CMS771v5 – Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic Hyperplasia

Male patients with an initial diagnosis of benign prostatic hyperplasia (BHP) 6 months prior to, or during the measurement period, and a urinary symptom score assessment (IPSS or AUASI) within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period. A qualifying visit in this case is an Office Visit.

Note: With the American Urological Association Symptom Index [AUASI], a quality of life assessment ‘If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]’ is to be performed as well.

– NUMERATOR

Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period..

– DENOMINATOR EXCLUSIONS

• Patients with urinary retention that starts within 1 year of initial BPH diagnosis.
• Patients with an initial BPH diagnosis that starts during, or within 30 days of hospitalization.

For hospitalization, an encounter for ‘Hospital Services for urology care’ must exist.

• Patients with a diagnosis of morbid obesity, or with a BMI Exam ≥ 40 before the follow up urinary symptom score.

For Denominator:

• To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.

• To document the BPH diagnosis, use the workflow Patient > Provider Notes > Diagnoses. Here, click ‘Add’ and search for the search for the ICD-10 Code N40.1. Fill out the details as needed, and once done, click ‘Save’.

• For the urinary symptom score assessments, head over to Patient > Provider Notes > Evaluations. Here, click ‘Add’ and search for the relevant assessment. From the ‘Status’ drop-down select ‘Performed’ and in the ‘Result’ text field, input the numeric result. Once done click ‘Save & Accept’ or ‘Sign & Accept’.

• The quality of life assessment can be documented in a similar manner through Patient > Provider Notes > Evaluations. Click ‘Add’ and search for the quality of life assessment question and from the ‘Status’ drop-down select ‘Performed’. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

For Numerator:

The urinary symptom score change (including the quality of life assessment) can be documented as guided in the Denominator workflow.

Note: In order to be counted in the numerator, the BPH diagnosis must exist for a patient (which can be documented as mentioned in the denominator workflow).

For Denominator Exclusions:

• To document the following diagnoses:
  • Urinary retention
  • Morbid obesity
  • Initial benign prostatic hyperplasia (BPH)

use the workflow Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out the details if needed and once done, click ‘Save’.

• To record the hospital services for urology care encounter, head over to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, enter the relevant encounter code.

• The BMI calculation is done via Patient > Provider Notes > Vitals. Here, click ‘Add’ and enter the values for ‘Weight’ and ‘Height’ using which the system automatically calculates the BMI of a patient.