#154: Falls: Risk Assessment

Quality ID

154

NQF

0101

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Family Medicine Internal Medicine Neurology Orthopedic Surgery Otolaryngology Physical Medicine Podiatry Preventive Medicine

Measure description

Percentage of patients aged 65 years and older with a history of falls that had a risk assessment for falls completed within 12 months

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure is appropriate for use in all non-acute settings (with the exception of emergency departments and acute care hospitals). This measure may be submitted by eligibleclinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients aged 65 years and older who have a history of falls (history of falls is defined as 2 or more falls in thepast year or any fall with injury in the past year). Documentation of patient reported history of falls is sufficient

Denominator Criteria (Eligible Cases):

Patients aged ≥ 65 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 92540, 92541, 92542, 92548, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99211, 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, 99349, 99350, G0402, G0438, G0439

AND

Patient screened for future fall risk; documentation of two or more falls in the past year or any fall with injury in the past year: 1100F

AND NOT

DENOMINATOR EXCLUSIONS:

Hospice services for patient provided any time during the measurement period: G9718

 

Numerator

Patients who had a risk assessment for falls completed within 12months

Numerator Instructions: All components do not need to be completed during one patient visit, butshould be documented in the medical record as having been performed within the past 12months.

Definitions:

Fall – A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure,or overwhelming external force.

Risk Assessment – Comprised of balance/gait AND one or more of the following: postural bloodpressure, vision, home fall hazards, and documentation on whether medications are a contributing factor or not tofalls within the past 12 months.

Balance/gait Assessment - Medical record must include documentation of observed transfer and walking or use of a standardized scale (e.g., Get Up & Go, Berg, Tinetti) or documentation of referral forassessment of balance/gait.

Postural blood pressure - Documentation of blood pressure values in supine and then standing positions.

Vision Assessment - Medical record must include documentation that patient is functioning well withvision or not functioning well with vision based on discussion with the patient or use of a standardized scaleor assessment tool (e.g., Snellen) or documentation of referral for assessment ofvision.

Home fall hazards Assessment - Medical record must include documentation of counseling on homefalls hazards or documentation of inquiry of home fall hazards or referral for evaluation of home fall hazards.

Medications Assessment - Medical record must include documentation of whether the patient’s current medications may or may not contribute to falls.

Numerator Options:

Performance Met: Falls risk assessment documented (3288F)

OR

Denominator Exception: Documentation of medical reason(s) for not completing a risk assessment for falls (i.e., patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair bound, dependent on helper pushing wheelchair, independent in wheelchair or minimal help in wheelchair (3288F with 1P)

OR

Performance Not Met: Falls risk assessment not completed, reason not otherwise specified (3288F with 8P)

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