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2013 PQRS Measures Groups Specifications Manual
HEART FAILURE (HF) MEASURES GROUP OVERVIEW
2013 PQRS OPTIONS FOR MEASURES GROUPS:
REGISTRY ONLY

2013 PQRS MEASURES IN HEART FAILURE (HF) MEASURES GROUP:
Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) #198. Heart Failure: Left Ventricular Ejection Fraction (LVEF) Assessment #226. P reventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
INSTRUCTIONS FOR REPORTING: (These instructions apply to registry reporting. Do not report this
measures group via claims.)
� It is not necessary to submit the measures group-specific intent G-code for registry-based submissions. However, the measures group-specific intent G-code has been created for registry only measures groups for use by registries that utilize claims data. G8548: I intend to report the Heart Failure (HF) Measures Group
20 Patient Sample Method: 20 unique patients (a majority of which must be Medicare P art B FFS
[fee for service] patients) meeting patient sample criteria for the measures group during the reporting period (J anuary 1 through December 31, 2013 OR J uly 1 through December 31, 2013).
� Patient sample criteria for the HF Measures Group are patients aged 18 years and older with a specific diagnosis of HF accompanied by a specific patient encounter: One of the fol owing diagnosis codes indicating heart failure:
ICD-9-CM: 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1,
428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, ICD-10-CM [Reference ONLY/Not Reportable]: I11.0, I13.0, I13.2, I50.1, I50.20, I50.21, I50.22,
I50.23, I50.30, I50.31, I50.32, I50.33, I50.40, I50.41, I50.42, I50.43, I50.9 Accompanied by

One of the fol owing patient encounter codes: 99201, 99202, 99203, 99204, 99205, 99212,
99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, � Report a numerator option on al applicable measures within the HF Measures Group for each
patient within the eligible professional’s patient sample. � Instructions for qualifying numerator option reporting for each of the measures within the HF Measures Group are displayed on the next several pages. The fol owing composite G-code has been created for registry only measures groups for use by registries that utilize claims data. This composite G-code may be reported in lieu of the individual quality-data codes for each of the measures within the group, if al quality actions for the patient have been performed for al the measures within the group. However, it is not necessary to submit the fol owing composite G-code Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Composite G-code G8551: Al quality actions for the applicable measures in the Heart Failure
(HF) Measures Group have been performed for this patient � To report satisfactorily the HF Measures Group it requires al applicable measures for each
patient within the eligible professional’s patient sample to be reported a minimum of once during � Measures #5 and #8 are represented dif erently from the corresponding individual measures. Therefore the individual measures are specified and analyzed in a slightly dif erent manner than the same measures contained within the measures group. Use the measure specifications as defined within the measures group for reporting purposes in order to satisfactorily report the � Measures groups containing a measure with a 0% performance rate wil not be counted as satisfactorily reporting the measures group. The recommended clinical quality action must be performed on at least one patient for each measure within the measures group reported by the eligible professional. P erformance exclusion quality-data codes are not counted in the performance denominator. If the eligible professional submits al performance exclusion quality-data codes, the performance rate would be 0/0 and would be considered satisfactorily reporting. � When using the 20 Patient Sample Method, report al applicable measures for the 20 unique patients seen a majority of which must be Medicare P art B FFS patients for the 12-month or 6- NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Measure #5 (NQF 0081): Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or
Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)

DESCRIPTION:
P ercentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient set ing OR at each hospital discharge
NUMERATOR:
P atients who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient set ing or at hospital discharge NUMERATOR NOTE: The reporting numerator options contained within this specification are
represented dif erently than the corresponding individual measure. Reference this specification only in order to satisfactorily report the measures group. For purposes of the Heart Failure Measures Group, hospital discharge codes are not included as part of the common denominator. This measure should only be reported on those patients seen in Numerator Instructions: The LVSD may be determined by quantitative or qualitative assessment,
which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of LVSD or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients. LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction.
Definition:
Prescribed - Outpatient setting: May include prescription given to the patient for ACE inhibitor or
ARB therapy at one or more visits in the measurement period OR patient already taking ACE inhibitor or ARB therapy as documented in current medication list. Prescribed - Inpatient setting: May include prescription given to the patient for ACE inhibitor or
ARB therapy at discharge OR ACE inhibitor or ARB therapy to be continued after discharge as documented in the discharge medication list.
Numerator Options:
Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy prescribed or currently being taken (4010F)
Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (3021F)
Documentation of medical reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (eg, hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia) (4010F with 1P)
Documentation of patient reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (4010F with 2P)
Documentation of system reason(s) for not prescribing angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy (4010F with 3P)
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Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (3021F)

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ventricular systolic function (3022F)
Left ventricular ejection fraction (LVEF) was not performed or documented (3021F with 8P)
Angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) therapy was not prescribed, reason not otherwise specified (4010F with 8P)
Left ventricular ejection fraction < 40% or documentation of moderately or severely depressed left ventricular systolic function (3021F)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Measure #8 (NQF 0083): Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic
Dysfunction (LVSD)

DESCRIPTION:
P ercentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient set ing OR at each hospital discharge

NUMERATOR:
P atients who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient set ing or at each hospital discharge NUMERATOR NOTE: The reporting numerator options contained within this specification are
represented dif erently than the corresponding individual measure. Reference this specification only in order to satisfactorily report the measures group. For purposes of the Heart Failure Measures Group, hospital discharge codes are not included as part of the common denominator. This measure should only be reported on those patients seen in
Numerator Instructions: The left ventricular systolic dysfunction may be determined by
quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of left ventricular systolic dysfunction or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function. Any current or prior ejection fraction study documenting LVSD can be used to identify patients. LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe left ventricular systolic dysfunction.
Definitions:
Prescribed – Outpatient Setting: May include prescription given to the patient for beta-blocker
therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. Prescribed – Inpatient Setting: May include prescription given to the patient for beta-blocker
therapy at discharge OR beta-blocker therapy to be continued after discharge as documented in Beta-blocker Therapy for Patients with Prior LVEF < 40% – Should include bisoprolol,
carvedilol, or sustained release metoprolol succinate.
Numerator Options:
Beta-blocker therapy prescribed (G8450)
Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (G8923)
Clinician documented patient with left ventricular ejection fraction (LVEF) < 40% or documentation as moderately or severely depressed left ventricular systolic function was not eligible candidate for beta-blocker therapy (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, al ergy, intolerance, other medical reasons, patient declined, other patient reasons, or other reasons at ributable to the healthcare system) (G8451)
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ventricular systolic function (G8395)
Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Left ventricular ejection fraction (LVEF) not performed or documented (G8396)
Beta-blocker therapy not prescribed (G8452)
Left ventricular ejection fraction (LVEF) < 40% or documentation of moderately or severely depressed left ventricular systolic function (G8923)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Measure #198 (NQF 0079): Heart Failure: Left Ventricular Ejection Fraction (LVEF) Assessment
DESCRIPTION:
P ercentage of patients aged 18 years and older with a diagnosis of heart failure for whom the quantitative or qualitative results of a recent or prior (any time in the past) LVEF assessment is documented within a 12 NUMERATOR:
P atients for whom the quantitative or qualitative results of a recent or prior (any time in the past) LVEF assessment is documented within a 12 month period
Numerator Instructions: The left ventricular systolic dysfunction may be determined by
quantitative or qualitative assessment, which may be current or historical. Examples of a quantitative or qualitative assessment may include an echocardiogram: 1) that provides a numerical value of left ventricular systolic function or 2) that uses descriptive terms such as moderately or severely depressed left ventricular systolic function.
Documentation must include documentation in a progress note of the results of an LVEF
assessment, regardless of when the evaluation of ejection fraction was performed.
Definitions:
Qualitative Results Correspond to Numeric Equivalents as Fol ows:
� Hyperdynamic: corresponds to LVEF greater than 70%
� Normal: corresponds to LVEF 50% to 70% (midpoint 60%)
� Mild dysfunction: corresponds to LVEF 40% to 49% (midpoint 45%)
� Moderate dysfunction: corresponds to LVEF 30% to 39% (midpoint 35%)
� Severe dysfunction: corresponds to LVEF less than 30%

Numerator Options:
Left ventricular ejection fraction (LVEF) < 40% or documentation as normal or mildly depressed left ventricular systolic function (G8738)
���������������������������������������������������documentation of severely or moderately depressed left ventricular systolic function (G8739)
Left ventricular ejection fraction (LVEF) not performed or assessed, reason not given (G8740)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 2013 PQRS Measures Groups Specifications Manual
Measure #226 (NQF 0028): Preventive Care and Screening: Tobacco Use: Screening and
Cessation Intervention
DESCRIPTION:
P ercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user
NUMERATOR:
P atients who were screened for tobacco use at least once within 24 months AND who received tobacco
cessation counseling intervention if identified as a tobacco user Definitions:
Tobacco Use – Includes use of any type of tobacco
Cessation Counseling Intervention – Includes brief counseling (3 minutes or less), and/or
NUMERATOR NOTE: In the event that a patient is screened for tobacco use and identified as a
user but did not receive tobacco cessation counseling report 4004F with 8P.
Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Patient Screened for Tobacco Use
CPT I 4004F: P atient screened for tobacco use AND received tobacco cessation intervention
(counseling, pharmacotherapy, or both), if identified as a tobacco user Patient Screened for Tobacco Use and Identified as a Non-User of Tobacco
CPT I 1036F: Current tobacco non-user
Tobacco Screening not Performed for Medical Reasons
Append a modifier (1P) to CPT Category I code 4004F to report documented circumstances that
appropriately exclude patients from the denominator 4004F with 1P: Documentation of medical reason(s) for not screening for tobacco use (e.g.,
limited life expectancy, other medical reason) Tobacco Screening OR Tobacco Cessation not Performed Reason Not Otherwise Specified
Append a reporting modifier (8P) to CP T Category I code 4004F to report circumstances when the
action described in the numerator is not performed and the reason is not otherwise specified. 4004F with 8P: Tobacco screening OR tobacco cessation not performed, reason not otherwise


NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures
groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012

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