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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
155 0101 Process Yes Communication and Care Coordination Registry

Measure Description

Percentage of patients aged 65 years and older with a history of falls that had a plan of care for falls documented 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 with a plan of care for falls documented 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.

Numerator Quality-Data Coding Options

Denominator Exclusion: G9720:

Patient receiving Hospice Services, Patient Not Eligible:

Hospice services for patient provided any time during the measurement period

OR

Denominator Exception: 0518F with 1P:

Risk Assessment for Falls not Completed for Medical Reasons

Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair

Plan of Care Documented

Performance Met: CPT II 0518F:

Falls plan of care documented

Performance Not Met: 0518F with 8P:
Plan of Care not Documented, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 0518F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Falls plan of care not documented, reason not otherwise specified

NUMERATOR NOTE:

Data not available

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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