Code sets

For the updated code sets to be used for each measure, reference the National Library of Medicine Value Set Authority Center 

Clinical quality measures

Tobacco use: screening and cessation intervention

Patients 18 and older with at least two encounters who were screened during the reporting period and received tobacco cessation intervention during the reporting period, or 6 months before the reporting period, will be counted in this measure. 

Numerator 1:

Patients who were screened for tobacco use at least once during the measurement period

Numerator 2:

Patients who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period

Numerator 3:

Patients who were screened for tobacco use at least once during the measurement period AND who received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period if identified as a tobacco user

The smoking status should be recorded in the Social History section of the encounter, and the accepted procedure code(s) for tobacco cessation or counseling should be recorded for smokers. Patients who are in hospice for any part of the reporting period should be excluded. 

CMS138v11 Code Set

Childhood immunization status

Patients 2 years old with at least one encounter recorded will be counted in this measure. Vaccines should be recorded in the Immunization section of the encounter or directly on the patient dashboard. Illnesses should be documented in the Problems section of the encounter or directly on the patient dashboard. Test results should be recorded in the Results section of the patient dashboard. Allergic reactions to a vaccine should be recorded in the Allergies section of the patient dashboard. Patients who are in hospice care for any part of the reporting period should be excluded. In addition, patients with severe combined immunodeficiency, immunodeficiency, HIV, lymphoreticular cancer, multiple myeloma or leukemia, or intussusception on or before the child’s second birthday should also be excluded. 

CMS117v11 Code Set

Chlamydia screening for women

Female patients aged 16-24 by the end of the reporting period, with at least one encounter recorded on the patient chart, or an appropriate diagnosis, lab result, procedure, or medication order recorded during the reporting period, will be counted in this measure. The patient must have indicated they are sexually active with the proper Dx code documented. Of those patients, a lab result for Chlamydia screening must be recorded in the Results section of the patient dashboard.  

CMS153v11 Code Set

Weight assessment and counseling for nutrition and physical activity for children/adolescents

Patients aged 3-17 by the end of the reporting period, with at least one outpatient visit recorded on the patient chart during the reporting period with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN), will be counted in this measure. 

Numerator 1:

Height, Weight and body mass index (BMI) must be recorded in the Vitals tab of the patient chart. 

Numerator 2:

CPT code for nutrition counseling must be recorded in the Procedures tab of the patient chart during the reporting year.  

Numerator 3:

CPT code for physical activity counseling must be recorded in the Procedures tab of the  patient chart during the reporting year.  

The patient will be excluded if they have a diagnosis of pregnancy during the reporting period.

CMS155v11 Code Set

Preventive care and screening: body mass index (BMI) screening and follow-up plan

Patients 18 or older with at least one encounter recorded on the patient chart during the reporting period will be counted in this measure. Height, weight and body mass index (BMI) must be recorded in the Vitals tab, along with the appropriate CPT code in the Procedures tab. Also, a follow-up plan must be documented on an encounter with the proper CPT codes if the most recent BMI was outside of normal parameters (Normal Parameter is between 18.5 and 25). The patient will be excluded if they have a pregnancy diagnosis recorded in the Problems tab of the patient dashboard or if they received hospice or palliative care at any time during the reporting period.

CMS69v11 Code Set

Documentation of current medications in the medical record

Patients 18 or older with at least one encounter recorded during the reporting period will be counted in this measure. Medications must be recorded in the Current tab on the patient dashboard. Eligible clinician attests to documenting, updating, or reviewing the patient's current medications using all immediate resources available on the date of the encounter.

CMS68v12 Code Set

Follow-up care for children prescribed ADHD medication (ADD) 

RXNT Instructions: Patients aged 6-12 as of the Intake Period, who were prescribed an ADHD medication during the Intake Period will be counted in this measure. Two rates are reported:

Numerator 1:

Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase

Numerator 2:

Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the 31-300 days after the IPSD

The patient will be excluded if narcolepsy is recorded in the Problems tab of the patient chart or if the patient is in hospice care for any part of the measurement period.

CMS136v12 Code Set

Preventive care and screening: influenza immunization

Patients aged 6 months and older seen for a visit between October 1 and March 31 with at least one encounter recorded on the patient chart during the reporting period, or the patient has Hemodialysis or Peritoneal Dialysis recorded in the Procedures tab, will be counted in this measure. The influenza vaccine must be recorded in the Immunization tab or the appropriate code must be  recorded in the Procedures tab of the patient dashboard. Those who received an influenza immunization, OR who reported previous receipt of an influenza immunization between July 1 of the year prior to the reporting period to June 30 of the reporting period, will be counted. The patient will be excluded if they are in hospice care for any part of the reporting period. 

CMS147v12 Code Set

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