Measure IROMS 13: Functional Status Change for Patients With Lower Extremity Functional Status Deficit

IROMS 13: Functional Status Change for Patients With Lower Extremity Functional Status Deficit is a calculated value derived from the completion of the Lower Extremity Functional Scale (LEFS), a patient-reported survey. To complete the LEFS, patients use a five-point scale to rate the level of difficulty that they associate with 20 activities, including performing usual work, housework, and school activities; putting on shoes and socks; and walking two blocks. To each question, patients respond with either: 

  • Extreme difficulty or unable to perform activity (zero points)
  • Quite a bit of difficulty (one point)
  • Moderate difficulty (two points)
  • A little bit of difficulty (three points)
  • No difficulty (four points)

To calculate the functional status change for IROMS 13, patients must complete the LEFS at least twice during their episode of care. If the LEFS surveys are administered on paper, the surveys must be filled out electronically for the risk adjusted MCID calculation.

Note: 

  • Currently, this measure does not have a benchmark and is capped at 3 points. CMS has indicated that they intend to use 2021 performance data to establish a performance benchmark for this measure, so we anticipate that this measure will be worth up to 10 points for the 2022 reporting period. 

  • This is a guide for SOAP 1.0 measure reporting. Click here to learn how IROMS 13 is documented in SOAP 2.0. 

Clinic Settings

We recommend enabling 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.

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

IROMS 13 is an outcome quality measure and satisfies the outcome measure reporting requirement for PTs and OTs.

Patient Eligibility

Patients who meet any of the criteria below are not eligible to complete IROMS OMTs:

  • Patient has a life expectancy of less than 6 months
  • Patient is non-English speaking and translation services are unavailable
  • Patient has a mental or cognitive impairment that compromises their ability to complete the OMT
  • Patient meets Medicare requirements for maintenance therapy
  • Ongoing care not indicated
  • Patient is extremely medically complex and likely to make poor clinical progress

When do I report on this measure?

IROMS 13 is tied to note types, not procedure codes (unlike measures in the QPP set). You’ll report this measure when the following is true:

  • The patient is 18 years of age or older,
  • The patient has a diagnosis related to their foot, ankle, knee, hip, or pelvis function. See the Diagnoses that Trigger Reporting (ICD-10) section below.
  • The visit type is Initial Evaluation, Re-Evaluation, and/or Discharge
Important To report this measure, you must document the LEFS on the Initial Evaluation.

Measure Requirements

IROMS 13 is measured through the completion of at least two LEFS surveys by the patient. The first outcome measurement must occur during the Initial Evaluation. The next must occur on a Discharge.
Note: 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 Minimum Clinically Important Difference (MCID) of 9. This means that the patient’s reported scores must decrease by 9 points to contribute positively to your MIPS score. After you collect two survey scores, the MCID will be calculated. We partnered with Healthmonix to provide these measures, and they will apply the risk adjustment formula to the MCID score. The risk-adjusted score will be available in your MIPSPro account. 

Measure Reporting in the WebPT EMR

  1. On the Subjective tab, select Yes for Surgery Performed if the patient has recently had surgery directly related to the episode of care. This field is required for accurate measure calculations.
  2. In the Medical History section of the Subjective Tab, use the radio buttons to indicate if your patient is eligible to complete IROMS OMTs. Click here to view patient exclusions and exceptions.
  3. Then, on the Objective tab, navigate to the Outcome Measurement Tools section and choose the Lower Extremity Functional Scale from the ‘Select a questionnaire’ drop-down.

  4. From the Lower Extremity Functional Scale 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.

    Note: If the survey is completed on paper, the survey must also be completed electronically.
  5. Complete documentation (including all appropriate MIPS measures) and finalize the note.
  6. During the patient’s next evaluation (Progress Note/Discharge), go to the Objective tab, select Show Test, and complete the OMT. If you have staged the survey using one of our intake methods, select the correct survey date and click Get Score (See image in step 4). The previous score will remain until it’s replaced.
  7. WebPT will automatically calculate the patient’s MCID and apply the risk adjustment formula. The appropriate option for this measure will be automatically selected on the MIPS tab, and the patient’s score will be visible in your MIPSPro account.
    Important: The measure will only appear on the MIPS tab after the patient has completed the OMT twice.

MIPS Tab Reporting Selections

On the MIPS tab, the system will automatically select the option that best fits your documentation.

A)  You have documented both of the OMTs necessary to calculate the patient’s MCID. The MCID has been calculated, the risk adjustment applied, and is available in your MIPSPro account.

B) Your patient is Excluded from the measure for one of the reasons listed.

C) Your patient is Excepted from this measure for one of the reasons listed.

Diagnoses that Trigger Reporting (ICD-10)

Ankle Diagnosis Ankle ICD-10 Hip Diagnosis Hip ICD-10
Achilles tendinopathy M76.6*, M76.89*
Femoroacetabular impingement M25.85*
Posterior tibialis dysfunction M76.82*, M76.89* Hamstring tendinopathies M67.85*, M70.85*, M76.89*, S76*
Ligament sprain S86.0*, S93.4* Greater trochanteric pain syndrome M70.6*, M70.7*, M76.1*, M76.2*, M25.55*
Fractures of ankle S82.5*, S82.6*, S82.84*, S82.85*, S82.9*
Hip osteoarthritis M16.*
Fractures of fibula S82.4* Hip Arthroplasty Z47.1*, Z96.64*
Repetitive stress injury to musculoskeletal system (ankle-related) M70.87*, M25.37*, M25.47*, M25.57*, M25.67*, M79.67* Fracture of femur S72*
Hip Arthroscopy AfterCare Z47.1 AND appropriate code to indicate HIP
Foot Diagnosis Foot ICD-10 Hip Arthroscopy Z96.64
Plantar fasciitis M72.2 Osteoarthritis of hip M16.*
Hallus valgus M20.1* Repetitive stress injury to musculoskeletal system (hip-related) M70.6*, M70.7*, M70.85*, M25.35*, M25.45, M25.55*, M25.65*, M79.65*
Bunion M21.61* Knee Diagnosis Knee ICD-10
In-toeing Q66.6 Ligamentous injury S83*, M23*
Club foot M21.54*, Q66.0, Q66.89 Meniscal S83.2*, M23.3*
Pes Planus Q66.5*, M21.4 Patellofemoral dysfunction M22.2X1, M22.2X2
Fractures of foot and toes S92* Tendon disorders M76.3*, M76.5*
Knee Arthroplasty Z47.1*, Z96.65*
Pelvis Diagnosis Pelvis ICD-10 Fractures of knee  S82.1*, S82.2*, S82.3*
Sacroiliac dysfunction M53.2X8, M53.88 Knee Arthroscopy AfterCare Z47.1 AND appropriate code to indicate KNEE
Piriformis syndrome G57.0* Knee Arthroscopy Z96.65
Fracture of pelvis S32.3*, S32.4*, S32.5*, S32.6* Osteoarthritis of knee M17.*
Repetitive stress injury to musculoskeletal system (knee-related) M70.4*, M70.5*, M70.86*, M25.36*, M25.46*, M25.56*, M25.66*, M79.66*
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