PQRS measures for 2014

By Government Relations staff

There will be 13 individual PQRS measures in 2014 that may be used by psychologists depending upon the population they treat, the services they provide and the way in which they report. The individual measures are:

  • Major depressive disorder: diagnostic evaluation (No. 106): Indicates the percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who met the DSM-IV criteria during the visit in which the new diagnosis or recurrent episode was identified. This measure is to be reported a minimum of once per reporting period for all patients with an active diagnosis of major depressive disorder seen during the reporting period, including episodes of MDD that began prior to the reporting period.

  • Major depressive disorder: suicide risk assessment (No. 107): Indicates the percentage of patients aged 18 years and older with a new diagnosis or recurrent episode of MDD who had a suicide risk assessment completed at each visit during the measurement period. This measure is to be reported a minimum of once per reporting period for all patients with an active diagnosis of major depressive disorder seen during the reporting period, including episodes of MDD that began prior to the reporting period.

  • Body mass index (No. 128): Indicates the percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documents in the medical record and if the most recent BMI is outside parameters, a follow-up plan is documented. The measure may be reported when a BMI calculation has been performed in the office or facility or by another health care provider and is documented within the previous six months in outside medical records obtained by the provider.

  • Documentation and verification of current medications in the medical record (No. 130): Indicates the percentage of patients aged 18 years and older with a list of current medications with dosages (includes prescription, over-the-counter, herbals, vitamin/mineral/dietary [nutritional] supplements) and verification with the patient or authorized representative is documented by the provider. This measure is to be reported at each visit occurring during the 12-month reporting period. There is no diagnosis associated with this measure.

  • Pain assessment prior to initiation of patient treatment (No. 131): Indicates the percentage of patients aged 18 years and older with documentation of a pain assessment (if pain is present, including location, intensity and description) through discussion with the patient including the use of a standardized tool on each qualifying visit prior to initiation of therapy and documentation of a follow-up plan. This measure is to be reported for each qualifying visit occurring during the reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure.

  • Screening for clinical depression (No. 134): Indicates the percentage of patients aged 18 years and older screened for clinical depression using a standardized tool and follow-up plan documented. This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure.

  • Elder maltreatment screen and follow-up plan (No. 181): Indicates the percentage of patients aged 65 years and older with documentation of a screen for elder maltreatment and documented follow-up plan. This measure is to be reported once during the reporting period for patients seen during the reporting period. When reporting CPT codes 96116, 97803, and G0270 the measure is to be reported each time the code is submitted. The not eligible code can be used to report if it is not an initial evaluation with screening for elder maltreatment.

  • Preventive care and screening: tobacco use — screening and cessation intervention (No. 226): Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months and who received cessation counseling intervention if identified as a tobacco user. This measure is to be reported once per reporting period.

  • Substance use disorders — counseling regarding psychosocial and pharmacologic treatment options for alcohol dependence (No. 247): Percentage of patients aged 18 years and older with a diagnosis of current alcohol dependence who were counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence within the 12-month reporting period. This measure is to be reported once per reporting period for patients with a diagnosis of alcohol dependence seen during the reporting period.

  • Substance use disorders — screening for depression among patients with substance abuse or dependence (No. 248): Percentage of patients aged 18 years and older with a diagnosis of current substance abuse or dependence who were screened for depression within the 12-month reporting period. This measure is to be reported a minimum of once per reporting period for patients with a diagnosis of current substance abuse or dependence seen during the reporting period.

Measures Available Through Registry Reporting 

Two measures psychologists are eligible to use are no longer available for claims-based reporting in 2014. The following measures may now only be reported through a registry. 

  • Major depressive disorder: antidepressant medication during acute phase (No. 9): Indicates the percentage of patients aged 18 years and older diagnosed with a new episode of MDD and documented as treated with antidepressant medication during the entire 84-day (12-week) acute treatment phase. This measure is to be reported for each occurrence of MDD during the reporting period.

  • Unhealthy alcohol use (No. 173): Indicates the percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method within 24 months. This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. This measure is intended to determine whether or not all patients aged 18 years and older were screened for unhealthy alcohol use during the reporting period. There is no diagnosis associated with this measure.

The following measure is still only available through registry reporting:
  • Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions (No. 325): Indicates the Percentage of medical records of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) and a specific diagnosed comorbid condition (diabetes, coronary artery disease, ischemic stroke, intracranial hemorrhage, chronic kidney disease [stages 4 or 5], ESRD or congestive heart failure) being treated by another clinician with communication to the other clinician treating the comorbid condition. This measure is to be reported a minimum of once per reporting period for patient with a diagnosis of MDD seen during the reporting period.

Measures Group on Dementia

Measures groups are a subset of four or more PQRS measures that have a particular clinical condition or focus in common. All applicable measures within a group must be reported for each patient within the sample that meets the required criteria (such as age or gender). Eligible professionals can choose more than one reporting option (individual measures or measures groups), but can only earn a maximum of one incentive payment equal to 0.5 percent of their total estimated allowed Medicare charges.

In 2014 there is still one measures group on dementia that can be reported by psychologists. The Dementia Measures Group consists of nine measures: Staging of dementia (No. 280), Cognitive Assessment (No. 281), Functional status assessment (No. 282), Neuropsychological symptom assessment (No. 283), Management of neuropsychiatric symptoms (No. 284), Screening for depressive symptoms (No. 285), Counseling regarding safety concerns (No. 286), Counseling regarding risks of driving (No. 287), and Caregiver education and support (No. 288). The Dementia Measures Group is reportable through both claims-based and registry reporting.

Psychologists who do not find any measures in this entire list to be applicable to their services and/or patient population are advised to contact the CMS QualityNet Help Desk for assistance. The QualityNet Help Desk is available Monday through Friday, 7 a.m.-7 p.m. CST, by telephone at (866) 288-8912 (TTY (877) 715-6222). Inquiries may be sent by email.

Updated February 2014