Hospital Outpatient Quality Reporting Specifications Manual, v11.0b

For use in submitting data for encounters from 01/01/18 through 12/31/18.

NOTE: Measures OP-25 and OP-26 have been removed from the program beginning with January 1, 2018 encounters. For more information regarding the removal of these measures, please see the 11.0a Release Notes or review the CY 2018 OPPS/ASC Final Rule.

View and/or download individual sections of the Specifications Manual, (PDF documents, unless noted), listed below.

Release Notes, Version 11.0b (12/13/18)
Release Notes, Version 11.0b (10/01/18)
Release Notes, Version 11.0a (03/13/18)
Release Notes, Version 11.0a (11/21/17)
Release Notes, Version 11.0 (06/29/17)

Table of Contents


Program Background
Using the Manual
Outpatient Delivery Settings

Measure Information Form Format Overview

1.1 - Acute Myocardial Infarction (AMI)

AMI Measure Set

AMI General Data Element List
AMI Specific Data Element List
AMI Population Algorithm
Measurement Information Forms and Algorithms
(OP-1, OP-2, OP-3, OP-4, OP-5)

Note: Measurement Information Forms OP-4 and OP-5 are used for both AMI and Chest Pain.

1.2 - Chest Pain (CP)

CP Measure Set

CP General Data Element List
CP Specific Data Element List
CP Population Algorithm
Measurement Information Forms and Algorithms
(OP-4, OP-5)

1.3 - Emergency Department (ED)-Throughput

ED-Throughput Measure Set

ED-Throughput General Data Element List
ED-Throughput Specific Data Element List
ED-Throughput Population Algorithm
Measurement Information Forms and Algorithms
(OP-18, OP-20, OP-22)

1.4 - Pain Management

Pain Management Measure Set

Pain Management General Data Element List
Pain Management Specific Data Element List
Pain Management Population Algorithm
Measurement Information Form and Algorithm

1.5 - Stroke

Stroke Measure Set

Stroke General Data Element List
Stroke Specific Data Element List
Stroke Population Algorithm
Measurement Information Form and Algorithm

1.6 - Imaging Efficiency

OP-8: MRI Lumbar Spine for Low Back Pain

OP-9: Mammography Follow-up Rates

OP-10: Abdomen CT - Use of Contrast Material

OP-11: Thorax CT - Use of Contrast Material

OP-13: Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac Low-Risk Surgery

OP-14: Simultaneous Use of Brain Computed Tomography (CT) and Sinus Computed Tomography (CT)

1.7 - Measures Submitted via a Web-Based Tool

OP-12: The Ability for Providers with HIT to Receive Laboratory Data Electronically Directly into their Office of the National Coordinator for Health Information Technology (ONC) Certified Electronic Health Record (EHR) System as Discrete Searchable Data

OP-17: Tracking Clinical Results Between Visits

OP-27: Influenza Vaccination Coverage Among Healthcare Personnel (Updated 12/13/18)

OP-29: Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

OP-30: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use

OP-31: Cataracts - Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery

OP-33: External Beam Radiotherapy for Bone Metastases (Updated 02/27/18)

1.8 - Outcome Measures

OP-32: Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy (Updated 12/13/18)

OP-35: Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy

OP-36: Hospital Visits after Hospital Outpatient Surgery (Updated 12/13/18)

Data Dictionary and General Abstraction Guidelines

Interpretation of Data Dictionary Terms
Data Dictionary Terms
General Abstraction Guidelines

Alphabetical Data Element List and Data Dictionary

Unable to be Determined (UTD) and Missing/Invalid Values

Data Collection and the UTD Allowable Value
Missing and Invalid Data
Abstraction Software Skip Logic and Missing Data

Population, Sampling and Transmission

Order of Data Flow
Sample Size Requirements
Sampling Approaches
Transmission of Outpatient Population and Sample Data Elements
Introduction and Guidelines for Submission of Data
Transmission Data Element List and Transmission Data Element Pages
Transmission Data Processing Flow

Hospital Outpatient Clinical Data XML File Layout

Hospital Outpatient Population Data XML File Layout

Tools and Resources Table of Contents
Arrival Time Guidelines
Departure Time Guidelines

Reason for Delay in Fibrinolytic Therapy Guidelines

OP-29 and OP-30 Tool

OP-29 Algorithm

OP-29 Denominator Codes

OP-29 Fact Sheet

OP-30 Algorithm

OP-30 Denominator Codes

OP-30 Fact Sheet

OP-31 Cataracts Improvement After Surgery

OP-33 Algorithm

OP-33 Fact Sheet

A - ICD-10-CM Diagnosis and CPT Code Tables

Q4 Encounters (10/01/18-12/31/18): XLSX or PDF
Q1 through Q3 Encounters (01/01/18-09/30/18): XLSX or PDF (Updated 02/20/19)

B - Glossary of Terms, PDF

C - Medication Tables, XLSX or PDF

D - Preview Section, PDF

Download Entire Manual, PDF or ZIP (Updated 02/21/19)

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