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Instructions for Use of the PQRI Coding Tool for Diabetes Measures Group Template

This one-page document is a coding tool for reporting the appropriate quality measure codes found in the PQRI Diabetes Measures Group. It lists the 5 individual quality measures that comprise the Diabetes Measures Group and highlights the code that is to be included on the claim form for the first patient in the group to indicate your intent to report on 15 consecutive Medicare beneficiaries with diabetes. To use this tool, follow these instructions:

  • Print this Word document
  • Place these forms in patient examination rooms or, if you are a paper-based practice, attach a blank copy of the form to the chart of each Medicare beneficiary you are scheduled to see on a particular day
  • When seeing a beneficiary who has diabetes:
    • Put the patient's name, record number, and date of encounter in the appropriate area on the upper right corner of the form
    • Circle the appropriate code for each quality measure in the group
    • Submit this form to your billing staff for reporting of the quality measure codes on the claim form that will be submitted to bill for the encounter

Feel free to modify this form to suit the needs of your office and staff.

Click here to download the PQRI Diabetes Measures Group Coding Tool