2021 MIPS Measure #425: Photodocumentation of Cecal Intubation

Measure Description

The rate of screening and surveillance colonoscopies for which photodocumentation of at least two landmarks of cecal intubation is performed to establish a complete examination

Instructions

This measure is to be submitted each time a colonoscopy is performed for patients 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

Patients for whom a screening or surveillance colonoscopy was performed

Denominator Criteria (Eligible Cases):

Patients regardless of age

AND

Patient procedure during the performance period (CPT or HCPCS): 44388, 44389, 44392, 44394, 44404, 45378, 45380, 45381, 45384, 45385, G0105, G0121

WITHOUT

Modifier: 73 or 74

AND NOT

DENOMINATOR EXCLUSION:

Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal resection, etc.): G9613

Numerator

Number of patients undergoing screening or surveillance colonoscopy who have photodocumentation of at least two landmarks of cecal intubation to establish a complete examination

NUMERATOR NOTE: In the instance that the patient has an anatomical/physiological reason for not capturing photodocumentation of two or more of cecal landmarks (i.e., patient has no cecum), it would be appropriate to submit G9613.

Numerator Options:

Performance Met:

Photodocumentation of two or more cecal landmarks to establish a complete examination (G9612)

OR

Performance Not Met:

Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks or only one cecal landmark) to establish a complete examination (G9614)