CMS Measure ID: #52
Collection Type: CQM
Reporting Frequency: Once per patient per year
Outcome: No
High Priority: No
NQS Domain: Effective Clinical Care
Measure Age: > 2 years
Instructions
This measure is to be submitted a minimum of once per performance period for all COPD patients seen 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:
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 submissions; however, these codes may be submitted for those registries that utilize claims data.
Description
Percentage of patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%) and who have an FEV1 less than 60% predicted and have symptoms who were prescribed an long-acting inhaled bronchodilator
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: Yes
Capped at 7: Yes
Decile 0: 0 – 8.49
Decile 1: 8.5 – 58.43
Minimum: 58.44 – 72.16
Decile 3: 72.17 – 88.53
Decile 4: 88.54 – 97.25
Decile 5: 97.26 – 99.99
Decile 10: 100 – 100
Denominator
All patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%), who have an FEV1 < 60% predicted and have symptoms (e.g., dyspnea, cough/sputum, wheezing)
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9
AND
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99424, 99426
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
AND
Spirometry test results demonstrate FEV1/FVC < 70%, FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): G8924
Numerator
Patients who were prescribed a long-acting inhaled bronchodilator
Definition:
Prescribed – Includes patients who were prescribed medication at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.
Numerator Options:
Performance Met:
Long-acting inhaled bronchodilator prescribed (G9695)
OR
Denominator Exception:
Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (G9696)
OR
Denominator Exception:
Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (G9697)
OR
Denominator Exception:
Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (G9698)
OR
Performance Not Met:
Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (G9699)