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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
182 2624 Process Yes Communication and Care Coordination Registry

Measure Description

Percentage of visits for patients aged 18 years and older with documentation of a current functional outcome assessment using a standardized functional outcome assessment tool on the date of the encounter AND documentation of a care plan based on identified functional outcome deficiencies on the date of the identified deficiencies

Instructions

This measure is to be submitted each denominator eligible visit for patients seen during the 12 month performance period. The functional outcome assessment is required to be current as defined in the definition section. 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 documented current functional outcome assessment using a standardized tool AND a documented care plan based on the identified functional outcome deficiencies

Numerator Instructions:

Documentation of a current functional outcome assessment must include identification of the standardized tool used.

Numerator Quality-Data Coding Options

Functional Outcome Assessment not Documented, Patient not Eligible

Denominator Exception: G8540:

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

OR

Functional Outcome Assessment Documented, Care Plan not Documented, Patient not Eligible

Denominator Exception: G9227:

Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter

Functional Outcome Assessment Documented as Positive AND Care Plan Documented

Performance Met: G8539:

Functional outcome assessment documented as positive using a standardized tool AND a care plan based, on identified deficiencies on the date of the functional outcome assessment, is documented

OR

Functional Outcome Assessment Documented, No Functional Deficiencies Identified, Care Plan not Required

Performance Met: G8542:

Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required

OR

Functional Outcome Assessment Documented AND Care Plan Documented, if Indicated, Within the Previous 30 Days

Performance Met: G8942:

Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented

Functional Outcome Assessment not Documented, Reason not Given

Performance Not Met: G8541:

Functional outcome assessment using a standardized tool not documented, reason not given

OR

Functional Outcome Assessment Documented as Positive, Care Plan not Documented, Reason not Given

Performance Not Met: G8543:

Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given

NUMERATOR NOTE:

The intent of this measure is for a functional outcome assessment tool to be utilized at a minimum of every 30 days but submission is required at each visit due to coding limitations. Therefore, for visits occurring within 30 days of a previously documented functional outcome assessment, the numerator quality-data code G8942 should be used for submission purposes.

Denominator

All patients aged 65 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 ≥ 65 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96116, 96118, 96150, 96151, 96152, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0270, G0402, G0438, G0439, G0502, G0505

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

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