2021 MIPS Measure #052: Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%) and who have an FEV1 less than 60% predicted and have symptoms who were prescribed an long-acting inhaled bronchodilator

Instructions

This measure is to be submitted a minimum of once per performance period for all COPD patients seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

All patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%), who have an FEV1 < 60% predicted and have symptoms (e.g., dyspnea, cough/sputum, wheezing)

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Spirometry test results demonstrate FEV1/FVC < 70%, FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): G8924

Numerator

Patients who were prescribed a long-acting inhaled bronchodilator

Numerator Note: Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Definition:

Prescribed – Includes patients who were prescribed medication at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.

Numerator Options:

Performance Met:

Long-acting inhaled bronchodilator prescribed (G9695)

OR

Denominator Exception:

Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (G9696)

OR

Denominator Exception:

Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (G9697)

OR

Denominator Exception:

Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (G9698)

OR

Performance Not Met:

Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (G9699)