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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
046 0097 Process Yes Communication and Care Coordination
Registry

Measure Description

The percentage of discharges from any inpatient facility (e.g. hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record.

This measure is submitted as three rates stratified by age group:

  • Submission Criteria 1: 18-64 years of age
  • Submission Criteria 2: 65 years and older
  • Total Rate: All patients 18 years of age and older

Instructions

This measure is to be submitted at an outpatient visit occurring within 30 days of each inpatient facility discharge date during the performance period. This measure is appropriate for use in the ambulatory setting only. There is no diagnosis associated with this measure. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. This measure is not to be submitted unless a patient has been discharged from an inpatient facility within 30 days prior to the outpatient visit.

This measure will be calculated with 3 performance rates:

  1. Performance Rate 1: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18-64 years of age seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing ongoing care for whom the discharge  medication list was reconciled with the current medication list in the
    outpatient medical record
    AND
  2. Performance Rate 2: Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 65 years and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing ongoing care for whom the discharge medication list was reconciled with the current medication list in the
    outpatient medical record
    AND
  3. Total Rate (Overall Performance Rate): Percentage of discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care for whom the discharge medication list was reconciled with the current medication list in the outpatient medical record

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Medication reconciliation conducted by a prescribing practitioner, clinical pharmacists or registered nurse on or within 30 days of discharge

 

Definition

Medication Reconciliation – A type of review in which the discharge medications are reconciled with the most recent medication list in the outpatient medical record. Documentation in the outpatient medical record must include evidence of medication reconciliation and the date on which it was performed. Any of the following evidence meets criteria: (1) Documentation of the current medications with a notation that references the discharge medications (e.g., no changes in meds since discharge, same meds at discharge, discontinue all discharge meds), (2) Documentation of the patient’s current medications with a notation that the discharge medications were reviewed, (3) Documentation that the provider “reconciled the current and discharge meds,” (4) Documentation of a current medication list, a discharge medication list and notation that the appropriate practitioner type reviewed both lists on the same date of service, (5) Notation that no medications were prescribed or ordered upon discharge; (6) Documentation that patient was seen for postdischarge follow-up with evidence of medication reconciliation or review, (7) Documentation in the discharge summary that the discharge medications were reconciled with the current medications; the discharge summary must be in the outpatient chart.

Numerator Quality-Data Coding Options

Performance Met: CPT II 1111F:
Documentation of Reconciliation of Discharge Medication with Current Medication List in the
Medical Record
:

Discharge medications reconciled with the current medication list in outpatient medical record

Denominator Exception: G9691:
Patient receiving Hospice Services, Patient Not Eligible:

Patient had hospice services any time during the
measurement period

Performance Not Met: 1111F with 8P:

Discharge Medication not Reconciled with Current Medication List in the Medical Record, Reason
Not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 1111F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Discharge medications not reconciled with the current medication list in outpatient medical record, reason not otherwise specified

NUMERATOR NOTE: Medication reconciliation should be completed and documented on or within 30 days of discharge. If the patient has an eligible discharge but medication reconciliation is not performed and documented within 30 days, submit 1111F with 8P.

Denominator

All discharges from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) for patients 18 years of age and older seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care.

Eligible cases are determined, and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients 18-64 years of age on date of encounter
SUBMISSION CRITERIA 2: Patients aged 65 years and older on date of encounter
SUBMISSION CRITERIA 3: All Patients 18 years of age and older

AND

Patient discharged from an inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) within the last 30 days

 


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