C4)
45330, 45331, 45332, 45333, 45334, 45335, 45337,
45338, 45339, 45340, 45341, 45342, 45345
OR
FLEX SIG CODE (HCPCS)
G0104
OR
FLEX SIG CODE (I9)
45.24, 45.42
OR
DCBE CODE (C4)
74270, 74280
OR
DCBE CODE (HCPCS)
G0106
OR
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COLOSCOPE CODE (C4)
44388, 44389, 44390, 44391, 44392, 44393, 44394,
44397, 45355, 45378, 45379, 45380, 45381, 45382,
45383, 45384, 45385, 45386, 45387, 45391, 45392
OR
COLOSCOPE CODE (HCPCS)
G0105, G0120, G0121
OR
COLOSCOPE CODE (I9)
45.22, 45.23, 45.25, 45.43
OR
COLOREC SCREEN CODE (SNM)
275978004, 275979007, 316635002
Denominator Exclusions: (Exclusions only applied if screening for colorectal cancer not
performed)
TOPIC_MEDICAL_EXCLUSION Table lists applicable ICD-9-CM (I9), CPT
(C4) and SNOMED (SNM) codes for medical reason exclusion:
EXCLUSION CODE (I9)
45.8, 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6,
153.7, 153.8, 153.9, 154.0, 154.1, 197.5, V10.05,
V10.06
OR
EXCLUSION CODE (C4)
44150, 44151, 44155, 44156, 44157, 44158, 44210,
44211, 44212
OR
EXCLUSION CODE (SNM)
300936002
OR
TOPIC_MEDICAL_EXCLUSION Table lists an applicable CPT Category II (C4)
code for medical reason exclusion:
MEDICAL REASON (C4)
3017F-1P
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Rationale:
Colorectal cancer is the second leading cause of cancer-related death in the United States. There were an
estimated 135,400 new cases and 56,700 deaths from the disease during 2001. Colorectal cancer (CRC)
places significant economic burden on the society as well with treatment costs over $6.5 billion per year
and, among malignancies, is second only to breast cancer at $6.6 billion per year (Schrag, 1999).
Colorectal cancer screening can detect pre-malignant polyps and early stage cancers. Unlike other
screening tests that only detect disease, colorectal cancer screening can guide removal of pre-malignant
polyps, which in theory can prevent development of colon cancer. Four tests are currently available for
screening: fecal occult blood testing (FOBT), flexible sigmoidoscopy, colonoscopy, and double contrast
barium enema.
Clinical Recommendation Statements:
During the past decade, compelling evidence has accumulated that systematic screening of the
population can reduce mortality from colorectal cancer. Three randomized, controlled trials
demonstrated that fecal occult blood testing (FOBT), followed by complete diagnostic evaluation of the
colon for a positive test, reduced colorectal cancer mortality (Hardcastle et al., 1996; Mandel & Oken,
1998; Kronborg; 1996). One of these randomized trials (Mandel et al., 1993) compared annual FOBT
screening to biennial FOBT screening, and found that annual screening resulted in greater reduction in
colorectal cancer mortality. Two case control studies have provided evidence that sigmoidoscopy
reduces colorectal cancer mortality (Selby et al., 1992; Newcomb et al., 1992). Approximately 75% of
all colorectal cancers arise sporadically (Stephenson et al., 1991). Part of the effectiveness of colorectal
cancer screening is mediated by the removal of the precursor lesion—an adenomatous polyp
(Vogtelstein et al., 1988). It has been shown that removal of polyps in a population can reduce the
incidence of colorectal cancer (Winawer, 1993). Colorectal screening may also lower mortality by
allowing detection of cancer at earlier stages, when treatment is more effective (Kavanaugh, 1998).
Because of the accumulated evidence, broad consensus has emerged about the virtue of screening
individuals aged 50 years or older for colorectal cancer. In 1996, the U.S. Preventive Services Task
Force (USPSTF) published guidelines that recommended screening all persons aged 50 and older for
colorectal cancer by annual FOBT or sigmoidoscopy (at unspecified periodicity) or both (USPSTF,
1997). In February 1997, clinical practice recommendations were issued by an interdisciplinary task
force originally convened by the Agency for Health Care Policy and Research (AHCPR; the agency has
since been renamed the Agency for Healthcare Research and Quality) and supported by a consortium of
professional organizations including the American Gastroenterological Association (Winawer, 1997).
The American Cancer Society (ACS) has recommended screening for colorectal cancer since 1980 and
recently updated its guidelines in January, 2002 (Smith et al., 2002). These updated guidelines
recommend colorectal cancer screening starting at age 50 for all persons at average risk of developing
colorectal cancer using one of five options for screening: (1) annual FOBT; (2) flexible sigmoidoscopy
every 5 years; (3) annual FOBT plus flexible sigmoidoscopy every 5 years; (4) double contrast barium
enema (DCBE) every five years; or (5) colonoscopy every 10 years.
The USPSTF released its updated recommendations for colorectal cancer screening in July 2002. The
USPSTF strongly recommends that clinicians screen men and women 50 years of age or older for
colorectal cancer (A recommendation). The USPSTF found good evidence for FOBT screening, fair
evidence for sigmoidoscopy (alone or in combination with FOBT), and no direct evidence for
colonoscopy or double contrast barium enema. The USPSTF found insufficient evidence to recommend
new technologies, such as virtual colonoscopy. The recommended periodicity is annually for FOBT,
every 5 years for sigmoidoscopy and double contrast barium enema, and every 10 years for
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colonoscopy. FOBT is the only test for which direct evidence on periodicity exists. The intervals for the
other tests are based on their sensitivity and the natural course of the disease.
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 38 of 56
2010 EHR Warehouse Measure Specifications
ANALYTIC NARRATIVES
Measure #124: Health Information Technology (HIT): Adoption/Use of Electronic Health
Records (EHR)
Description: Documents whether provider has adopted and is using health information
technology. To qualify, the provider must have adopted and be using a
certified/qualified electronic health record (EHR).
Denominator: All patient encounters
Denominator Inclusions:
All patient encounters. To be eligible for performance calculations, patients must
have at least one face-to-face office visit with the clinician during the measurement
period.
TOPIC_EVALUATION_CODES Table lists applicable CPT (C4) and HCPCS
(HCPCS) codes for inclusion:
ENCOUNTER CODE (C4)
90801, 90802, 90804, 90805, 90806, 90807, 90808,
90809, 92002, 92004, 92012, 92014, 96150, 96151,
96152, 97001, 97002, 97003, 97004, 97750, 97802,
97803, 97804, 98940, 98941, 98942, 99201, 99202,
99203, 99204, 99205, 99211, 99212, 99213, 99214,
99215, 99241, 99242, 99243, 99244, 99245, 99381
99382
, 99383
, 99384
, 99385
, 99386
,
99387
, 99391
, 99392
, 99393
, 99394
,
99395
, 99396
, 99397
,
OR
ENCOUNTER CODE (HCPCS)
D7140, D7210, G0101, G0108, G0109, G0270, G0271
Numerator: Patient encounter documentation substantiates use of certified/qualified EHR
Numerator Inclusions:
Patient encounters with documentation substantiating the use of a CCHIT certified
or qualified (non-CCHIT certified) EHR during the measurement period.
TOPIC_EVALUATION_CODES Table lists applicable HCPCS (HCPCS) codes
for inclusion:
EHR CODE (HCPCS)
G8447, G8448
Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These noncovered services will not be counted in the denominator population for PQRI reporting calculations.
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Denominator Exclusions:
None
Version 1.0
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Rationale:
The need for clinical information systems to provide high-quality, safe care is a well recognized fact, as
publicized by Dr. Ed Wagner in his Chronic Care Model. A comprehensive clinical information system
can enhance the care of individual patients by:
• Providing timely reminders about needed services
• Summarizing data to track and plan care
• Identifying groups of patients needing additional care
• Facilitating performance monitoring and quality improvement efforts
While it is preferable to encourage adoption of CCHIT certified EMRs, it became apparent during
measure field testing that CCHIT certified EMRs are not currently available for all provider settings and
specialty groups that may report this measure. Therefore, additional numerator coding was added to
enable providers who have adopted a non-CCHIT certified product, which meets a set of standards, to
also report this measure. The following is an excerpt taken from the CCHIT website:
The 2006 Ambulatory EHR Criteria represent basic requirements that the Commission and its
Workgroups believe are appropriate for many common ambulatory care settings. CCHIT acknowledges
that these Criteria may not be suitable for settings such as behavioral health, emergency departments, or
specialty practices and our current certification makes no representation for these. Purchasers should not
interpret a lack of CCHIT Certification as being of significance for specialties and domains not yet
addressed by CCHIT Criteria.
Evidence Supporting the Criterion of Quality Measure:
Overall Evidence Grading: SORT Strength of Recommendation B: considerable patient-oriented
evidence, i.e., re: better patient care management, higher patient satisfaction, reduction of adverse drug
events, better quality performance, and improved patient safety, but not consistently high quality
evidence
Committee on Quality Health Care in America (2001). Crossing the Quality Chasm: A new health
system for the 21st century. Washington, D.C., National Academy Press.
This report explains the difficulty managing a patient’s care using a written medical record,
which can be cumbersome to navigate through, as well as illegible. Not only would an EMR be
consistent and legible, it can provide reminders and prompts, allowing better management of
patient care. In addition, patients who can access their provider using e-mail can have their needs
met more quickly and cost effectively.
Study quality level 2 (limited-quality patient-oriented evidence)
Hillestad, R., et al. (2005). "Can electronic medical record systems transform health care? Potential
health benefits, savings and costs." Health Affairs 24(5): 1103-1117.
This article concludes that two-thirds of the approximately 8 million adverse drug events that
occur in the outpatient setting would be avoided through the widespread use of computerized
physician order entry (CPOE).
Study quality level 2 (limited-quality patient-oriented evidence)
Jha, A. K., et al. (2003). "Effect of the transformation of the Veterans Affairs Health Care System on
quality of care." NEJM 348(22): 2218-2227.
The Veterans Health Administration medical system uses an EMR system-wide. The authors
attribute the VHA’s superior quality performance in part to “an emphasis on the use of
information technology.”
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Study quality level 2 (limited-quality patient-oriented evidence)
Middleton, B. (2005). The value of health information technology in clinical practice. Pennsylvania
eHealth Initiative, Harrisburg.
This article highlights the impact that various components of HIT and EMR will have on
improving patient safety. Additionally, Dr. Middleton enumerates the cost benefits of ambulatory
computerized physician order entry (ACPOE).
Study quality level 2 (limited-quality patient-oriented evidence)
Mitchell, E., Sullivan, F. (2001). "A descriptive feast but an evaluative famine: systematic review of
published articles on primary care computing during 1980-1997." BMJ 322(7281): 279-282.
This older systematic review documents the value of using ECI in a variety of primary care
situations.
Study quality level 2 (limited-quality patient-oriented evidence; systematic review but older)
— List of Data Elements located in Appendix A
Version 1.0
Updated July 2009
Page 42 of 56
2010 EHR Warehouse Measure Specifications
COPYRIGHTS
The following notice applies to each of the measures that contain a diamond (♦) before the title:
NCQA Notice of Use. Broad public use and dissemination of these measures is encouraged and the measure developers have agreed with
NQF that noncommercial uses do not require the consent of the measure developer. Use by health care providers in connection with their
own practices is not commercial use. Commercial use of a measure does require the prior written consent of the measure developer. As
used herein, a "commercial use" refers to any sale, license, or distribution of a measure for commercial gain, or incorporation of a measure
into any product or service that is sold, licensed, or distributed for commercial gain, (even if there is no actual charge for inclusion of the
measure.)
These performance measure were developed and are owned by the National Committee for Quality Assurance ("NCQA"). These
performance measures are not clinical guidelines and do not establish a standard of medical care. NCQA makes no representations,
warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no
liability to anyone who relies on such measures. NCQA holds a copyright in this measure and can rescind or alter this measure at any time.
Users of the measure shall not have the right to alter, enhance, or otherwise modify the measure and shall not disassemble, recompile, or
reverse engineer the source code or object code relating to the measure. Anyone desiring to use or reproduce the measure without
modification for a noncommercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved
by NCQA and are subject to a license at the discretion of NCQA. ©2004 National Committee for Quality Assurance, all rights reserved.
Performance measures developed by NCQA for CMS may look different from the measures solely created and owned by NCQA.
The following notice applies to each of the measures that contain a triangle (▲) before the title:
Physician Performance Measures (Measures) and related data specifications, developed by the Physician Consortium for Performance
Improvement® (the Consortium), are intended to facilitate quality improvement activities by physicians.
These Measures are intended to assist physicians in enhancing quality of care. Measures are designed for use by any physician who
manages the care of a patient for a specific condition or for prevention. These performance Measures are not clinical guidelines and do not
establish a standard of medical care. The Consortium has not tested its Measures for all potential applications. The Consortium
encourages the testing and evaluation of its Measures.
Measures are subject to review and may be revised or rescinded at any time by the Consortium. The Measures may not be altered without
the prior written approval of the Consortium. Measures developed by the Consortium, while copyrighted, can be reproduced and
distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices.
Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a
product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement
between the user and American Medical Association, on behalf of the Consortium. Neither the Consortium nor its members shall be
responsible for any use of these Measures.
THE MEASURES ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND
© 2007 American Medical Association. All Rights Reserved
Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all
necessary licenses from the owners of these code sets. The AMA, the Consortium and its members disclaim all liability for use or accuracy
of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.
THE SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND.
CPT® contained in the Measures specifications is copyright 2008 American Medical Association.
The following notice applies to each of the measures that contain a spade (♠) before the title:
These measures were developed by Quality Insights of Pennsylvania as a special project under the Quality Insights' Medicare Quality
Improvement Organization (QIO) contract HHSM-500-2005-PA001C with the Centers for Medicare & Medicaid Services. These measures
are in the public domain.
LOINC® copyright 2009 Regenstrief Institute, Inc.
SNOMED Clinical Terms® (SNOMED CT®) copyright 2009 IHTSDO. All rights reserved.
Version 1.0
Updated July 2009
Page 43 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #1:
Diabetes Mellitus:
Hemoglobin A1cPoor
Control in Diabetes
Mellitus
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
DX CODING SYSTEM
DX CODE
DX DATE
A1C CODING SYSTEM
A1C CODE
A1C DATE
A1C RESULT
DRUG CODING SYSTEM
DRUG CODE
DRUG ORDER DATE
DRUG EXCLUSION
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement year begins
Date the measurement year ends
Type of coding system applicable to faceto-face office visit (CPT, HCPCS)
Code used for encounter
Date of encounter
Type of coding system applicable to the
diagnosis code (ICD-9-CM)
Diagnosis code
Date of diagnosis
Type of coding system applicable for
A1C testing (CPT, LOINC)
Code used for A1C test performed
Date A1C testing was performed
Numeric result for HbA1c value (%)
Type of coding system applicable for
drug codes (NDC)
Code used for insulin or oral
hypoglycemics/antihyperglycemics drugs
Date the drug was prescribed
Is drug used as an exclusion to the
measure (Yes or No)
Type of coding system applicable to the
medical exclusions (ICD-9-CM)
Code used for a medical exclusion
Date medical exclusion was documented
Updated July 2009
Page 44 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #2:
Diabetes Mellitus:
Low Density Liproprotein
(LDL-C) Control in
Diabetes Mellitus
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
DX CODING SYSTEM
DX CODE
DX DATE
LDL CODING SYSTEM
LDL CODE
LDL DATE
LDL RESULT
DRUG CODING SYSTEM
DRUG CODE
DRUG ORDER DATE
DRUG EXCLUSION
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement year begins
Date the measurement year ends
Type of coding system applicable to faceto-face office visit (CPT, HCPCS)
Code used for encounter
Date of encounter
Type of coding system applicable to the
diagnosis code (ICD-9-CM)
Diagnosis code
Date of diagnosis
Type of coding system applicable for a
LDL-C test (CPT, LOINC)
Code used for LDL-C testing
Date LDL-C test was performed
Numeric result for LDL-C value (mg/dL)
Type of coding system applicable for
drug codes (NDC)
Code used for insulin or oral
hypoglycemics/antihyperglycemics drugs
Date the drug was prescribed
Is drug used as an exclusion to the
measure (Yes or No)
Type of coding system applicable to the
medical exclusions (ICD-9-CM)
Code used for a medical exclusion
Date medical exclusion was documented
Updated July 2009
Page 45 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #3:
Diabetes Mellitus:
High Blood Pressure
Control in Diabetes
Mellitus
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
DX CODING SYSTEM
DX CODE
DX DATE
SYSTOLIC CODING SYSTEM
SYSTOLIC CODE
SYSTOLIC DATE
SYSTOLIC RESULT
DIASTOLIC CODING SYSTEM
DIASTOLIC CODE
DIASTOLIC DATE
DIASTOLIC RESULT
DRUG CODING SYSTEM
DRUG CODE
DRUG ORDER DATE
DRUG EXCLUSION
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement year begins
Date the measurement year ends
Type of coding system applicable to faceto-face office visit (CPT, HCPCS)
Code used for encounter
Date of encounter
Type of coding system applicable to the
diagnosis code (ICD-9-CM)
Diagnosis code
Date of diagnosis
Type of coding system applicable for a
systolic blood pressure measurement
(SNOMED)
Code used for systolic blood pressure
Date systolic blood pressure was
documented
Result of systolic blood pressure
measurement (mm Hg)
Type of coding system applicable for a
diastolic blood pressure measurement
(SNOMED)
Code used for diastolic blood pressure
Date diastolic blood pressure was
documented
Result of diastolic blood pressure
measurement (mm Hg)
Type of coding system applicable for
drug codes (NDC)
Code used for insulin or oral
hypoglycemics/antihyperglycemics drugs
Date the drug was prescribed
Is drug used as an exclusion to the
measure (Yes or No)
Type of coding system applicable to the
medical exclusions (ICD-9-CM)
Code used for a medical exclusion
Date medical exclusion was documented
Updated July 2009
Page 46 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #5:
Heart Failure:
Angiotensin-Converting
Enzyme (ACE) Inhibitor
or Angiotensin Receptor
Blocker (ARB) Therapy
for Left Ventricular
Systolic Dysfunction
(LVSD)
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
DX CODING SYSTEM
DX CODE
DX DATE
EJEC FRAC CODING SYSTEM
EJEC FRAC CODE
EJEC FRAC DATE
EJEC FRAC RESULT
DRUG CODING SYSTEM
DRUG CODE
ORDER DATE
DRUG EXCLUSION
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
PREGNANCY CODING SYSTEM
PREGNANCY CODE
PREGNANCY DATE
ALLERGY CODING SYSTEM
ALLERY CODE
ALLERGY DATE
PATIENT REASON CODING SYSTEM
PATIENT REASON
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT)
Code used for encounter
Date of encounter
Type of coding system applicable to the
diagnosis code (ICD-9-CM)
Diagnosis code
Date of diagnosis
Type of coding system applicable for an
ejection fraction code (CPT, SNOMED)
Code used for an ejection fraction
Date ejection fraction was documented
Numeric result of ejection fraction percentage
(%)
Type of coding system applicable for drug
codes (NDC)
Code used for ACE inhibitor and ARB
therapy drugs
Date the drug was prescribed
Is drug used as an exclusion to the measure
(Yes or No)
Type of coding system applicable to the
medical exclusions (ICD-9-CM)
Code used for a medical exclusion
Date medical exclusion was documented
Type of coding system applicable for a
pregnancy diagnosis code (ICD-9-CM)
Code used for pregnancy diagnosis
Date pregnancy diagnosis was documented
Type of coding system applicable for an
allergy diagnosis code (SNOMED)
Code used for an allergy diagnosis
Date allergy diagnosis was documented
Type of coding system used for patient reason
for exclusion (CPT Category II)
Code used for patient reason for exclusion
Updated July 2009
Page 47 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #5:
Heart Failure:
Angiotensin-Converting
Enzyme (ACE) Inhibitor
or Angiotensin Receptor
Blocker (ARB) Therapy
for Left Ventricular
Systolic Dysfunction
(LVSD)
PATIENT REASON DATE
MEDICAL REASON CODING SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
SYSTEM REASON CODING SYSTEM
SYSTEM REASON
SYSTEM REASON DATE
Version 1.0
Date patient reason for exclusion was
identified
Type of coding system used for medical
reason for exclusion (CPT Category II)
Code used for medical reason for exclusion
Date medical reason for exclusion was
identified
Type of coding system used for system reason
for exclusion (CPT Category II)
Code used for system reason for exclusion
Date system reason for exclusion was
identified
Updated July 2009
Page 48 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
Data Element
Short Name
2010 Measure
Data Element
Description
Measure #7:
Coronary Artery
Disease (CAD):
Beta-Blocker Therapy
for CAD Patients with
Prior Myocardial
Infarction (MI)
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
DX CODING SYSTEM
DX CODE
DX DATE
MI DX CODING SYSTEM
MI DX CODE
MI DX DATE
DRUG CODING SYSTEM
DRUG CODE
DRUG ORDER DATE
DRUG EXCLUSION
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
HEART RATE CODING SYSTEM
HEART RATE CODE
HEART RATE DATE
HEART RATE RESULT
AV BLOCK CODING SYSTEM
AV BLOCK CODE
AV BLOCK DATE
PERM PACEMAKER CODING
SYSTEM
PERM PACEMAKER CODE
PERM PACEMAKER DATE
PATIENT REASON CODING
SYSTEM
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-to-face
office visit (CPT)
Code used for encounter
Date of encounter
Type of coding system applicable to the
diagnosis code (ICD-9-CM, CPT)
Diagnosis and procedure codes used to identify
the patients diagnosis
Date of diagnosis
Type of coding system applicable to the
diagnosis code for myocardial infarction (ICD9-CM)
Myocardial infarction diagnosis code
Date of myocardial infarction diagnosis
Type of coding system applicable for drug codes
(NDC)
Code used for beta-blocker drugs
Date the drug was prescribed
Is drug used as an exclusion to the measure (Yes
or No)
Type of coding system applicable to the medical
exclusions (ICD-9-CM, SNOMED)
Code used for a medical exclusion
Date medical exclusion was documented
Type of coding system applicable for a heart rate
code (SNOMED)
Code used for heart rate
Date heart rate measurement documented
Result of heart rate measurement (bpm)
Type of coding system applicable to the AV
block diagnosis code (ICD-9-CM)
Diagnosis code used for AV block
Date AV block was documented
Type of coding system applicable for a
permanent pacemaker code (ICD-9-CM)
Code used for a permanent pacemaker
Date permanent pacemaker was documented
Type of coding system used for patient reason
for exclusion (CPT Category II)
Updated July 2009
Page 49 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #7:
Coronary Artery
Disease (CAD):
Beta-Blocker Therapy
for CAD Patients with
Prior Myocardial
Infarction (MI)
PATIENT REASON
PATIENT REASON DATE
MEDICAL REASON CODING
SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
SYSTEM REASON CODING
SYSTEM
SYSTEM REASON
SYSTEM REASON DATE
Version 1.0
Code used for patient reason for exclusion
Date patient reason for exclusion was identified
Type of coding system used for medical reason
for exclusion (CPT Category II)
Code used for medical reason for exclusion
Date medical reason for exclusion was identified
Type of coding system used for system reason
for exclusion (CPT Category II)
Code used for system reason for exclusion
Date system reason for exclusion was identified
Updated July 2009
Page 50 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #110:
Preventive Care and
Screening: Influenza
Immunization for Patients
≥ 50 Years Old
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
INFLUENZA CODING SYSTEM
INFLUENZA CODE
INFLUENZA DATE
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
ALLERY CODING SYSTEM
ALLERGY CODE
ALLERGY DATE
ADVERSE EFFECT 1 CODING SYSTEM
ADVERSE EFFECT 1 CODE
ADVERSE EFFECT 1 DATE
ADVERSE EFFECT 2 CODING SYSTEM
ADVERSE EFFECT 2 CODE
ADVERSE EFFECT 2 DATE
PATIENT REASON CODING SYSTEM
PATIENT REASON
PATIENT REASON DATE
MEDICAL REASON CODING SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
SYSTEM REASON CODING SYSTEM
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT)
Code used for encounter
Date of encounter
Coding system applicable to influenza
vaccination (ICD-9-CM, CPT, CVX, HCPCS,
SNOMED)
Code for influenza vaccination
Date of influenza vaccination
Type of coding system applicable to the
medical exclusions (ICD-9-CM)
Code used for a medical exclusion
Date medical exclusion was documented
Coding system applicable to the allergy
reasons for exclusion (SNOMED)
Allergy code used for exclusion
Date allergy was documented
Coding system applicable to adverse effects
(ICD-9-CM)
Code (1 of 2) used for adverse effects
Date adverse effect (1 of 2) was documented
Coding system applicable to adverse effects
(ICD-9-CM E codes)
Code (2 of 2) used for adverse effects
Date adverse effect (2 of 2) was documented
Type of coding system used for patient reason
for exclusion (CPT Category II, SNOMED)
Code used for patient reason for exclusion
Date patient reason for exclusion was
identified
Type of coding system used for medical
reason for exclusion (CPT Category II,
SNOMED)
Code used for medical reason for exclusion
Date medical reason for exclusion was
identified
Type of coding system used for system reason
for exclusion (CPT Category II)
Updated July 2009
Page 51 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #110:
Preventive Care and
Screening: Influenza
Immunization for Patients
≥ 50 Years Old
SYSTEM REASON
SYSTEM REASON DATE
Version 1.0
Code used for system reason for exclusion
Date system reason for exclusion was
identified
Updated July 2009
Page 52 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #111:
Preventive Care and
Screening: Pneumonia
Vaccination for Patients
65 Years and Older
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
PNEUMO CODING SYSTEM
PNEUMO CODE
PNEUMO DATE
ALLERY CODING SYSTEM
ALLERGY CODE
ALLERGY DATE
ADVERSE EFFECT 1 CODING SYSTEM
ADVERSE EFFECT 1 CODE
ADVERSE EFFECT 1 DATE
ADVERSE EFFECT 2 CODING SYSTEM
ADVERSE EFFECT 2 CODE
ADVERSE EFFECT 2 DATE
PATIENT REASON CODING SYSTEM
PATIENT REASON
PATIENT REASON DATE
MEDICAL REASON CODING SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT)
Code used for encounter
Date of encounter
Coding system applicable to pneumococcal
vaccination (ICD-9-CM, CPT, CVX, HCPCS,
SNOMED)
Code for pneumococcal vaccination
Date of pneumococcal vaccination
Coding system applicable to the allergy
reasons for exclusion (SNOMED)
Allergy code used for exclusion
Date allergy was documented
Coding system applicable to adverse effects
(ICD-9-CM)
Code (1 of 2) used for adverse effects
Date adverse effect (1 of 2) was documented
Coding system applicable to adverse effects
(ICD-9-CM E codes)
Code (2 of 2) used for adverse effects
Date adverse effect (2 of 2) was documented
Type of coding system used for patient reason
for exclusion (CPT Category II, SNOMED)
Code used for patient reason for exclusion
Date patient reason for exclusion was
identified
Type of coding system used for medical
reason for exclusion (CPT Category II,
SNOMED)
Code used for medical reason for exclusion
Date medical reason for exclusion was
identified
Updated July 2009
Page 53 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #112:
Preventive Care and
Screening: Screening
Mammography
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
MAMMO CODING SYSTEM
MAMMO CODE
MAMMO DATE
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
MEDICAL REASON CODING SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT)
Code used for encounter
Date of encounter
Coding system applicable to mammography
testing (ICD-9-CM, CPT, HCPCS,
SNOMED)
Code used for mammography testing
Date mammography was performed
Type of coding system applicable to the
medical exclusions (ICD-9-CM, CPT)
Code used for a medical exclusion
Date medical exclusion was documented
Type of coding system used for medical
reason for exclusion (CPT Category II)
Code used for medical reason for exclusion
Date medical reason for exclusion was
identified
Updated July 2009
Page 54 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
2010 Measure
Data Element
Short Name
Data Element
Description
Measure #113:
Preventive Care and
Screening: Colorectal
Cancer Screening
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
FOBT CODING SYSTEM
FOBT CODE
FOBT DATE
FLEX SIG CODING SYSTEM
FLEX SIG CODE
FLEX SIG DATE
DCBE CODING SYSTEM
DCBE CODE
DCBE DATE
COLOSCOPE CODING SYSTEM
COLOSCOPE CODE
COLOSCOPE DATE
COLOREC SCREEN CODING SYSTEM
COLOREC SCREEN CODE
COLOREC SCREEN DATE
EXCLUSION CODING SYSTEM
EXCLUSION CODE
EXCLUSION DATE
MEDICAL REASON CODING SYSTEM
MEDICAL REASON
MEDICAL REASON DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT)
Code used for encounter
Date of encounter
Coding system applicable to fecal occult
blood testing (LOINC, CPT, HCPCS, ICD-9CM)
Fecal occult blood testing code
Date of fecal occult blood testing
Coding system applicable to flexible
sigmoidoscopy (CPT, HCPCS, ICD-9-CM)
Flexible sigmoidoscopy code
Date of flexible sigmoidoscopy
Coding system applicable to double contrast
barium enema testing (CPT, HCPCS)
Double contrast barium enema testing code
Date of double contrast barium enema testing
Coding system applicable to colonoscopy
testing (CPT, HCPCS, ICD-9-CM)
Colonoscopy code
Date of colonoscopy
Coding system applicable to colorectal
screening (SNOMED)
Colorectal screening code
Date of colorectal screening
Type of coding system applicable to the
medical exclusions (CPT, ICD-9-CM,
SNOMED)
Code used for a medical exclusion
Date medical exclusion was documented
Type of coding system used for medical
reason for exclusion (CPT Category II)
Code used for medical reason for exclusion
Date medical reason for exclusion was
identified
Updated July 2009
Page 55 of 56
APPENDIX A
EHR MEASURES WITH CORRESPONDING DATA ELEMENTS
Data Element
Short Name
2010 Measure
Data Element
Description
Measure #124:
Health Information
Technology (HIT) Adoption/Use of
Electronic Health Records
(EHR)
TOPIC TYPE
TOPIC INDICATOR
BIRTHDATE
MEASURE START DATE
MEASURE END DATE
ENCOUNTER CODING SYSTEM
ENCOUNTER CODE
ENCOUNTER DATE
EHR CODING SYSTEM
EHR CODE
EHR DATE
Version 1.0
Topic that is being reported
The specific indicator or measure
Birth date
Date the measurement period begins
Date the measurement period ends
Type of coding system applicable to face-toface office visit (CPT, HCPCS)
Code used for encounter
Date of encounter
Type of coding system used to document use
of electronic health record (EHR) system
(HCPCS)
Code used for electronic health record (EHR)
system
Date electronic health record (EHR) system
was identified
Updated July 2009
Page 56 of 56
| File Type | application/pdf |
| Subject | 2009 EHR Warehouse |
| Author | PPIC/IFMC |
| File Modified | 2009-07-29 |
| File Created | 2009-07-29 |