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.