#219: Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Lower Leg, Foot or Ankle Impairments

Quality ID

219

NQF

0424

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

N/A Physical Therapy/Occupational Therapy

Measure Description

A patient-reported outcome measure of risk-adjusted change in functional status for patients 14 years+ with foot, ankle and lower leg impairments. The change in functional status (FS) assessed using the Foot/Ankle FS patient-reported outcome measure (PROM) (©Focus on Therapeutic Outcomes, Inc.). The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician, and at the clinic level to assess quality. The measure is available as a computer adaptive test, for reduced patient burden, or a short form (static survey)

 

Instructions

This outcomes measure is to be submitted once per treatment episode for all patients with a functional deficit related to the lower leg, foot or ankle. This is an outcome measure and its calculation requires submitting of the patient’s FS score, as a minimum, at admission to and again at discharge from an episode of rehabilitation. The admission score is recorded during the first rehabilitation treatment encounter, and the discharge score is recorded at or near the conclusion of the final rehabilitation treatment encounter. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians providing treatment for functional lower leg, foot or ankle deficits will submit this measure.

Definitions:

Functional Deficit – Limitation or impairment of physical abilities/function resulting in evaluation and inclusion in a treatment plan of care.

Treatment Episode – A Treatment Episode is defined as beginning with an Admission for a functional lower leg, foot or ankle deficit, progressing to development of a plan of care, including treatment, without interruption of care (for example, a hospitalization or surgical intervention), and ending with Discharge from clinical care by the MIPS eligible clinician. A patient currently under clinical care for a foot, ankle or lower leg deficit remains in a single episode of care until the Discharge is conducted and documented by the MIPS eligible clinician.

Admission (Option 1 & 2) – An Admission is the first encounter for a functional deficit involving the lower leg, foot or ankle and includes an evaluation (CPT 97161, 97162, 97163 for physical therapy or 97165, 97166, 97167 for occupational therapy) and development of a plan of care by the MIPS eligible clinician. A patient presenting with a lower leg, foot or ankle impairment, who has had an interruption of a Treatment Episode for the same functional lower leg, foot or ankle deficit secondary to an appropriate reason like hospitalization or surgical intervention, is a new Admission.

Admission (Option 3 & 4) – An Admission is the first encounter for a functional deficit involving the lower leg, foot or ankle and includes an evaluation (CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 for physician or 98940, 98941, 98942, 98943 for chiropractic care) and development of a plan of care by the MIPS eligible clinician. A patient presenting with a lower leg, foot or ankle impairment, who has had an interruption of a Treatment Episode for the same functional lower leg, foot or ankle deficit secondary to an appropriate reason like hospitalization or surgical intervention, is a new Admission.

Discharge (Option 1 & 2) – Discharge is accompanied by a re-evaluation CPT 97164 for physical therapy, or 97168 for occupational therapy, or Functional Limitation Submitting Discharge Status G-Code (G8980, G8983, G8986, G8989, G8992 or G8995) identifying the close of a Treatment Episode for the same lower leg, foot or ankle deficit identified at admission and documented by a discharge report by the MIPS eligible clinician. An interruption in clinical care for an appropriate reason like hospitalization or surgical intervention requires a discharge from the current Treatment Episode.

Discharge (Option 3 & 4) – Discharge is accompanied by a treatment finalization and evaluation completion M-Code (M1011) for physicians and chiropractors identifying the close of a Treatment Episode for the same lower leg, foot or ankle deficit identified at admission and documented by a discharge report by the MIPS eligible clinician. An interruption in clinical care for an appropriate reason like hospitalization or surgical intervention requires a discharge from the current Treatment Episode.

Encounter – A face to face visit between the patient and the provider for the purpose of assessing and/or improving a functional deficit.

Patient Reported – The patient directly provides answers to the FS measure items using standardized, reliable and valid, computerized adaptive testing or paper and pencil method. If the patient cannot reliably respond independently (e.g. in the presence of cognitive deficits), a suitable proxy may provide answers.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

All patients 14 years and older with foot, ankle or lower leg impairments who have initiated rehabilitation treatment and completed the Foot/Ankle FS PROM at admission and discharge DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Option 1 – Physical Therapy Denominator Criteria (Eligible Cases):

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 97161, 97162, 97163

AND

Patient encounter during the performance period identifying discharge (CPT or HCPCS): 97164, G8980, G8983, G8986, G8989, G8992, G8995

AND

Functional deficit affecting the lower leg, foot or ankle

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9730

OR

Patient unable to complete the Foot/Ankle FS PROM at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available: G9731

OR

Option 2 – Occupational Therapy Denominator Criteria (Eligible Cases):

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 97165, 97166, 97167

AND

Patient encounter during the performance period identifying discharge (CPT or HCPCS): 97168, G8980, G8983, G8986, G8989, G8992, G8995

AND

Functional deficit affecting the lower leg, foot or ankle

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9730

OR

Patient unable to complete the Foot/Ankle FS PROM at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available: G9731

OR

Option 3 – Physician Denominator Criteria (Eligible Cases)

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

AND

Patient treatment and final evaluation complete: M1011

AND

Functional deficit affecting the lower leg, foot or ankle

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9730

OR

Patient unable to complete the Foot/Ankle FS PROM at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available: G9731

OR

Option 4 – Chiropractic Care Denominator Criteria (Eligible Cases)

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 98940, 98941, 98942, 98943*

AND

Patient treatment and final evaluation complete: M1011

AND

Functional deficit affecting the lower leg, foot or ankle

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9730

OR

Patient unable to complete the Foot/Ankle FS PROM at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility and an adequate proxy is not available: G9731

 

Numerator

Patients who were presented with the Foot/Ankle FS PROM at Admission (Intake) and Discharge (Status) for the purpose of calculating the patient’s Risk-Adjusted Functional Status Change Residual Score

Register with MDinteractive