Functional Status Assessments for Congestive Heart Failure (2022)
| eCQMs / NQF #: | CMS90v11 / XXXX |
| Measure: | Percentage of patients 18 years of age and older with congestive heart failure who completed initial and follow-up patient-reported functional status assessments. |
| Numerator: | Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health, PROMIS-29) present in the EHR two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA. |
| Denominator: | Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts before and continues into the measurement period. |
| Denominator Exclusion: | Exclude patients with severe cognitive impairment in any part of the measurement period.
Exclude patients who are in hospice care for any part of the measurement period. |
| Domain: | Person and Caregiver-Centered Experience and Outcomes |
In ChartMaker Clinical:
In order to qualify for this measure, the provider must have seen the patient (age 18 and older) at least two times during the reporting period and have the appropriate information documented in the chart:
Required Data Elements for the Denominator:
This is captured by adding a procedure with a valid CPT, HCPCS, or SNOMED code using the Procedure widget in a note.
| CPT: | |
| Code | Description |
| 98966 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 98967 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 98968 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 98969 | Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network |
| 98970 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 98971 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 98972 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes |
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 99422 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 99423 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 99458 | Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure) |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2061 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes |
| G2062 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes |
| G2063 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes |
| SNOMED: | |
| Code | Description |
| 185317003 | Telephone encounter (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185464004 | Out of hours visit – not night visit (procedure) |
| 185465003 | Weekend visit (procedure) |
| 30346009 | Evaluation and management of established outpatient in office or other outpatient facility (procedure) |
| 314849005 | Telephone contact by consultant (procedure) |
| 3391000175108 | Office visit for pediatric care and assessment (procedure) |
| 37894004 | Evaluation and management of new outpatient in office or other outpatient facility (procedure) |
| 386472008 | Telephone consultation (procedure) |
| 386473003 | Telephone follow-up (procedure) |
| 401267002 | Telephone triage encounter (procedure) |
| 439740005 | Postoperative follow-up visit (procedure) |
This is captured by adding a procedure with a valid CPT, HCPCS, or SNOMED code using the Procedure widget in a note.
| CPT: | |
| Code | Description |
| 98966 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 98967 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 98968 | Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 98969 | Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network |
| 98970 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 98971 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 98972 | Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes |
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes |
| 99422 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes |
| 99423 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes |
| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion |
| 99458 | Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure) |
| G0071 | Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only |
| G2010 | Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment |
| G2012 | Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion |
| G2061 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes |
| G2062 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes |
| G2063 | Qualified nonphysician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes |
| SNOMED: | |
| Code | Description |
| 185317003 | Telephone encounter (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185464004 | Out of hours visit – not night visit (procedure) |
| 185465003 | Weekend visit (procedure) |
| 30346009 | Evaluation and management of established outpatient in office or other outpatient facility (procedure) |
| 314849005 | Telephone contact by consultant (procedure) |
| 3391000175108 | Office visit for pediatric care and assessment (procedure) |
| 37894004 | Evaluation and management of new outpatient in office or other outpatient facility (procedure) |
| 386472008 | Telephone consultation (procedure) |
| 386473003 | Telephone follow-up (procedure) |
| 401267002 | Telephone triage encounter (procedure) |
| 439740005 | Postoperative follow-up visit (procedure) |
This is captured by adding a diagnosis with a valid ICD10 or SNOMED code using the Diagnosis widget in a note.
| ICD-10: | |
| Code | Description |
| I11.0 | Hypertensive heart disease with heart failure |
| I13.0 | Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease |
| I13.2 | Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease |
| I50.1 | Left ventricular failure, unspecified |
| I50.20 | Unspecified systolic (congestive) heart failure |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.22 | Chronic systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.30 | Unspecified diastolic (congestive) heart failure |
| I50.31 | Acute diastolic (congestive) heart failure |
| I50.32 | Chronic diastolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.40 | Unspecified combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.41 | Acute combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.42 | Chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.43 | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.814 | Right heart failure due to left heart failure |
| I50.82 | Biventricular heart failure |
| I50.83 | High output heart failure |
| I50.84 | End stage heart failure |
| I50.89 | Other heart failure |
| I50.9 | Heart failure, unspecified |
| SNOMED: | |
| Code | Description |
| 10091002 | High output heart failure (disorder) |
| 101281000119107 | Congestive heart failure due to cardiomyopathy (disorder) |
| 10633002 | Acute congestive heart failure (disorder) |
| 111283005 | Chronic left-sided heart failure (disorder) |
| 120851000119104 | Systolic heart failure stage D (disorder) |
| 120861000119102 | Systolic heart failure stage C (disorder) |
| 120871000119108 | Systolic heart failure stage B (disorder) |
| 120881000119106 | Diastolic heart failure stage D (disorder) |
| 120891000119109 | Diastolic heart failure stage C (disorder) |
| 120901000119108 | Diastolic heart failure stage B (disorder) |
| 153931000119109 | Acute combined systolic and diastolic heart failure (disorder) |
| 153941000119100 | Chronic combined systolic and diastolic heart failure (disorder) |
| 153951000119103 | Acute on chronic combined systolic and diastolic heart failure (disorder) |
| 15629541000119106 | Congestive heart failure stage C due to Ischemic cardiomyopathy (disorder) |
| 15629591000119103 | Congestive heart failure stage B due to ischemic cardiomyopathy (disorder) |
| 15629641000119107 | Systolic heart failure stage B due to ischemic cardiomyopathy (disorder) |
| 15629741000119102 | Systolic heart failure stage C due to ischemic cardiomyopathy (disorder) |
| 15781000119107 | Hypertensive heart AND chronic kidney disease with congestive heart failure (disorder) |
| 15964701000119109 | Acute cor pulmonale co-occurrent and due to saddle embolus of pulmonary artery (disorder) |
| 194767001 | Benign hypertensive heart disease with congestive cardiac failure (disorder) |
| 194779001 | Hypertensive heart and renal disease with (congestive) heart failure (disorder) |
| 194781004 | Hypertensive heart and renal disease with both (congestive) heart failure and renal failure (disorder) |
| 195111005 | Decompensated cardiac failure (disorder) |
| 195112003 | Compensated cardiac failure (disorder) |
| 195125002 | Acute left ventricular failure (disorder) |
| 206586757 | Congenital cardiac failure (disorder) |
| 23341000119109 | Congestive heart failure with right heart failure (disorder) |
| 233924009 | Heart failure as a complication of care (disorder) |
| 25544003 | Low output heart failure (disorder) |
| 314206753 | Refractory heart failure (disorder) |
| 364006 | Acute left-sided heart failure (disorder) |
| 410431009 | Cardiorespiratory failure (disorder) |
| 417996759 | Systolic heart failure (disorder) |
| 418304008 | Diastolic heart failure (disorder) |
| 42343007 | Congestive heart failure (disorder) |
| 424404003 | Decompensated chronic heart failure (disorder) |
| 426263006 | Congestive heart failure due to left ventricular systolic dysfunction (disorder) |
| 426611007 | Congestive heart failure due to valvular disease (disorder) |
| 43736758 | Rheumatic left ventricular failure (disorder) |
| 44088000 | Low cardiac output syndrome (disorder) |
| 441481004 | Chronic systolic heart failure (disorder) |
| 441530006 | Chronic diastolic heart failure (disorder) |
| 44313006 | Right heart failure secondary to left heart failure (disorder) |
| 443253003 | Acute on chronic systolic heart failure (disorder) |
| 443254009 | Acute systolic heart failure (disorder) |
| 443343001 | Acute diastolic heart failure (disorder) |
| 443344007 | Acute on chronic diastolic heart failure (disorder) |
| 46113002 | Hypertensive heart failure (disorder) |
| 471880001 | Heart failure due to end stage congenital heart disease (disorder) |
| 48447003 | Chronic heart failure (disorder) |
| 5148006 | Hypertensive heart disease with congestive heart failure (disorder) |
| 5375005 | Chronic left-sided congestive heart failure (disorder) |
| 56675007 | Acute heart failure (disorder) |
| 67431000119105 | Congestive heart failure stage D (disorder) |
| 67441000119101 | Congestive heart failure stage C (disorder) |
| 698594003 | Symptomatic congestive heart failure (disorder) |
| 703272007 | Heart failure with reduced ejection fraction (disorder) |
| 703273002 | Heart failure with reduced ejection fraction due to coronary artery disease (disorder) |
| 703274008 | Heart failure with reduced ejection fraction due to myocarditis (disorder) |
| 703275009 | Heart failure with reduced ejection fraction due to cardiomyopathy (disorder) |
| 703276755 | Heart failure with reduced ejection fraction due to heart valve disease (disorder) |
| 717840005 | Congestive heart failure stage B (disorder) |
| 72481000119103 | Congestive heart failure as early postoperative complication (disorder) |
| 74967503 | Acute left-sided congestive heart failure (disorder) |
| 82523003 | Congestive rheumatic heart failure (disorder) |
| 83105008 | Malignant hypertensive heart disease with congestive heart failure (disorder) |
| 84125007 | Heart failure (disorder) |
| 85232009 | Left heart failure (disorder) |
| 871617000 | Low output heart failure due to and following Fontan operation (disorder) |
| 88805009 | Chronic congestive heart failure (disorder) |
| 90727007 | Pleural effusion due to congestive heart failure (disorder) |
| 92506755 | Biventricular congestive heart failure (disorder) |
Denominator Exclusions:
Denominator exclusions include patients with severe cognitive impairment or patients whose hospice care that overlaps the measurement period.
In order to meet the requirements for this exclusion, at least one of the aforementioned must be documented in the chart and start before or during the measurement period:
NOTE: Documenting Severe Dementia is recognized only by the SNOMED indicated. This code must be attached to an appropriate and applicable Diagnosis treated/addressed at the initial and follow up encounters.
This is captured by adding a diagnosis with a valid SNOMED code using the Diagnosis widget in a note.
| SNOMED: | |
| Code | Description |
| 428351000124105 | Severe dementia (disorder) |
This is captured by adding a procedure with a valid SNOMED code using the Procedure widget in a note.
| 385763009 | Hospice care (regime/therapy) |
| 385765002 | Hospice care management (procedure) |
Required Data Elements for the Numerator:
This is captured by adding a finding with a valid LOINC code using the Checklist widget in a note.
| LOINC: | |
| Code | Description |
| 71938-5 | Total score MLHFQ |
| 71940-1 | Overall summary score KCCQ |
| 71955-9 | PROMIS-29 Sleep disturbance score T-score |
| 71957-5 | PROMIS-29 Satisfaction with participation in social roles score T-score |
| 71959-1 | PROMIS-29 Physical function score T-score |
| 71961-7 | PROMIS-29 Pain interference score T-score |
| 71963-3 | PROMIS-29 Fatigue score T-score |
| 71965-8 | PROMIS-29 Depression score T-score |
| 71967-4 | PROMIS-29 Anxiety score T-score |
| 71969-0 | PROMIS-10 Global Mental Health (GMH) score T-score |
| 71971-6 | PROMIS-10 Global Physical Health (GPH) score T-score |
| 71973-2 | VR 36 MH – raw score – oblique method VR |
| 71974-0 | VR 36 RE – raw score – oblique method VR |
| 71975-7 | VR 36 SF – raw score – oblique method VR |
| 71976-5 | VR 36 VT – raw score – oblique method VR |
| 71977-3 | VR 36 GH – raw score – oblique method VR |
| 71978-1 | VR 36 BP – raw score – oblique method VR |
| 71979-9 | VR 36 RP – raw score – oblique method VR |
| 71980-7 | VR 36 PF – raw score – oblique method VR |
| 71981-5 | VR 36 MH – T score – oblique method VR |
| 71982-3 | VR 36 RE – T score – oblique method VR |
| 71983-1 | VR 36 SF – T score – oblique method VR |
| 71984-9 | VR 36 VT – T score – oblique method VR |
| 71985-6 | VR 36 GH – T score – oblique method VR |
| 71986-4 | VR 36 BP – T score – oblique method VR |
| 71987-2 | VR 36 RP – T score – oblique method VR |
| 71988-0 | VR 36 PF – T score – oblique method VR |
| 71989-8 | VR-36 Physical component summary (PCS) score – oblique method T-score |
| 71990-6 | VR-36 Mental component summary (MCS) score – oblique method T-score |
| 71991-4 | VR 36 MH – raw score – orthogonal method VR |
| 71992-2 | VR 36 RE – raw score – orthogonal method VR |
| 71993-0 | VR 36 SF – raw score – orthogonal method VR |
| 71994-8 | VR 36 VT – raw score – orthogonal method VR |
| 71995-5 | VR 36 GH – raw score – orthogonal method VR |
| 71996-3 | VR 36 BP – raw score – orthogonal method VR |
| 71997-1 | VR 36 RP – raw score – orthogonal method VR |
| 71998-9 | VR 36 PF – raw score – orthogonal method VR |
| 71999-7 | VR 36 MH – T score – orthogonal method VR |
| 72000-3 | VR 36 RE – T score – orthogonal method VR |
| 72001-1 | VR 36 SF – T score – orthogonal method VR |
| 72002-9 | VR 36 VT – T score – orthogonal method VR |
| 72003-7 | VR 36 GH – T score – orthogonal method VR |
| 72004-5 | VR 36 BP – T score – orthogonal method VR |
| 72005-2 | VR 36 RP – T score – orthogonal method VR |
| 72006-0 | VR 36 PF – T score – orthogonal method VR |
| 72007-8 | VR-36 Physical component summary (PCS) score – orthogonal method T-score |
| 72008-6 | VR-36 Mental component summary (MCS) score – orthogonal method T-score |
| 72009-4 | VR 12 MH – raw score – oblique method VR |
| 72010-2 | VR 12 RE – raw score – oblique method VR |
| 72011-0 | VR 12 SF – raw score – oblique method VR |
| 72012-8 | VR 12 VT – raw score – oblique method VR |
| 72013-6 | VR 12 GH – raw score – oblique method VR |
| 72014-4 | VR 12 BP – raw score – oblique method VR |
| 72015-1 | VR 12 RP – raw score – oblique method VR |
| 72016-9 | VR 12 PF – raw score – oblique method VR |
| 72017-7 | VR 12 MH – T score – oblique method VR |
| 72018-5 | VR 12 RE – T score – oblique method VR |
| 72019-3 | VR 12 SF – T score – oblique method VR |
| 72020-1 | VR 12 VT – T score – oblique method VR |
| 72021-9 | VR 12 GH – T score – oblique method VR |
| 72022-7 | VR 12 BP – T score – oblique method VR |
| 72023-5 | VR 12 RP – T score – oblique method VR |
| 72024-3 | VR 12 PF – T score – oblique method VR |
| 72025-0 | VR-12 Physical component summary (PCS) score – oblique method T-score |
| 72026-8 | VR-12 Mental component summary (MCS) score – oblique method T-score |
| 72027-6 | VR-12 Physical component summary (PCS) score – orthogonal method T-score |
| 72028-4 | VR-12 Mental component summary (MCS) score – orthogonal method T-score |
| 72189-4 | Quality of life score KCCQ |
| 72190-2 | Self-efficacy score KCCQ |
| 72191-0 | Total symptom score KCCQ |
| 72192-8 | Symptom burden score KCCQ |
| 72193-6 | Symptom frequency score KCCQ |
| 72194-4 | Symptom stability score KCCQ |
| 72195-1 | Physical limitation score KCCQ |
| 72196-9 | Social limitation score KCCQ |
| 85609-6 | Emotional score MLHFQ |
| 85618-7 | Physical score MLHFQ |
| 86923-0 | Kansas City Cardiomyopathy Questionnaire – 12 item KCCQ-12 |
| 86924-8 | Overall summary score KCCQ-12 |
This is captured by adding a finding with a valid LOINC code using the Checklist widget in a note.
| LOINC: | |
| Code | Description |
| 71938-5 | Total score MLHFQ |
| 71940-1 | Overall summary score KCCQ |
| 71955-9 | PROMIS-29 Sleep disturbance score T-score |
| 71957-5 | PROMIS-29 Satisfaction with participation in social roles score T-score |
| 71959-1 | PROMIS-29 Physical function score T-score |
| 71961-7 | PROMIS-29 Pain interference score T-score |
| 71963-3 | PROMIS-29 Fatigue score T-score |
| 71965-8 | PROMIS-29 Depression score T-score |
| 71967-4 | PROMIS-29 Anxiety score T-score |
| 71969-0 | PROMIS-10 Global Mental Health (GMH) score T-score |
| 71971-6 | PROMIS-10 Global Physical Health (GPH) score T-score |
| 71973-2 | VR 36 MH – raw score – oblique method VR |
| 71974-0 | VR 36 RE – raw score – oblique method VR |
| 71975-7 | VR 36 SF – raw score – oblique method VR |
| 71976-5 | VR 36 VT – raw score – oblique method VR |
| 71977-3 | VR 36 GH – raw score – oblique method VR |
| 71978-1 | VR 36 BP – raw score – oblique method VR |
| 71979-9 | VR 36 RP – raw score – oblique method VR |
| 71980-7 | VR 36 PF – raw score – oblique method VR |
| 71981-5 | VR 36 MH – T score – oblique method VR |
| 71982-3 | VR 36 RE – T score – oblique method VR |
| 71983-1 | VR 36 SF – T score – oblique method VR |
| 71984-9 | VR 36 VT – T score – oblique method VR |
| 71985-6 | VR 36 GH – T score – oblique method VR |
| 71986-4 | VR 36 BP – T score – oblique method VR |
| 71987-2 | VR 36 RP – T score – oblique method VR |
| 71988-0 | VR 36 PF – T score – oblique method VR |
| 71989-8 | VR-36 Physical component summary (PCS) score – oblique method T-score |
| 71990-6 | VR-36 Mental component summary (MCS) score – oblique method T-score |
| 71991-4 | VR 36 MH – raw score – orthogonal method VR |
| 71992-2 | VR 36 RE – raw score – orthogonal method VR |
| 71993-0 | VR 36 SF – raw score – orthogonal method VR |
| 71994-8 | VR 36 VT – raw score – orthogonal method VR |
| 71995-5 | VR 36 GH – raw score – orthogonal method VR |
| 71996-3 | VR 36 BP – raw score – orthogonal method VR |
| 71997-1 | VR 36 RP – raw score – orthogonal method VR |
| 71998-9 | VR 36 PF – raw score – orthogonal method VR |
| 71999-7 | VR 36 MH – T score – orthogonal method VR |
| 72000-3 | VR 36 RE – T score – orthogonal method VR |
| 72001-1 | VR 36 SF – T score – orthogonal method VR |
| 72002-9 | VR 36 VT – T score – orthogonal method VR |
| 72003-7 | VR 36 GH – T score – orthogonal method VR |
| 72004-5 | VR 36 BP – T score – orthogonal method VR |
| 72005-2 | VR 36 RP – T score – orthogonal method VR |
| 72006-0 | VR 36 PF – T score – orthogonal method VR |
| 72007-8 | VR-36 Physical component summary (PCS) score – orthogonal method T-score |
| 72008-6 | VR-36 Mental component summary (MCS) score – orthogonal method T-score |
| 72009-4 | VR 12 MH – raw score – oblique method VR |
| 72010-2 | VR 12 RE – raw score – oblique method VR |
| 72011-0 | VR 12 SF – raw score – oblique method VR |
| 72012-8 | VR 12 VT – raw score – oblique method VR |
| 72013-6 | VR 12 GH – raw score – oblique method VR |
| 72014-4 | VR 12 BP – raw score – oblique method VR |
| 72015-1 | VR 12 RP – raw score – oblique method VR |
| 72016-9 | VR 12 PF – raw score – oblique method VR |
| 72017-7 | VR 12 MH – T score – oblique method VR |
| 72018-5 | VR 12 RE – T score – oblique method VR |
| 72019-3 | VR 12 SF – T score – oblique method VR |
| 72020-1 | VR 12 VT – T score – oblique method VR |
| 72021-9 | VR 12 GH – T score – oblique method VR |
| 72022-7 | VR 12 BP – T score – oblique method VR |
| 72023-5 | VR 12 RP – T score – oblique method VR |
| 72024-3 | VR 12 PF – T score – oblique method VR |
| 72025-0 | VR-12 Physical component summary (PCS) score – oblique method T-score |
| 72026-8 | VR-12 Mental component summary (MCS) score – oblique method T-score |
| 72027-6 | VR-12 Physical component summary (PCS) score – orthogonal method T-score |
| 72028-4 | VR-12 Mental component summary (MCS) score – orthogonal method T-score |
| 72189-4 | Quality of life score KCCQ |
| 72190-2 | Self-efficacy score KCCQ |
| 72191-0 | Total symptom score KCCQ |
| 72192-8 | Symptom burden score KCCQ |
| 72193-6 | Symptom frequency score KCCQ |
| 72194-4 | Symptom stability score KCCQ |
| 72195-1 | Physical limitation score KCCQ |
| 72196-9 | Social limitation score KCCQ |
| 85609-6 | Emotional score MLHFQ |
| 85618-7 | Physical score MLHFQ |
| 86923-0 | Kansas City Cardiomyopathy Questionnaire – 12 item KCCQ-12 |
| 86924-8 | Overall summary score KCCQ-12 |
ADDITIONAL INFORMATION:
- The patient must be at least 65 years of age before the start of the measurement period.
- Initial encounter is defined as the first encounter during the first 185 days of the measurement year. Follow-up encounter is defined as the last encounter that is at least 30 days but no more than 180 after the initial encounter.
- A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity.
- The FSA questionnaire must be present in the chart. In order to indicate that it is present for calculation in the numerator, a valid LOINC code must be selected each time an FSA is completed. This LOINC code must be linked to a procedure code (that is not the office code). The procedure code will be office defined. It must be indicated as a result in the procedure properties and tagged to the appropriate LOINC code.
- The MLHF and KCCQ Questionnaires are available as templates. Please contact software support if they are not currently in your list of available templates.
- The only data used to determine the denominator is data from ChartMaker Clinical. If a patient encounter was not entered into Clinical, that encounter is not included in the denominator for the statistical calculations in the MIPS Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.