Measure HM4: Functional Status Change for Patients with Upper-limb Functional Status Deficit

HM4: Functional Status Change for Patients with Upper-limb Functional Status Deficit is a calculated value derived from the completion of the QuickDASH (or Disability of the Arm, Shoulder, and Hand), a patient-reported survey. To complete the QuickDASH, patients use a five-point Likert scale to rate the severity of their symptoms and their ability to perform activities within the last week. Responses range from “1” (not at all, no difficulty) to “5” (extremely, unable). There are 11 questions available with two optional modules for patients whose conditions are impacting their work and/or their ability to play a musical instrument or sport. 

In order to calculate the functional status change for HM4, patients must complete the QuickDash at least twice during their episode of care.  If the QuickDASH surveys are administered on paper, the surveys must be filled out electronically for the risk adjusted MCID calculation.

Note: This measure does not have a benchmark and is capped at 3 points.  

Clinic Settings

We recommend enabling the Show entire OMT questionnaire when clicking on OMT scorebox in Clinic Settings. Enabling this feature displays the full OMT when the score field is selected and requires each question on the OMT to be answered. To learn more about Clinic Settings, click here.

Who can report this measure?

PTs and OTs can report on this measure. 

Important: This is a QCDR Measure. QCDR Measures are not included in the annual QPP measure set and are specific to the submitting QCDR. WebPT has partnered with Healthmonix to make these outcome measures available to you. Learn more about QCDR measures here. 

Measure Type

HM4 is an outcome quality measure and satisfies the outcome measure reporting requirement for PTs and OTs.

Patient Qualifications

  • Patient age (13 or older)
  • Visit Type: Initial Evaluation AND Re-Evaluation and/or Discharge Summary
  • A diagnosis related to the shoulder, elbow, wrist, or hand limb functionality. See the Diagnoses that Trigger Reporting (ICD-10) section below.

When do I report on this measure?

HM4 is tied to note types, not procedure codes (unlike measures in the QPP set). You’ll report this measure on the MIPS tab during a Progress Note/Re-cert/Re-eval if that type of visit occurs, and/or on the Discharge Summary. 

Important: In order to report the measure, you must have completed a survey on the Initial Evaluation.

Measure Requirements

HM4 is measured through the completion of at least two QuickDash surveys by the patient.

  • The first outcome measurement must occur during the Initial Evaluation.
  • Scores captured on Progress Notes (PN) will be used to calculate the MCID where no Discharge (DS) score exists (This ensures that patients who self-discharge can still be reported).

Successful reporting of the measure requires a minimal clinically important difference (MCID) of 18. This means that the patient’s reported scores must decrease by 18 points in order for the Performance Met code to be automatically selected in the reporting tab.

  • You’ll need at least two survey scores to calculate the MCID. 
  • MCID = [Most recent survey score (PN/DS)] - [Score at Initial Evaluation]

Measure Reporting in the WebPT EMR

  1. On the Objective tab, navigate to the Outcome Measurement Tools section and choose Upper Extremity Quick DASH from the ‘Select a questionnaire’ drop-down.

  2. From the Upper Extremity Quick Dash section, click Show Test and complete the survey. If you have staged the survey using one of our intake methods, select the correct survey date and click Get Score. If the survey is completed on paper, the survey must also be completed electronically. Complete documentation (including all appropriate MIPS measures) and finalize the note.

  3. On the patient’s next evaluation (Progress Note/Discharge), navigate to the Objective tab, select Show Test, and complete the OMT. The previous score will remain until it’s replaced. If you have staged the survey using one of our intake methods, select the correct survey date and click Get Score

  4. WebPT will automatically calculate the patient’s MCID and select the appropriate reporting option in the MIPS tab. Important: the measure will only appear on the MIPS tab after the patient has completed the OMT twice.
  5. You’ll be able to see the MIPS reporting option selected when opening the outcome PDF from the patient’s chart. 

MIPS Tab: Reporting Selections

In the MIPS tab, the system will automatically select the measure that best fits your documentation. Remember, if the patient has not seen an improvement of at least 18 points between the Initial Evaluation survey and the Discharge Survey, you will not be able to select the Performance Met code on the MIPS tab. Important: The selection in the MIPS tab will automatically update based on the difference between the Initial Evaluation and the most recently administered survey’s score (whether this is on a Progress Note or Discharge Note).

Below, we’ve indicated which selections meet the performance expectations.

Diagnoses that Trigger Reporting (ICD-10)

Elbow

  • Tendinopathies: M77.0*, M77.1*
  • Humeroulnar dislocation: S53*
  • Cubital tunnel syndrome: G56.2*, S54*
  • Fracture of lower end of humerus: S42.4*
  • Fracture of ulna: S52.0*, S52.2*, S52.6*
  • Fracture of radius: S52.3*, S52.5*
  • +J2Olecranon bursitis: M70.2*
  • Other bursitis: M70.3*
  • Other instability, elbow: M25.32*
  • Other soft tissue disorders related to use, overuse, and pressure of forearm: M70.83*, M70.84*
  • Effusion, elbow: M25.42*
  • Pain in elbow: M25.52*
  • Stiffness of elbow: M25.62*
  • Pain in forearm: M79.63*

Hand

  • Carpal tunnel syndrome: G56.0*
  • Dislocations: S63.0*, S63.1*, S63.2*
  • Tendon disorders: S63.3*, S63.4*, S63.5*, S63.6*, S63.8*, S63.9*
  • Fractures: S62*
  • Crepitant synovitis: M70.0*
  • Bursitis of hand: M70.1*
  • Other soft tissue discorders related to use, overuse and pressure: M70.84*
  • Other instability, hand: M25.34*
  • Effusion, hand: M25.44*
  • Pain in joints of hand: M25.54*
  • Stiffness of hand: M25.64*
  • Pain in hand and fingers: M79.64*

Wrist

  • Other instability, wrist: M25.33*
  • Effusion, wrist: M25.43
  • Pain in wrist: M25.53*
  • Stillness of wrist: M25.63*

Shoulder

  • Adhesive capsulitis of the shoulder: M75.0*
  • Disorder of glanohumeraljoint: M94.21*, S43*
  • Instability: M24.21*, M24.41*, M24.81*, M25.3
  • Labral pathology: S43.43*
  • Rotator cuff syndromes: M75.1*
  • Fracture of clavicle: S42.0*
  • Fracture of humerus: S42.2*, S42.3*
  • Other soft tissue disorders related to use, overuse, and pressure of shoulder: M70.81*
  • Other instability, shoulder: M25.31
  • Effusion, shoulder: M25.41*
  • Pain in shoulder: M25.51*
  • Pain in upper arm: M79.62*
  • Pain in arm: M79.601, M79.602, M79.603
  • Stiffness of Shoulder: M25.61*