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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
154 0101 Process Yes Patient Safety Registry

Measure Description

Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure is appropriate for use in all non-acute settings (with the exception of emergency departments and acute care hospitals). 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.

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

Patients who had a risk assessment for falls completed within 12 months

Numerator Instructions:

All components do not need to be completed during one patient visit, but should be documented in the medical record as having been performed within the past 12 months.

Definitions:
Fall
– A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force.

Risk Assessment – Comprised of balance/gait AND one or more of the following: postural blood pressure, vision, home fall hazards, and documentation on whether medications are a contributing factor or not to falls within the past 12 months.

Balance/gait Assessment – Medical record must include documentation of observed transfer and walking or use of a standardized scale (e.g., Get Up & Go, Berg, Tinetti) or documentation of referral for assessment of balance/gait.

Postural blood pressure – Documentation of blood pressure values in supine and then standing positions.

Vision Assessment – Medical record must include documentation that patient is functioning well with vision or not functioning well with vision based on discussion with the patient or use of a standardized scale or assessment tool (e.g., Snellen) or documentation of referral for assessment of vision.

Home fall hazards Assessment – Medical record must include documentation of counseling on home falls hazards or documentation of inquiry of home fall hazards or referral for evaluation of home fall hazards.

Medications Assessment – Medical record must include documentation of whether the patient’s current medications may or may not contribute to falls.

Numerator Quality-Data Coding Options

Denominator Exclusion: G9718:

Patient receiving Hospice Services, Patient Not Eligible:

(One code [G9718] is required on the claim form to submit this numerator option)

Hospice services for patient provided any time during the measurement period

OR

Denominator Exclusion: CPT II 1101F:

If patient is not eligible for this measure because patient has documentation of no falls or only one fall without injury the past year, submit: Patient not at Risk for Falls

(One CPT II code [1101F] is required on the claim form to submit this numerator option)

Patient screened for future fall risk; documentation of no falls in the past year or only one fall without injury in the past year

OR

Denominator Exclusion: 1101F with 8P:

If patient is not eligible for this measure because falls status is not documented, submit: Falls Status not Documented
(One CPT II code [1101F-8P] is required on the claim form to submit this numerator option)

No documentation of falls status

OR

Denominator Exclusion: 3288F with 1P:

Risk Assessment for Falls not Completed for Medical Reasons

Documentation of medical reason(s) for not completing a risk assessment for falls (i.e., patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair

AND

CPT II 1100F:

Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

Risk Assessment for Falls Completed

Performance Met: CPT II 3288F:

Falls risk assessment documented

AND

CPT II 1100F:

Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

Performance Not Met: 3288F with 8P:
Risk Assessment for Falls not Completed, Reason not Otherwise Specified

(Two CPT II codes [3288F-8P & 1100F] are required on the claim form to submit this numerator option)
Append a submission modifier (8P) to CPT Category II code 3288F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Falls risk assessment not completed, reason not otherwise specified

AND

CPT II 1100F:

Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year

NUMERATOR NOTE:

The correct combination of numerator code(s) must be submitted on the claim form in order to properly submit this measure. The “correct combination” of codes may require the submission of multiple numerator codes.

Denominator

All patients aged 65 years and older who have a history of falls (history of falls is defined as 2 or more falls in the past year or any fall with injury in the past year). Documentation of patient reported history of falls is sufficient

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 65 years on date of encounter

Patient encounter during the performance period (CPT or HCPCS): 92540, 92541, 92542, 92548, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 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, G0402, G0438, G0439

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