2021 MIPS Measure #185: Colonoscopy Interval for Patients with a History of Adenomatous Polyps– Avoidance of Inappropriate Use

Measure Description

Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior adenomatous polyp(s) in previous colonoscopy findings, which had an interval of 3 or more years since their last colonoscopy

Instructions

INSTRUCTIONS:

This measure is to be submitted each time a surveillance colonoscopy is performed during the performance period. It is anticipated the eligible clinician who performs the listed procedures, as specified in the denominator coding, will submit on this measure. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73 or 74 will not qualify for inclusion into 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 s 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 receiving a surveillance colonoscopy, with a history of a prior adenomatous polyp(s) in previous colonoscopy findings

Denominator Instructions: Eligible clinicians who indicate that the colonoscopy procedure is incomplete or was discontinued should use the procedure number and the addition (as appropriate) of modifier 52, 53, 73, or 74. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into this measure.

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

AND

Diagnosis for history of adenomatous (colonic) polyp(s) (ICD-10-CM): Z86.010

AND

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

WITHOUT

Modifiers: 52, 53, 73 or 74

Numerator

Patients who had an interval of 3 or more years since their last colonoscopy

Numerator Options:

Performance Met:

Interval of 3 or more years since patient’s last colonoscopy, documented (0529F)

OR

Denominator Exception:  

Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [Crohn’s disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer]) (0529F with 1P)

OR

Denominator Exception:

Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, previous colonoscopy report was incomplete) (0529F with 3P)

OR

Performance Not Met:

Interval of less than 3 years since patient’s last colonoscopy, reason not otherwise specified (0529F with 8P)