| About the Author |
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xii | |
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1 | (14) |
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Physician Consortium for Performance Improvement® (PCPI) |
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2 | (1) |
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Key Concepts Underlying Measure Development Work of the PCPI |
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2 | (1) |
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Process for Measure Development |
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3 | (1) |
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3 | (1) |
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Cross-Specialty and Multi-Disciplinary Work Groups |
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3 | (1) |
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4 | (1) |
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4 | (1) |
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Evaluation and Implementation |
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4 | (1) |
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5 | (1) |
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5 | (1) |
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Specifications for Electronic Medical Records |
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5 | (1) |
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Specifications for Paper Medical Records |
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5 | (1) |
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Specifications for Administrative Data (Paper or Electonic) |
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6 | (1) |
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PCPI Measures Developed to Date |
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6 | (4) |
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CPT® Category II Codes for Performance Measurement |
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10 | (5) |
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Performance Measurement Advisory Group |
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11 | (1) |
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How to Read and Apply CPT® Category II Codes |
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12 | (1) |
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13 | (2) |
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The Medicare Physician Quality Reporting Initiative (PQRI) |
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15 | (24) |
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15 | (1) |
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16 | (9) |
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Quality Measures for Reporting |
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16 | (1) |
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Form and Manner of Reporting |
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16 | (1) |
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Determination of Successful Reporting |
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17 | (1) |
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18 | (1) |
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19 | (1) |
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19 | (1) |
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Confidential Feedback Reports |
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19 | (1) |
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Transition from the 2007 Physician Quality Reporting Initiative |
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19 | (1) |
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Changes in 2008 PQRI Measures from 2007 |
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20 | (1) |
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21 | (4) |
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25 | (1) |
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25 | (4) |
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PQRI Measure Denominators and Numerators |
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25 | (1) |
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Reporting Frequency and Performance Timeframes |
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25 | (1) |
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26 | (1) |
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27 | (1) |
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Use of CPT® Category II Modifiers |
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27 | (2) |
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Form and Manner of Reporting |
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29 | (3) |
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Claims-Based Reporting Principles |
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29 | (1) |
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Submission Through Carriers/Medicare Administrative Contractors (MACs) |
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29 | (1) |
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Submission of Data on Quality Measures via Medical Registry |
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30 | (1) |
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Submission of Data on Quality Measures via Electronic Health Record (EHR) |
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31 | (1) |
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Individual/Group NPI Submission |
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32 | (1) |
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Timeliness of Quality Data Submission |
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32 | (1) |
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How to Incorporate PQRI Measures into Your Practice |
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32 | (2) |
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34 | (2) |
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Example of Successful Quality Data Reporting |
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34 | (2) |
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Example of Successful Reporting of a Performance Measure |
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36 | (1) |
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Expanding the Use of Performance Measures |
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36 | (3) |
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Continuing Medical Education (CME) |
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36 | (2) |
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Maintenance of Certification (MOC™) |
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38 | (1) |
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Physician Quality Measures |
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39 | (519) |
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PQRI Measures Specifications |
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39 | (519) |
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Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus |
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41 | (4) |
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Low Density Lipoprotein Control in Type 1 or 2 Diabetes Mellitus |
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45 | (4) |
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High Blood Pressure Control in Type 1 or 2 Diabetes Mellitus |
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49 | (5) |
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Screening for Future Fall Risk |
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54 | (4) |
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Heart Failure: Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) |
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58 | (4) |
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Oral Antiplatelet Therapy Prescribed for Patients with Coronary Artery Disease |
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62 | (5) |
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Beta-blocker Therapy for Coronary Artery Disease Patients with Prior Myocardial Infarction (MI) |
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67 | (4) |
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Heart Failure: Beta-blocker Therapy for Left Ventricular Systolic Dysfunction |
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71 | (4) |
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Antidepressant Medication During Acute Phase for Patients with New Episode of Major Depression |
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75 | (5) |
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Stroke and Stroke Rehabilitation: Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Reports |
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80 | (4) |
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Stroke and Stroke Rehabilitation: Carotid Imaging Reports |
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84 | (4) |
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Primary Open Angle Glaucoma: Optic Nerve Evaluation |
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88 | (4) |
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Age-Related Macular Degeneration: Dilated Macular Examination |
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92 | (4) |
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Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy |
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96 | (4) |
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Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care |
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100 | (4) |
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Perioperative Care: Timing of Antibiotic Prophylaxis-Ordering Physician |
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104 | (5) |
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Perioperative Care: Selection of Prophylactic Antibiotic-First or Second Generation Cephalosporin |
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109 | (5) |
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Perioperative Care: Discontinuation of Prophylactic Antibiotics (Non-Cardiac Procedures) |
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114 | (5) |
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Perioperative Care: Venous Thromboembolism (VTE) Prophulaxis (When Indicated in ALL Patients) |
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119 | (6) |
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Osteoporosis: Communication with the Physician Managing Ongoing Care Post Fracture |
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125 | (5) |
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Aspirin at Arrival for Acute Myocardial Infarction (AMI) |
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130 | (4) |
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Periperative Care: Timing of Prophylactic Antibiotic-Administering Physician |
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134 | (4) |
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Stroke and Stroke Rehabilitation: Deep Vein Thrombosis Prophylaxis (DVT) for Ischemic Stroke or Intracranial Hemorrhage |
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138 | (4) |
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Stroke and Stroke Rehabilitation: Discharged on Antiplatelet Therapy |
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142 | (4) |
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Stroke and Stroke Rehabilitation: Anticoagulant Therapy Prescribed for Atrial Fibrillation at Discharge |
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146 | (4) |
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Stroke and Stroke Rehabilitation: Tissue Plasminogen Activator (t-PA) Considered |
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150 | (4) |
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Stroke and Stroke Rehabilitation: Screening for Dysphagia |
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154 | (4) |
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Stroke and Stroke Rehabilitation: Consideration of Rehabilitation Services |
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158 | (4) |
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Screening or Therapy for Osteoporosis for Women Aged 65 Years and Older |
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162 | (5) |
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Osteoporosis: Management Following Fracture |
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167 | (7) |
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Osteoporosis: Pharmacologic Therapy |
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174 | (4) |
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Use of Internal Mammary Artery (IMA) in Coronary Artery Bypass Graft (CABG) Surgery |
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178 | (4) |
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Pre-Operative Beta-blocker in Patients with Isolated Coronary Artery Bypass Graft (CABG) Surgery |
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182 | (4) |
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Perioperative Care: Discontinuation of Prophylactic Antibiotics (Cardiac Procedures) |
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186 | (4) |
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Medication Reconciliation |
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190 | (5) |
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195 | (4) |
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Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older |
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199 | (4) |
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Characterization of Urinary Incontinence in Women Aged 65 Years and Older |
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203 | (4) |
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Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older |
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207 | (4) |
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Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation |
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211 | (4) |
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Chronic Obstructive Pulmonary Disease (COPD): Bronchodilator Therapy |
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215 | (4) |
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Asthma: Pharmacologic Therapy |
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219 | (4) |
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Electrocardiogram Performed for Non-Traumatic Chest Pain |
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223 | (4) |
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Electrocardiogram Performed for Syncope |
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227 | (4) |
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Vital Signs for Community-Acquired Bacterial Pneumonia |
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231 | (4) |
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Assessment of Oxygen Saturation for Community-Acquired Bacterial Pneumonia |
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235 | (4) |
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Assessment of Mental Status for Community-Acquired Bacterial Pneumonia |
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239 | (4) |
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Empiric Antibiotic for Community-Acquired Bacterial Pneumonia |
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243 | (4) |
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247 | (4) |
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Appropriate Treatment for Children with Upper Respiratory Infection (URI) |
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251 | (4) |
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Appropriate Testing for Children with Pharyngitis |
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255 | (4) |
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Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow |
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259 | (5) |
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Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy |
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264 | (4) |
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Multiple Myeloma: Treatment with Bisphosphonates |
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268 | (4) |
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Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry |
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272 | (4) |
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Hormonal Therapy for Stage IC-III, ER/PR Positive Breast Cancer |
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276 | (5) |
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Chemotherapy for Stage III Colon Cancer Patients |
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281 | (5) |
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Plan for Chemotherapy Documented Before Chemotherapy Administered |
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286 | (4) |
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Radiation Therapy Recommended for Invasive Breast Cancer Patients Who Have Undergone Breast Conserving Surgery |
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290 | (4) |
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Prevention of Ventilator-Associated Pneumonia-Head Elevation |
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294 | (4) |
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Prevention of Catheter-Related Bloodstream Infections (CRBSI) - Central Venous Catheter Insertion Protocol |
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298 | (4) |
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Assessment of GERD Symptoms in Patients Receiving Chronic Medication for GERD |
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302 | (4) |
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Vascular Access for Patients Undergoing Hemodialysis |
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306 | (4) |
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Influenza Vaccination in Patients with End Stage Renal Disease (ESRD) |
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310 | (4) |
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Plan of Care for ESRD Patients with Anemia |
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314 | (4) |
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Plan of Care for Inadequate Hemodialysis in ESRD Patients |
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318 | (4) |
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Plan of Care for Inadequate Peritoneal Dialysis |
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322 | (4) |
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Testing of Patients with Chronic Hepatitis C (HCV) for Hepatitis C Viremia |
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326 | (4) |
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Initial Hepatitis C RNA Testing |
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330 | (4) |
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HCV Genotype Testing Prior to Therapy |
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334 | (4) |
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Consideration for Antiviral Therapy in HCV Patients |
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338 | (5) |
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HCV RNA Testing at Week 12 of Therapy |
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343 | (4) |
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Hepatitis A and B Vaccination in Patients with HCV |
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347 | (4) |
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Counseling Patients with HCV Regarding Use of Alcohol |
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351 | (4) |
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Counseling of Patients Regarding Use of Contraception Prior to Starting Antiviral Therapy |
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355 | (4) |
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Acute Otitis Externa (AOE): Topical Therapy |
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359 | (4) |
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Acute Otitis Externa (AOE): Pain Assessment |
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363 | (4) |
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Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy---Avoidance of Inappropriate Use |
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367 | (4) |
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Otitis Media with Effusion (OME): Diagnostic Evaluation-Assessment of Tympanic Membrane Mobility |
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371 | (4) |
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Otitis Media with Effusion (OME): Hearing Testing |
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375 | (4) |
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Otitis Media with Effusion (OME): Antihistamines or Decongestants---Avoidance of Inappropriate Use |
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379 | (4) |
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Otitis Media with Effusion (OME): Systemic Antimicrobials---Avoidance of Inappropriate Use |
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383 | (4) |
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Otitis Media with Effusion (OME): Systemic Corticosteroids---Avoidance of Inappropriate Use |
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387 | (4) |
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Breast Cancer Patients Who Have a pT and pN Category and Histologic Grade for Their Cancer |
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391 | (5) |
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Colorectal Cancer Patients Who Have a pT and pN Category and Histologic Grade for Their Cancer |
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396 | (5) |
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Appropriate Intial Evaluation of Patients with Prostate Cancer |
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401 | (4) |
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Inappropriate Use of Bone Scan for Staging Low-Risk Prostate Cancer Patients |
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405 | (5) |
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Review of Treatment Options in Patients with Clinically Localized Prostate Cancer |
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410 | (4) |
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Adjuvant Hormonal Therapy for High-Risk Prostate Cancer Patients |
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414 | (4) |
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Three-dimensional Radiotherapy for Patients with Prostate Cancer |
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418 | (4) |
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Patients who have Major Depression Disorder who meet DSM IV Criteria |
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422 | (5) |
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Patients Who Have Major Depression Disorder Who Are Assessed for Suicide Risks |
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427 | (4) |
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Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis |
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431 | (5) |
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Patients with Osteoarthritis Who Have an Assessment of Their Pain and Function |
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436 | (4) |
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Influenza Vaccination for Patients ≥ 50 Years Old |
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440 | (4) |
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Pneumonia Vaccination for Patients 65 Years and Older |
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444 | (5) |
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449 | (5) |
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Colorectal Cancer Screening |
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454 | (5) |
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Inquiry Regarding Tobacco Use |
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459 | (4) |
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463 | (4) |
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Inappropriate Antibiotic Treatment for Adults with Acute Bronchitis |
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467 | (4) |
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Dilated Eye Exam in Diabetic Patient |
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471 | (5) |
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Angiotensin Converting Enzyme Inhibitor (ACE) or Angiotensin Receptor Blocker (ARB) Therapy for Patients with Coronary Artery Disease and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD) |
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476 | (5) |
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Urine Screening for Microalbumin or Medical Attention for Nephropathy in Diabetic Patients |
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481 | (5) |
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ACE Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy in Patients with CKD |
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486 | (4) |
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Chronic Kidney Disease (CKD): Laboratory Testing (Calcium, Phosphours, Intact Parathyroid Hormone (IPTH) and Lipid Profile) |
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490 | (4) |
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Chronic Kidney Disease (CKD): Blood Pressure Management |
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494 | (4) |
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Chronic Kidney Disease (CKD): Plan of Care: Elevated Hemoglobin for Patients Receiving Erythropoiesis-Stimulating Agents (ESA) |
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498 | (5) |
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HIT - Adoption/Use of Health Information Technology (Electronic Health Records) |
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503 | (5) |
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HIT - Adoption/Use of e-Prescribing |
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508 | (5) |
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Diabetic Foot and Ankle Care, Peripheral Neuropathy: Neurological Evaluation |
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513 | (4) |
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Diabetic Foot and Ankle Care, Ulcer Prevention: Evaluation of Footwear |
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517 | (4) |
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Universal Weight Screening and Follow-Up |
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521 | (5) |
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Universal Influenza Vaccine Screening and Counseling |
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526 | (5) |
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Universal Documentation and Verification of Current Medications in the Medical Record |
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531 | (5) |
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Pain Assessment Prior to Initiation of Patient Treatment |
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536 | (5) |
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Patient Co-Development of Treatment Plan/Plan of Care |
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541 | (6) |
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Screening for Cognitive Impairment |
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547 | (6) |
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Screening for Clinical Depression |
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553 | (5) |
| Appendix A - 2008 Physician Quality Reporting Initiative (PQRI) Glossary of Terms |
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558 | (3) |
| Appendix B - CPT® Category II Codes |
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561 | (17) |
| Appendix C - Summary of Abbreviations and Acronyms |
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578 | (2) |
| Appendix D - Alternative Reporting Periods and Criteria for 2008 PQRI |
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