Measure IROMS 19: Functional Status Change for Patients with Upper-limb Functional Status Deficit (SOAP 2.0)

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 2.0 measure reporting. Click here for the SOAP 1.0 guide. 
  • 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.

Who can report this measure? 

PTs and OTs can report on this measure.

Measure Type

IROMS 19 is an outcome quality measure and satisfies the outcome measure reporting requirement for PTs and OTs. nd

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). 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
Note: To report this measure, you must select the QuickDASH as the Primary OMT on the Initial Evaluation.

Measure Requirements

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

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 when a patient is present. 

Note: Scores captured on Progress Notes (PN) will be used to calculate the MCID where no Discharge score exists (This ensures that patients who self-discharge can still be reported).

Initial Exam

  1. In the Patient Presentation section of an Initial Evaluation, select Yes or No to indicate if the patient’s episode of care is directly related to a recent surgery. Based on the answer selected, the Date of Surgery or Date of Injury/Onset will be required for accurate measure calculations.
  2. In the Past Medical History section, select if the patient is eligible to complete IROMS OMT’s. Click here to view patient exclusions and exceptions.
  3. In the Standardized Tests section of the note, click QuickDASH (Disabilities of the Arm, Shoulder, and Hand) to add the test to the note.
    Note:
    • If the triggering diagnosis codes are added to the patient case before the Initial Evaluation is opened, all eligible MIPS tests will preload in the section.
    • If you have administered the test using one of our Outcomes Intake methods, click here to learn how to add the test to the note. If the survey is completed on paper, the survey must also be documented electronically. 
  4. Administer the questionnaire and complete the QuickDASH by using the drop-down menus. The Disability/Symptom Score is automatically calculated.
  5. Complete documentation (including all appropriate MIPS measures) and finalize the note.
  6. If you have administered more than one OMT, you will be prompted to select the Primary OMT before note finalization. To report IROMS 19, select QuickDASH as the primary OMT.
    Note: The Primary OMT selected on the Initial Evaluation is the Primary OMT for future evaluative notes in this case. To select a different Primary OMT on a future evaluation, you must add an addendum to the Initial Evaluation first.

Discharge/Progress Note

  1. On the patient’s next evaluation, navigate to the Objective section and click Standardized Tests.

  2. The previous score will remain until it’s replaced. Re-administer the QuickDASH and use the drop-down menus to document the OMT. 

    Note: If you have administered the test using one of our Outcomes Intake methods, click here to learn how to add the test to the note. If the survey is completed on paper, the survey must also be documented electronically.
  3. Complete documentation (including all appropriate MIPS measures) and finalize the note.

Measure Status Section

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. The Measure Status section will indicate if the patient is excluded or excepted from the measure, and the reason why based on the documentation on the IE.

Important: The measure will only appear as excluded on the MIPS drawer after the IROMS eligibility questions is added to a Progress Note. Measure Met will only appear if the patient has completed the OMT twice.

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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