PQRS Simplified

In 2016, audiologists who bill traditional Medicare Part B must report on six measures, when eligible to do so, on at least 50% of the eligible patients, to avoid a 2% penalty on all Medicare claims in 2018.

The six measures are:
  • Measure #130: Documentation and verification of current medications in the medical record.
    • Must be reported at every visit where you are submitting a claim for covered service.
  • Measure #134: Screening for clinical depression and follow-up plan.
    • Must be reported at least once per calendar year where you are submitting a claim for covered services.
  • Measure #154: Falls Risk Assessment
    • Must be reported at least once per calendar year where you are submitting a claim for covered services.
  • Measure #155: Falls Risk Plan of Care
    • Must be reported at least once per calendar year where you are submitting a claim for covered services.
  • Measure #226: Screening for Tobacco Use/Cessation
    • Must be reported at least once per calendar year where you are submitting a claim for covered services.
  • Measure #261: Referral for otologic evaluation for patients with acute or chronic dizziness.
    • Must be reported at least once per calendar year where you are submitting a claim for covered services.
“Eligibility” to report is determined by two things:
  1. Did you perform one of the procedures included and listed within the measure or
  2. Did you code a diagnosis that is included and listed within the measure. This ONLY applies to measure #261 (referral for acute or chronic dizziness). None of the other measures require specific diagnosis codes for eligibility.
Now, let’s simplify it even further.
Here is a listing of when you are eligible (required) to report PQRS for audiologists:
  • Measure #130: Documentation and verification of current medications in the medical record.
    • You are eligible to report this measure if you perform a/an:
      • Audiogram
      • Immittance Testing
      • Vestibular Evaluation
      • ABR
      • Comprehensive OAEs or
      • Cochlear implant or auditory osseointegrated device candidacy assessment,
  • Measure #134: Screening for clinical depression and follow-up plan.
    • You are eligible to report this measure if you perform a tinnitus assessment.
  • Measure #154: Falls Risk Assessment
    • You are eligible to report this measure if you perform vestibular evaluations.
  • Measure #155: Falls Risk Plan of Care
    • You are eligible to report this measure if you perform vestibular evaluations.
  • Measure #226: Screening for Tobacco Use/Cessation
    • You are eligible to report this measure if you perform a/an:
      • Audiogram
      • Vestibular Evaluation or
      • Tinnitus Assessment
  • Measure #261: Referral for otologic evaluation for patients with acute or chronic dizziness.
    • You are eligible to report this measure if you perform a/an:
      • Audiogram
      • Vestibular Evaluation
      • Immittance AND diagnose
        • Dizziness (R41) or
        • BPPV (H81.10-H81.13)
Things to note:
  • No codes are optional.
  • There could be some clinical situations where you are reporting on five or six measures for one patient for that date of service.
  • The measure code you choose must be a POSITIVE ACTION (that you documented the medications, screened for depression, falls risk, or tobacco use, created a plan of care for depression or tobacco cessation, or referred for acute or chronic dizziness).
  • A NEGATIVE ACTION = NO REPORTING.
You can learn more specific information about PQRS, please go to www.audiologyquality.org.

Please contact Kim Cavitt, AuD at kim.cavitt@audiologyresources.com or (773) 960-6625 if you have any further questions or need personal assistance.