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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
131 0420 Process Yes Communication and Care Coordination
Registry

Measure Description

Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present

Instructions

This measure is to be submitted at each denominator eligible visit occurring during the performance period for patients seen during the performance period. 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. The documented follow-up plan must be related to the presence of pain, example: “Patient referred to pain management specialist for back pain” or “Return in two weeks for re-assessment of pain”.

NOTE: No notes for this Quality ID

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

Patient visits with a documented pain assessment using a standardized tool(s) AND documentation of a follow-up plan when pain is present

Numerator Instructions:

Data not available

Numerator Quality-Data Coding Options

Denominator Exception: G8442:

Pain Assessment not Documented Patient not Eligible

Pain assessment NOT documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter

Denominator Exception: G8939:

Pain Assessment Documented as Positive, Follow-Up Plan not Documented, Patient not Eligible

Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounter

Performance Met: G8730:

Pain Assessment Documented as Positive AND Follow-Up Plan Documented

Pain assessment documented as positive using a standardized tool AND a follow-up plan is documented

Performance Met: G8731:

Pain Assessment Documented as Negative, No Follow-Up Plan Required

Pain assessment using a standardized tool is documented as negative, no follow-up plan required

Performance Not Met: G8732:
Pain Assessment not Documented, Reason not Given

No documentation of pain assessment, reason not given

Performance Not Met: G8509:
Pain Assessment Documented as Positive, Follow-Up Plan not Documented, Reason not Given

Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given

Numerator Note:

The standardized tool used to assess the patient’s pain must be documented in the medical record (exception: A provider may use a fraction such as 5/10 for Numeric Rating Scale without documenting this actual tool name when assessing pain for intensity).

Denominator

All visits for patients aged 18 years and older

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥18 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 59400, 59510, 59610, 59618, 90791, 90792, 90832, 90834, 90837,90839, 92002, 92004, 92012, 92014, 92507, 92508, 92526, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92547, 92548, 92550, 92557, 92567, 92568, 92570, 92585, 92588, 92626, 96116, 96150, 96151, 96152, 97127*, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97802, 97803, 97804, 98960, 98961, 98962, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, 99281, 99282, 99283, 99284, 99285, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0101, G0108, G0270, G0402, G0438, G0439

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