MIPS Clinical Quality Measures (CQMS)
MEASURE TYPE: Process – High Priority
Description
Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of prior adenomatous polyp(s) in previous colonoscopy findings, which had an interval of 3 or more years since their last colonoscopy.
Instructions
This measure is to be submitted each time a surveillance colonoscopy is performed during the performance period. It is anticipated the Merit-based Incentive Payment System (MIPS) 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 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:
MIPS 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
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02, POS 10
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, or sessile serrated polyps ≥ 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. Crohn’s disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes]) (G9998)
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) (G9999)
OR
Performance Not Met: Interval of less than 3 years since patient’s last colonoscopy, reason not otherwise specified (0529F with 8P)
Stay updated with the latest news regarding MACRA and MIPS
The Healthmonix Advisor is a free news source that connects you to the latest in the value-based care industry!