CMS 147v11: Preventive Care and Screening: Influenza Immunization

Measure: Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization
Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator All patients aged 6 months and older seen for a visit during the measurement period and seen for a visit between October 1 and March 31
Numerator Patients who received an influenza immunization OR who reported previous receipt of an influenza immunization
Denominator Exceptions
  • Documentation of medical reason(s) for not receiving influenza immunization (e.g., patient allergy, other medical reasons)
  • Documentation of patient reason(s) for not receiving influenza immunization (e.g., patient declined, other patient reasons)
  • Documentation of system reason(s) for not receiving influenza immunization (e.g., vaccine not available, other system reasons)
Denominator Exclusions None

Patients who meet the following criteria will be included in the denominator:

  • Age is ≥ 6 months at the beginning of the Measurement Period

    AND

  • Have at least one initial qualifying encounter during the Measurement Period finalized by the EC

    AND

  • Have at least one eligible encounter between October 1 of the previous year through March 31 of the current year finalized by the EC

An initial qualifying encounter can be a visit that uses one of the eligible encounter codes below or any visit in which a procedure for Hemodialysis or Peritoneal Dialysis is documented.

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99384, 99382, 99381, 99383, 99385, 99386, 99387, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99315, 99316, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99394, 99392, 99391, 99393, 99395, 99396, 99397, 99441, 99442, 99443, 99421, 99422, 99423, 99024, 99251, 99252, 99253, 99254, 99255, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0438, G0439, G0071, G2010, G2012, G2061, G2062, G2063

To document a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete.

Hemodialysis

CPT: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 99512

Peritoneal Dialysis

CPT: 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970

A flu season encounter can be a visit that uses one of the eligible encounter codes below or any visit in which a procedure for Hemodialysis or Peritoneal Dialysis is documented. The visit must occur between October 1 of the previous year through March 31 of the current year.

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 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

HCPCS: G0438, G0439

To document a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete.

Hemodialysis

CPT: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 99512

Peritoneal Dialysis

CPT: 90945, 90947, 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970

A patient will be counted as an exception for this measure if there is documentation of a medical, patient, or system reason for not receiving an influenza immunization. An active diagnosis of allergy to eggs also qualifies as a patient exception

  1. Go to Encounters > Immunizations > 0 to 2, 2 to 18, or Adult tab
  2. Click the Add button for Influenza
  3. Select a reason from the Dose Not Given list
  4. Click Save

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for allergy to eggs are:

ICD-10: T78.08XA, T78.08XS, T78.08XD, Z91.012

A patient will be counted in the numerator if they received an influenza immunization OR reported previously receiving an influenza immunization.

The immunization administration date or the date an immunization was previously received must be within the 153 days prior to the start of the Measurement Period through the 89 days after the start of the Measurement Period.

  1. Go to Encounters > Immunizations > 0 to 2, 2 to 18, or Adult tab
  2. Click the Add button for Influenza
  3. Complete the fields in the Serum section
  4. Complete the applicable fields of the Administration section
  5. Click Save

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

CPT: 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90661, 90662, 90666, 90667, 90668, 90673, 90674, 90682, 90685, 90686, 90687, 90688, 90689, 90694, 90756

HCPCS: G0008, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039

Order Status must be marked as Complete.

To document a previously received influenza immunization:

  1. Go to Encounters > Immunizations > 0 to 2, 2 to 18, or Adult tab
  2. Click the Add button for Influenza
  3. Select the Historic checkbox
  4. Document the date the immunization was given in the Date field of the Administration section
  5. Click Save

https://ecqi.healthit.gov/ecqm/ep/2022/cms147v11

 

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