Measure IROMS 19: Functional Status Change for Patients with Upper-limb Functional Status Deficit

IROMS 19: 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. 

To calculate the functional status change for IROMS 19, 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: 

  • 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 to document IROMS 19 in SOAP 2.0. 

Clinic Settings

We recommend enabling the Show entire OMT questionnaire when clicking on OMT score box 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.

Measure Type

IROMS 19 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 19 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 shoulder, elbow, wrist, or hand limb functionality. 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 QuickDASH on the Initial Evaluation.

Measure Requirements

IROMS 19 is measured through the completion of at least two QuickDASH 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 8. This means that the patient’s reported scores must decrease by 8 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 Upper Extremity Quick DASH from the ‘Select a questionnaire’ drop-down.
  4. 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.

    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. 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)

Elbow Diagnoses Elbow ICD-10 Code Shoulder Shoulder ICD-10 Code
Tendinopathies M77.0*, M77.1* Adhesive capsulitis of the shoulder M75.0*
Humeroulnar dislocation S53* Disorder of glanohumeraljoint M94.21*, S43*
Cubital tunnel syndrome G56.2*, S54* Instability M24.21*, M24.41*, M24.81*, M25.3
Fracture of lower end of humerus S42.4* Labral pathology S43.43*
Fracture of ulna S52.0*, S52.2*, S52.6* Rotator cuff syndromes M75.1*
Fracture of radius S52.3*, S52.5* Fracture of clavicle S42.0*
Olecranon bursitis M70.2* Fracture of humerus S42.2*, S42.3*
Other bursitis M70.3* Other soft tissue disorders related to use, overuse, and pressure of shoulder M70.81*
Other instability, elbow M25.32* Other instability, shoulder M25.31
Other soft tissue disorders related to use, overuse, and pressure of forearm M70.83*, M70.84* Effusion, shoulder M25.41*
Effusion, elbow M25.42* Pain in shoulder M25.51*
Pain in elbow
M25.52* Pain in upper arm M79.62*
Stiffness of elbow
M25.62*
Pain in arm M79.601, M79.602, M79.603
Pain in forearm
M79.63* Stiffness of Shoulder M25.61*
Hand Hand ICD-10 Code Wrist
Wrist ICD-10 Code
Carpal tunnel syndrome G56.0*
Other instability, wrist M25.33*
Dislocations S63.0*, S63.1*, S63.2* Effusion, wrist M25.43
Tendon disorders S63.3*, S63.4*, S63.5*, S63.6*, S63.8*, S63.9* Pain in wrist M25.53*
Fractures S62* Stillness of wrist
Crepitant synovitis M70.0*
Bursitis of hand M70.1*
Other soft tissue disorders 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*
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