CMS90v13 – Functional Status Assessments for Heart Failure

Patients 18 years of age and older who had two outpatient encounters during the measurement period and a diagnosis of heart failure that starts any time before and continues into the measurement period.

A qualifying outpatient encounter in this case includes:

• Office Visit
• Telephone Visits
• Online Assessments

Note: The follow-up encounter should start 1 day or more after the day of end of initial visit.

– NUMERATOR

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12]; VR-36; Kansas City Cardiomyopathy Questionnaire [KCCQ]; KCCQ-12; Minnesota Living with Heart Failure Questionnaire [MLHFQ]; Patient-Reported Outcomes Measurement Information System [PROMIS]-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial FSA encounter and results for the follow-up FSA at least 30 days but no more than 180 days after the initial FSA.

The functional status assessments can include any of the following:

• VR12 Oblique Assessments
• VR12 Orthogonal Assessments
• VR36 Oblique Assessments
• VR36 Orthogonal Assessments
• PROMIS10 Assessments
• PROMIS29 Assessments
• MLHFQ Assessments
• KCCQ12 Assessments
• KCCQ Domain Assessments
• KCCQ Total Score Assessments

 – DENOMINATOR EXCLUSIONS

• Patients with severe cognitive impairment in any part of the measurement period.
• Patients who are in hospice care for any part of the measurement period.

For Denominator:

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

• To document the heart failure diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

For Numerator:

• To record an encounter, navigate to Patient > Provider Note > Create Superbill.
• To document a functional score assessment, use the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for any of the relevant evaluation. Select ‘Performed’ from the ‘Status’ dropdown and enter the result in the ‘Result’ field.

Note: The result for an assessment must not be null and all the assessments pertaining to a specific assessment category must be recorded on the same day.

For Denominator Exclusions:

• To document the dementia diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis, add the diagnosis details and click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.
• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.

• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.