2016 PQRS Measure #46: Medication Reconciliation

DESCRIPTION

Percentage of patients aged 65 years and older discharged from any inpatient facility (e.g., hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented.

This measure is reported as two rates stratified by age group:
 Reporting Age Criteria 1: 18-64 years of age
 Reporting Age Criteria 2: 65 years and olderdocumented

INSTRUCTIONS

This measure is to be reported at an outpatient visit occurring within 30 days of each inpatient facility discharge date during the reporting period. This measure is appropriate for use in the ambulatory setting only. There is no diagnosis associated with this measure. This measure may be reported by clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. This measure is not to be reported unless a patient has been discharged from an inpatient facility within 30 days prior to the outpatient visit.

This measure will be calculated with 2 performance rates:

1) Percentage of patients 18-64 years of age who were discharged from any inpatient facility (eg, hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented


AND


2) Percentage of patients 65 years and older who were discharged from any inpatient facility (eg, hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented

DENOMINATOR

All patients 18 years of age and older discharged from any inpatient facility (eg, hospital, skilled nursing facility, or rehabilitation facility) and seen within 30 days following discharge in the office by the physician, prescribing practitioner, registered nurse, or clinical pharmacist providing on-going care

Denominator Criteria (Eligible Cases):
REPORTING CRITERIA 1: Patients 18-64 years of age on date of encounter
REPORTING CRITERIA 2: Patients aged 65 years and older on date of encounter


AND


Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495, 99496, G0402, G0438, G0439

NUMERATOR

NUMERATOR (Reporting Criteria 1 & 2):
Patients who had a reconciliation of the discharge medications with the current medication list in the outpatient medical record documented

Definition:
Medical Record – Must indicate: The physician, prescribing practitioner, registered nurse, or clinical pharmacist providing ongoing care is aware of the inpatient facility discharge medications and will either keep the inpatient facility discharge medications or change the inpatient facility discharge medications or the dosage of an inpatient facility discharge medication.

NUMERATOR NOTE: Medication reconciliation should be completed and documented within 30 days of discharge. If the patient has an eligible discharge but medication reconciliation is not performed and documented within 30 days, report 1111F with 8P.

Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Documentation of Reconciliation of Discharge Medication with Current Medication List in the
Medical Record
Performance Met: CPT II 1111F: Discharge medications reconciled with the current medication list in outpatient medical record


OR


If patient is not eligible for this measure because patient was not discharged from an inpatient facility within the last 30 days, there are no reporting requirements in this case.


OR


Discharge Medication not Reconciled with Current Medication List in the Medical Record, Reason Not Otherwise Specified
Append a reporting modifier (8P) to CPT Category II code 1111F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
Performance Not Met: 1111F with 8P: Discharge medications not reconciled with the current
medication list in outpatient medical record, reason not otherwise specified

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Medication Reconciliation

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