2016 PQRS Measure #111: Pneumonia Vaccination Status for Older Adults

DESCRIPTION

Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine 

INSTRUCTIONS

This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. There is no diagnosis associated with this measure. Performance for this measure is not limited to the reporting period. This measure may be reported by clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding.

DENOMINATOR

Patients 65 years of age and older with a visit during the measurement period

DENOMINATOR NOTE: This measure assesses whether patients 65 years of age or older have received one or more pneumococcal vaccinations.

AND
Patient encounter during the reporting period (CPT or HCPCS): 90732, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

NUMERATOR

Patients who have ever received a pneumococcal vaccination

NUMERATOR NOTE: While the measure provides credit for adults 65 years of age and older who have ever received either the PCV13 or PPSV23 vaccine (or both), according to ACIP recommendations, patients should receive both vaccines. The order and timing of the vaccinations depends on certain patient characteristics, and are described in more detail in the ACIP recommendations.

Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Pneumococcal Vaccination Administered or Previously Received
Performance Met:
CPT II 4040F: Pneumococcal vaccine administered or previously received

OR
Pneumococcal Vaccination not Administered or Previously Received, Reason not Otherwise
Specified
Append a reporting modifier (8P) to CPT Category II code 4040F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
Performance Not Met:
4040F with 8P: Pneumococcal vaccine was not administered or previously received, reason not otherwise specified
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Pneumonia Vaccination Status for Older Adults

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If reporting for Physician Quality Reporting System (PQRS) through another Centers for Medicare and Medicaid Services’ (CMS) program (such as the Medicare Shared Savings Program, Comprehensive Primary Care Initiative, Pioneer Accountable Care Organizations), please check the program’s requirements for information on how to report quality data to earn a PQRS incentive and/or avoid the PQRS payment adjustment.

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