Physician Quality Reporting Initiative (PQRI) – Screening for Unhealthy Alcohol Use

In 2009, the Centers for Medicare and Medicaid Services (CMS) added a new PQRI measure titled Preventive Care and Screening: Unhealthy Alcohol Use – Screening. It was developed by the Physician Consortium for Performance Improvement. The criterion for the measure requires providers to assess a patient’s use of alcohol using a systematic method of screening on an annual basis. 

The United States Preventive Services Task Force (USPSTF) strongly recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults. The intent of the measure is to identify patients with potential overuse or dependence of alcohol so, though not required to report for this measure, brief counseling interventions may be initiated. It has been found that this type of evaluation has been effective in reducing alcohol use and enhances quality of care. Since alcohol abuse often goes undetected, the measure helps practitioners to identify the patients whose habits may put them at risk for adverse health outcomes.

It is quite common for providers to categorize drinking as social or occasional drinking. However, this may be too vague to fulfill the requirements of this measure. The USPSTF has recommended that providers ask their patients certain questions regarding their alcohol use. The following is an example of information that should be included in the medical record documentation:

• On average, how many days a week do you have an alcoholic drink? __________
• On a typical drinking day, how many drinks do you have? ____________

One of the following three quality codes should be reported on at least 80% of Medicare claims to successfully meet Medicare’s PQRI reporting requirement for this measure:

3016F – Screening for unhealthy alcohol use using a systematic screening method performed

3016F-1P – Medical reason(s) for not screening for unhealthy alcohol use

3016F-8P – Unhealthy alcohol use screening not performed; reason not specified

The resource for the measure can be found at: http://pubs.niaaa.nih.gov/publications/practitioner/cliniciansguide2005/clinicians_guide5_help_p.htm 

Additional information on the PQRI program is located at: http://www.cms.gov/pqri/.

Written By Marianne Russo, CPC, CMC