Microsoft word - pqrs_reporting_examples_2013.docx

The following examples are to assist you with PQRS reporting. These examples were
created in collaboration with the Academy of Doctors of Audiology and the American
Speech-Language-Hearing Association to assist audiologists in better understand the
practicalities of the PQRS system.
Example #1:

Patient: A 65-year-old male who is a Medicare Part B beneficiary, whose testing was
ordered by his internist
Chief Complaint: Gradual hearing loss bilaterally. He does not report any difference in
hearing acuity between his ears.
Problem Focused Case History:
 He has never had his hearing tested previously and he has never worn  No history of head injury or any recent accident or injury  No history of noise exposure, ear drainage, cerumen impaction, tinnitus,  Patient does not currently take any prescription medication, over the counter  Otoscopy revealed two large exotoses in both ears. The patient revealed that he swims daily in Lake Michigan, 6-8 months out of the year.
Procedures Performed:
 Comprehensive hearing test (92557)  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, bilateral (389.18)
 Exotosis of external ear canal (380.81)

Recommendations:

 Referral to otolaryngologist for an otologic evaluation due to canal exotoses prior to hearing aid evaluation and selection  Evaluation for binaural amplification pending medical evaluation and clearance PQRS Measure(s) to Report:

 Measure #188: Referral for Otologic Evaluation for Patients with Congenital or  Measure #130: Documentation of Current Medications in the Medical Record
PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8556: Referral to a physician for an otologic evaluation performed  G8430: Provider documentation that patient is not eligible for medication Example #2:

Patient: A 75-year-old male who is a Medicare Part B beneficiary, testing was ordered
by his otologist
Chief Complaint: Patient was in a serious car accident four days prior to the
appointment, having sustained significant damage/trauma to his right outer ear as a
result of the air bag deploying. Patient reports hearing loss, drainage, otalgia, and
tinnitus in his right ear. The patient has worn hearing aids bilaterally for the past five
years and was wearing his hearing aids at the time of the accident.
Problem Focused Case History:
 No prior history of noise exposure, cerumen impaction or dizziness  Patient currently takes an oral dose of Synthroid daily for his thyroid condition and Xanex orally, as needed, for anxiety  Otoscopy was unremarkable for the left ear and revealed evidence of a hematoma on the right pinna, drainage and swelling/collapse of the right ear canal. The referring physician reported that the right tympanic membrane was perforated.
Procedures Performed:
 Comprehensive hearing test (92557)  Tympanometry (92567)  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, unilateral (389.15)
 Mixed hearing loss, unilateral (389.21)
 Hematoma of auricle or pinna (380.31)
 Acquired stenosis of external ear canal, secondary to trauma (380.51)
 Central perforation of tympanic membrane (384.21)
Recommendations:

 Report including the results forwarded to ordering otologist for review  Recommend follow-up testing following medical/surgical intervention by  Recommend use of a water resistant ear plug in his right ear when showering or  Hearing aid follow-up/check appointment post medical clearance when patient may resume hearing aid use in the right ear.
PQRS Measure(s) to Report:

 Measure #188: Referral for Otologic Evaluation for Patients with Congenital or  Measure #130: Documentation of Current Medications in the Medical Record
PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8557: Patient is not eligible for the referral for otologic evaluation measure (e.g. for patients for whom an assessment of the congenital or traumatic deformity of the ear has been performed by a physician within the past six months, patients already under the care of a physician for congenital or traumatic deformity of the ear  G8428: Current medications (includes prescription, over the counter, herbals, vitamin/mineral [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified (this is still the appropriate code, as the audiologist documented the drug name, frequency and route but did not document the dosage) Example #3:

Patient: A 68-year-old female who is a Medicare Part B beneficiary, testing was ordered
by her primary care physician
Chief Complaint: Gradual hearing loss bilaterally and dizziness. She does not report any
difference in hearing acuity between her ears. Dizziness is described as a spinning
sensation when she gets up in the morning or moves her head quickly.
Problem Focused Case History:
 She has never had her hearing tested previously and has never worn  No history of head injury or any recent accident or injury  No history of ear drainage, cerumen impaction, tinnitus, trauma or deformity of  Patient reports osteoporosis for which she takes a daily One a Day vitamin orally and Boniva monthly (did not have dosage information available)
Procedures Performed:
 Comprehensive hearing test (92557)  Basic vestibular evaluation (92540)  Caloric vestibular test, per irrigation (92543 x 4)  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, bilateral (389.18)
 Benign paroxysmal positional vertigo (386.11)

Recommendations:

 Referral to otolaryngologist for an otologic evaluation, treatment and medical  Evaluation for binaural amplification pending medical evaluation and clearance
PQRS Measure(s) to Report:

 Measure #261: Referral for Otologic Evaluation for Patients with Acute or  Measure #130: Documentation of Current Medications in the Medical Record
PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8856: Referral to a physician for otologic evaluation performed  G8428: Current medications (includes prescription, over the counter, herbals, vitamin/mineral [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified (this is still the appropriate code, even though the audiologist documented the drug name, frequency and route but the dosage was not documented)
Example #4:

Patient: An 80-year-old female who is a Medicare Part B beneficiary, testing was
ordered by her otolaryngologist
Chief Complaint: Patient reports her dizziness as an unsteady feeling. She does not
report any hearing loss.
Problem Focused Case History:
 She has never had her hearing tested previously and she has never worn  No history of head injury or any recent accident or injury  No history of noise exposure, ear drainage, cerumen impaction, tinnitus, trauma  The patient is a Type II diabetic and has vascular issues for which she injects insulin at least three times per day and takes Pletal orally two times per day
Procedures Performed:
 Comprehensive hearing test (92557)  Basic vestibular evaluation (92540)  Caloric vestibular test, per irrigation (92543 x 4)  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, bilateral (389.18)
 Dizziness (780.4)

Recommendations:

 Follow-up with otolaryngologist given test findings  Evaluation for binaural amplification pending medical evaluation and clearance
PQRS Measure(s) to Report:

 Measure #261: Referral for Otologic Evaluation for Patients with Acute or  Measure #130: Documentation of Current Medications in the Medical Record PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8857: Patient is not eligible for the referral for otologic evaluation measure (e.g. patients who are already under the care of a physician for acute or chronic dizziness)  G8428: Current medications (includes prescription, over the counter, herbals, vitamin/mineral [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified (this is still the appropriate code, even though the audiologist documented the drug name, frequency and route but the dosage was not documented) Example #5:

Patient: An 70-year-old female who is a Medicare Part B beneficiary, testing was
ordered by her primary care physician (she called his office and they faxed over her
order).
Chief Complaint: Patient reports her dizziness as a spinning sensation. She reports a
mild hearing loss and tinnitus.
Problem Focused Case History:
 She has never had her hearing tested previously and she has never worn  No history of head injury or any recent accident or injury  No history of noise exposure, ear drainage, cerumen impaction, tinnitus, trauma  The patient is a Type II diabetic and has vascular issues for which she injects insulin at least three times per day and takes Pletal orally two times per day
Procedures Performed:
 Comprehensive hearing test (92557)  Tympanometry and acoustic reflex testing  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, bilateral (389.18)
 Tinnitus, subjective (388.31)
 Dizziness (780.4)

Recommendations:

 Follow-up with otolaryngologist given test findings  Evaluation for binaural amplification pending medical evaluation and clearance
PQRS Measure(s) to Report:

 Measure #261: Referral for Otologic Evaluation for Patients with Acute or  Measure #130: Documentation of Current Medications in the Medical Record PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8856: Referral to a physician for otologic evaluation performed  G8428: Current medications (includes prescription, over the counter, herbals, vitamin/mineral [nutritional] supplements) with drug name, dosage, frequency, and route not documented by the provider, reason not specified (this is still the appropriate code, even though the audiologist documented the drug name, frequency and route but the dosage was not documented)
Example #6:

Patient: An 80-year-old female who is a Medicare Part B beneficiary, testing was
ordered by her otolaryngologist
Chief Complaint: Patient reports hearing loss bilaterally. There is no report of any
asymmetry in hearing acuity between her ears.
Problem Focused Case History:
 She had her hearing tested five years ago and currently wears bilateral hearing  She recently noted a significant change in her hearing bilaterally  No history of head injury or any recent accident or injury  No history of noise exposure, ear drainage, cerumen impaction, tinnitus, trauma  The patient take one 150mg Boniva tablet orally each month for osteoporosis  Otoscopy unremarkable bilaterally
Procedures Performed:
 Comprehensive hearing test (92557)  No depression screen was performed
Diagnosis:

 Sensorineural hearing loss, bilateral (389.18; no significant change in hearing
Recommendations:

 Hearing aid check/evaluation to assess the function and appropriateness of her PQRS Measure(s) to Report:

 Measure #130: Documentation of Current Medications in the Medical Record
PQRS G-Codes are placed in the CPT/HCPCS box of 24D on the CMS 1500 claim form

 G8427: List of current medications (includes prescription, over the counter, herbals, vitamin/mineral [nutritional] supplements) documented by the provider, including drug name, dosage, frequency, and route

Source: http://www.audiologist.org/_resources/documents/professionals/pqri/PQRS_Reporting_Examples_2014.pdf