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HCPCS Range More Quality Measures

• 1 Left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd ( G8694 )

• 2 Patient not prescribed antibiotic ( G8708 )

• 3 Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne) ( G8709 )

• 4 Patient prescribed antibiotic ( G8710 )

• 5 Prescribed antibiotic on or within 3 days after the episode date ( G8711 )

• 6 Antibiotic not prescribed or dispensed ( G8712 )

• 7 pT category (primary tumor), pN category (regional lymph nodes), and histologic grade were documented in pathology report ( G8721 )

• 8 Documentation of medical reason(s) for not including the pT category, the pN category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal) ( G8722 )

• 9 Specimen site is other than anatomic location of primary tumor ( G8723 )

• 10 pT category, pN category and histologic grade were not documented in the pathology report, reason not given ( G8724 )

• 11 Elder maltreatment screen documented as positive and a follow-up plan is documented ( G8733 )

• 12 Elder maltreatment screen documented as negative, follow-up is not required ( G8734 )

• 13 Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given ( G8735 )

• 14 Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma) ( G8749 )

• 15 Most recent systolic blood pressure < 140 mmHg ( G8752 )

• 16 Most recent systolic blood pressure >= 140 mmHg ( G8753 )

• 17 Most recent diastolic blood pressure < 90 mmHg ( G8754 )

• 18 Most recent diastolic blood pressure >= 90 mmHg ( G8755 )

• 19 No documentation of blood pressure measurement, reason not given ( G8756 )

• 20 Normal blood pressure reading documented, follow-up not required ( G8783 )

• 21 Blood pressure reading not documented, reason not given ( G8785 )

• 22 Specimen site other than anatomic location of esophagus ( G8797 )

• 23 Specimen site other than anatomic location of prostate ( G8798 )

• 24 Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented ( G8806 )

• 25 Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup]) ( G8807 )

• 26 Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease) ( G8815 )

• 27 Statin medication prescribed at discharge ( G8816 )

• 28 Statin therapy not prescribed at discharge, reason not given ( G8817 )

• 29 Patient discharged to home no later than post-operative day #2 following evar ( G8826 )

• 30 Patient not discharged to home by post-operative day #2 following evar ( G8833 )

• 31 Patient discharged to home no later than post-operative day #2 following CEA ( G8834 )

• 32 Patient not discharged to home by post-operative day #2 following CEA ( G8838 )

• 33 Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness ( G8839 )

• 34 Sleep apnea symptoms not assessed, reason not given ( G8841 )

• 35 Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea ( G8842 )

• 36 Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months of initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)) ( G8843 )

• 37 Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months of initial evaluation for suspected obstructive sleep apnea, reason not given ( G8844 )

• 38 Positive airway pressure therapy prescribed ( G8845 )

• 39 Moderate or severe obstructive sleep apnea (apnea hypopnea index (AHI) or respiratory disturbance index (RDI) of 15 or greater) ( G8846 )

• 40 Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage) ( G8849 )

• 41 Positive airway pressure therapy not prescribed, reason not given ( G8850 )

• 42 Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented) ( G8851 )

• 43 Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given ( G8855 )

• 44 Referral to a physician for an otologic evaluation performed ( G8856 )

• 45 Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness) ( G8857 )

• 46 Referral to a physician for an otologic evaluation not performed, reason not given ( G8858 )

• 47 Patients not assessed for risk of bone loss, reason not given ( G8863 )

• 48 Pneumococcal vaccine administered or previously received ( G8864 )

• 49 Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction) ( G8865 )

• 50 Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal) ( G8866 )

• 51 Pneumococcal vaccine not administered or previously received, reason not given ( G8867 )

• 52 Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method ( G8875 )

• 53 Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician) ( G8876 )

• 54 Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given ( G8877 )

• 55 Sentinel lymph node biopsy procedure performed ( G8878 )

• 56 Stage of breast cancer is greater than T1N0M0 or T3N0M0 ( G8881 )

• 57 Sentinel lymph node biopsy procedure not performed, reason not given ( G8882 )

• 58 Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility ( G8907 )

• 59 Patient documented to have received a burn prior to discharge ( G8908 )

• 60 Patient documented not to have received a burn prior to discharge ( G8909 )

• 61 Patient documented to have experienced a fall within ASC ( G8910 )

• 62 Patient documented not to have experienced a fall within ambulatory surgical center ( G8911 )

• 63 Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event ( G8912 )

• 64 Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event ( G8913 )

• 65 Patient documented to have experienced a hospital transfer or hospital admission upon discharge from ASC ( G8914 )

• 66 Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from ASC ( G8915 )

• 67 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic initiated on time ( G8916 )

• 68 Patient with preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis, antibiotic not initiated on time ( G8917 )

• 69 Patient without preoperative order for IV antibiotic surgical site infection (SSI) prophylaxis ( G8918 )

• 70 Left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function ( G8923 )

• 71 Spirometry results documented (fev1/fvc < 70%) ( G8924 )

• 72 Left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function ( G8934 )

• 73 Clinician prescribed angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy ( G8935 )

• 74 Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons) ( G8936 )

• 75 Clinician did not prescribe angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy, reason not given ( G8937 )

• 76 Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment ( G8942 )

• 77 AJCC melanoma cancer Stage 0 through IIC melanoma ( G8944 )

• 78 Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) ( G8946 )

• 79 Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented ( G8950 )

• 80 Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given ( G8952 )

• 81 Most recent assessment of adequacy of volume management documented ( G8955 )

• 82 Patient receiving maintenance hemodialysis in an outpatient dialysis facility ( G8956 )

• 83 Assessment of adequacy of volume management not documented, reason not given ( G8958 )

• 84 Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery ( G8961 )

• 85 Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery ( G8962 )

• 86 Cardiac stress imaging test primarily performed on low CHD risk patient for initial detection and risk assessment ( G8965 )

• 87 Cardiac stress imaging test performed on symptomatic or higher than low CHD risk patient or for any reason other than initial detection and risk assessment ( G8966 )

• 88 No risk factors or one moderate risk factor for thromboembolism ( G8970 )

• 89 Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change) ( G8880 )

• 90 Patient has documented immunity to hepatitis B and initiating anti-TNF therapy ( G8869 )

• 91 Trans-abdominal or trans-vaginal ultrasound not performed, reason not given ( G8808 )

• 92 Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy) ( G8840 )

• 93 Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy) ( G8854 )

• 94 Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation) ( G8969 )

• 95 Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment) ( G8968 )

• 96 Fda approved oral anticoagulant is prescribed ( G8967 )