PQRS Simplified

Author: Kim Cavitt, Au.D.

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.    
Kim Cavitt, Au.D. was a clinical audiologist and preceptor at The Ohio State University and Northwestern University for the first ten years of her career. Since 2001, Dr. Cavitt has operated her own Audiology consulting firm, Audiology Resources, Inc. She currently serves as President of the Academy of Doctors of Audiology and on the State of Illinois Speech Pathology and Audiology Licensure Board. She also serves on committees through AAA and ASHA and is an Adjunct Lecturer at Northwestern University.