2021 MIPS Measure #386: Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences

Measure Description

Percentage of patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) who were offered assistance in planning for end of life issues (e.g., advance directives, invasive ventilation, hospice) at least once annually

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of ALS 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. This measure is appropriate for use in outpatient and long term care (e.g., nursing home, ambulatory). For each of these settings, there should be documentation in the medical record(s) that advance care planning was discussed or documented.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

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 with a diagnosis of Amyotrophic Lateral Sclerosis (ALS)

Denominator Criteria (Eligible Cases):

Diagnosis for Amyotrophic Lateral Sclerosis (ICD-10-CM): G12.21, G12.23, G12.24, G12.25

AND

Patient encounter during the performance period (CPT):  99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99345, 99348, 99349, 99350

AND NOT

DENOMINATOR EXCLUSION:

Patient in hospice at any time during the measurement period: G9758

Numerator

Patients who were offered assistance in planning for end of life issues (e.g., advance directives, invasive ventilation, or hospice) at least once annually

Definition:

Assistance with end of life issues – assessment of patient concerns, desires and needs relating to end of life issues. Bases on patient’s disease progression this may include discussions regarding invasive ventilation, advance directives and hospice.

Numerator Options:

Performance Met:

Patient offered assistance with end of life issues during the measurement period (G9380)

OR

Performance Not Met:

Patient not offered assistance with end of life issues during the measurement period (G9382)