CMS 122v8: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

HCPCS: G0438, G0439

The patient must have an active diagnosis of Type 1 or Type 2 diabetes during Measurement Period. Patients with a diagnosis of secondary diabetes due to another condition are not counted.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for diabetes can be located here.

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Pending or Complete.

Note

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

To document days spent in long term care:

1. Go to Chart > Admissions and click Add
2. Select a Place of Service
3. Optional: select a Facility
4. Populate the Admit Date
5. Optional: populate the Discharge Date
6. Click OK

The cumulative total of the patient's admission events during the Measurement Period must be greater than 90 days.

Note

If the admissions event does not have a Discharge Date, the length of stay will be calculated with a discharge date of the Reporting Period end date or the Measurement Period end date, whichever occurs first.

A patient has evidence of advanced illness if they meet any of the following criteria:

• Had an inpatient encounter with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
• Had 2 or more outpatient encounters with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
  • Diagnosis must be active during all eligible encounters
• Was prescribed medication for dementia during the Measurement Period or in the year prior

Advanced Illness Diagnosis

"Advanced illness" refers to a wide range of conditions and includes diseases such as Alzheimer's disease, cancer, and heart failure.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for advanced illness can be located here.

Inpatient Encounter Codes Eligible for Denominator Exclusion

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291

Outpatient Encounter Codes Eligible for Denominator Exclusion

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439, G0463, T1015

Medication

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible dementia medications can be located here.

A patient has evidence of frailty if they meet any of the following criteria:

• Has an active diagnosis of Frailty during the Measurement Period
• Has an active diagnosis of Frailty Symptom during the Measurement Period
• Has an order for a frailty device during the Measurement Period
• Is using a frailty device during the Measurement Period
• Has a frailty encounter during the Measurement Period

Frailty Diagnosis

"Frailty" refers to a range of conditions that includes falls and problems affecting mobility.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for frailty can be located here.

Frailty Symptom Diagnosis

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for frailty symptoms are:

ICD-10: R26.0, R26.1, R26.2, R26.89, R26.9, R41.81, R53.1, R53.81, R53.83, R54, R62.7, R63.4, R63.6, R64

Frailty Device Order

To document the order of a frailty device, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add an order. Order Status must be marked as Pending or Complete.

A comprehensive list of eligible frailty devices can be located here.

Frailty Device Use

To document the patient's use of a frailty device:

1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
2. Click Add New Flowsheet
3. Select the Frailty Device flowsheet and click Add
4. Click Add Column
5. Select a Device and the type (Value) of device
6. Populate a usage Start Date for the device
7. Optional: populate a usage Stop Date for the device
   1. The Stop Date cannot occur prior to the start of the Measurement Period
8. Optional: populate a Reason for use of the device
9. Click OK to save

Frailty Encounter Codes Eligible for Denominator Exclusion

CPT: 99504, 99509

HCPCS: G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031

A patient will be included in the numerator if the most recent HbA1c result is missing or if there are no HbA1c tests performed and no results documented during the Measurement Period.

1. From the Clinic Inbox, select the lab result to be stored and click View
2. Click Select to search for and select a patient
3. Verify patient displayed matches the lab result and select the I have verified the following lab results belong to the above patient checkbox
4. Click Sign/Route
5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.