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Problem List and CMS quality measures

CPS, C-EMR, PM

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kwolfe

(@kwolfe)

Posts: 63

Trusted Member

Topic starter

I'm curious to see what other specialty groups put in the problem list, only diagnosis or other historical data too?

I'm in an orthopedic practice and traditionally our problem lists only contain diagnosis codes related to our care. (does MU Core 3 require more?) The PMH/FM/SH given to us from patients is only entered as text.

We're not sure what the best approach is considering that many CMS quality measures are based on the problem list. From what I've read it seems ok to report zero as a report shows if the measure is not within our scope of practice, even though the report could provide a percentage if our problem lists included all of the patient's PMH. I guess I'm not sure what will be required in the future, but that's another topic.

Posted : April 26, 2012 7:57 am

lkeith

(@lkeith)

Posts: 457

Honorable Member

We had a meeting with a representative from Humana Medicare Advantage last week going over the Medicare Risk Adjustment and she emphasized that if the patient is seeing a specialist for a specific problem, such as a fractured ankle, and the patient has other problems that you have to take into account in order to treat the fracture, then those diagnosis should be submitted on your claim as well.

From the handout:

Documentation Requirements

ALL supportive diagnosis documentation must be included in the progress note for each claim submitted.

Chronic conditions addressed during the patient's visit.

Conditions affecting the patient's management for that visit.

Posted : April 27, 2012 1:35 am

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