2021 MIPS Measure #070: Hematology: Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry

Measure Description

Percentage of patients aged 18 years and older, seen within a 12 month reporting period, with a diagnosis of chronic lymphocytic leukemia (CLL) made at any time during or prior to the reporting period who had baseline flow cytometry studies performed and documented in the chart

Instructions

This measure is to be submitted a minimum of once per performance period for all chronic lymphocytic leukemia (CLL) patients seen during the performance period, regardless of when the diagnosis of CLL is made; the quality action being measured is that the baseline flow cytometry study occurred for each patient with CLL at the time of diagnosis or prior to initiating treatment. It is anticipated that eligible clinicians who provide services for patients with the diagnosis of chronic lymphocytic leukemia (not in remission) will submit this measure.

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, seen within a 12 month reporting period, with a diagnosis of chronic lymphocytic leukemia (CLL) made at any time during or prior to the performance period

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs

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

AND

Diagnosis for CLL – not in remission (ICD-10-CM): C91.10, C91.12

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Numerator

Patients who had baseline flow cytometry studies performed and documented in the chart

NUMERATOR NOTE: Denominator Exception(s) are determined at the time of the diagnosis of CLL or prior to initiating treatment.

Definition:

Baseline Flow Cytometry Studies – Refer to testing that is performed at time of diagnosis or prior to initiating treatment for that diagnosis. Treatment may include anti-neoplastic therapy.

Numerator Options:

Performance Met:

Baseline flow cytometry studies performed at time of diagnosis or prior to initiating treatment (3170F)

OR

Denominator Exception:

Documentation of medical reason(s) for not performing baseline flow cytometry studies (3170F with 1P)

OR

Denominator Exception:

Documentation of patient reason(s) for not performing baseline flow cytometry studies (eg, receiving palliative care or not receiving treatment as defined above) (3170F with 2P)

OR

Denominator Exception:

Documentation of system reason(s) for not performing baseline flow cytometry studies (eg, patient previously treated by another physician at the time baseline flow cytometry studies were performed) (3170F with 3P)

OR

Performance Not Met:

Baseline flow cytometry studies not performed at time of diagnosis or prior to initiating treatment, reason not otherwise specified (3170F with 8P)