CMS Measure ID: #205
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 patients with HIV/AIDS seen during the performance period. Only patients who had at least two visits during the performance period, with at least 90 days between each visit will be counted in the denominator for this measure. This measure is intended to reflect the quality of services provided for the primary management of patients with HIV/AIDS.
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 patients aged 13 years and older with a diagnosis of HIV/AIDS for whom chlamydia, gonorrhea, and syphilis screenings were performed at least once since the diagnosis of HIV infection
Denominator
Patients aged 13 and older with a diagnosis of HIV/AIDS who had at least two medical visits during the measurement year, with at least 90 days between each visit
Denominator Criteria (Eligible Cases):
Patients aged ≥ 13 years of age on date of encounter
AND
Diagnosis for HIV/AIDS (ICD-10-CM): Z21, B20
AND
Patient encounters during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, G0402
AND
At Least Two Denominator Eligible Encounters During the Measurement Year, With at Least 90 days Between Each
AND NOT
DENOMINATOR EXCLUSION:
Patients who use hospice services any time during the measurement period: G9725
Numerator
Patients with chlamydia, gonorrhea, and syphilis screenings performed at least once since the diagnosis of HIV infection
NUMERATOR NOTE: Submit G9228 when results are documented for all of the 3 screenings
Numerator Options:
Performance Met:
Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) (G9228)
OR
Denominator Exception:
Chlamydia, gonorrhea, and syphilis screening results not documented (Patient refusal is the only allowed exception) (G9229)
OR
Performance Not Met:
Chlamydia, gonorrhea, and syphilis screening results not documented as performed, reason not given (G9230)