2023 # 050 Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older

CMS Measure ID: #50

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: Yes

NQS Domain: Person and Caregiver-Centered Experience Outcomes

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure is appropriate for use in the ambulatory setting only. It is anticipated that eligible clinicians who provide services for patients with the diagnosis of urinary incontinence will submit this measure.

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:

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 for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of female patients aged 65 years and older with a diagnosis of urinary incontinence with a documented plan of care for urinary incontinence at least once within 12 months

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 0 – 1.69
Decile 1: 1.7 – 46.95
Minimum: 46.96 – 68.24
Decile 3: 68.25 – 75.17
Decile 4: 75.18 – 80.61
Decile 5: 80.62 – 83.79
Decile 6: 83.8 – 88.45
Decile 7: 88.46 – 96.96
Decile 8: 96.97 – 99.99
Decile 10: 100 – 100

Denominator

All female patients aged 65 years and older with a diagnosis of urinary incontinence

Denominator Criteria (Eligible Cases):

All female patients aged ≥ 65 years on date of encounter

AND

Diagnosis for urinary incontinence (ICD-10-CM): F98.0, N39.3, N39.41, N39.42, N39.43, N39.44, N39.45, N39.46, N39.490, N39.491, N39.492, N39.498, R32

AND

Patient encounter during the performance period (CPT or HCPCS): 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, G0402

AND NOT

DENOMINATOR EXCLUSION:

Hospice services utilized by patient any time during the measurement period: G9694

Numerator

Patients with a documented plan of care for urinary incontinence at least once within 12 months

Definition:

Plan of Care – May include behavioral interventions (e.g., bladder training, pelvic floor muscle training, prompted voiding), referral to specialist, surgical treatment, reassess at follow-up visit, lifestyle interventions, addressing co-morbid factors, modification or discontinuation of medications contributing to urinary incontinence, or pharmacologic therapy.

Numerator Options:

Performance Met:

Urinary incontinence plan of care documented (0509F)

OR

Performance Not Met

Urinary incontinence plan of care not documented, reason not otherwise specified (0509F with 8P)