PQRI Data Collection Sheets

To insure that the performance measures for the Physician Quality Reporting Initiative are reported for each eligible patient when the claim is submitted for services provided, the AAFP has developed tools to help you collect the performance measures data at the time of service. As the three measures related to diabetes are of high interest in family medicine, we have provided one set of tools which includes only the measures related to diabetes.

If you prefer to report on measures other than diabetes, there are 27 applicable measures for family medicine. We have developed a second set in an Excel workbook, which you can save and customize to your specifications by deleting all measures except those that you will report.

Each set of tools includes a Physician’s Data Collection Sheet and a Coder’s Data Collection Sheet. Depending on your practice’s workflow and staffing, you may choose to use one or both tools to assist with your reporting of the appropriate measures and selection of the correct CPT Category II codes and modifiers.

The Physician Data Collection Sheet includes the following:

Front desk or nursing staff should place this sheet on the front of the charts for eligible patients prior to their visit. For each measure, the reporting options are listed in rows with the first column providing a place for the physician to initial indicating what is to be reported for the patient.

The Coder’s Data Collection Sheet provides a quick reference and verification tool for coders and charge entry staff. When laid on top of the Physician’s Data Collection Sheet, the rows will align, allowing for quick code verification. This sheet also includes the following: