CMS Measure ID: #254
Collection Type: CQM
Reporting Frequency: Every visit
Outcome: No
High Priority: No
NQS Domain: Effective Clinical Care
Measure Age: > 2 years
Instructions
This measure is to be submitted each time a pregnant patient presents to the ED with a chief complaint of abdominal pain and/or vaginal bleeding during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide care in the ED will submit this measure. The claim form place of service field must indicate that the encounter has taken place in the ED.
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 pregnant female patients aged 14 to 50 who present to the emergency department (ED) with a chief complaint of abdominal pain or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound to determine pregnancy location
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: Yes
Capped at 7: Yes
Decile 0: 0 – 72.46
Decile 1: 72.47 – 90.12
Minimum: 90.13 – 93.32
Decile 3: 93.33 – 95.87
Decile 4: 95.88 – 97.05
Decile 5: 97.06 – 98.14
Decile 6: 98.15 – 98.92
Decile 7: 98.93 – 99.99
Decile 10: 100 – 100
Denominator
All pregnant female patients aged 14 to 50 who present to the ED with a chief complaint of abdominal pain or vaginal bleeding
Denominator Criteria (Eligible Cases):
Pregnant females aged 14 to 50 on date of encounter
AND
Diagnosis of Other Current Condition in the Mother Classifiable Elsewhere but Complicating Pregnancy, Childbirth, or the Puerperium (ICD-10-CM): O26.891, O26.899, O26.90, O26.91
AND
Diagnosis of Abdominal Pain (ICD-10-CM): R10.0, R10.10, R10.13, R10.2, R10.30, R10.31, R10.32, R10.33, R10.813, R10.814, R10.815, R10.816, R10.817, R10.819, R10.823, R10.824, R10.825, R10.826, R10.827, R10.829, R10.84, R10.9
OR
Diagnosis of Vaginal Bleeding (ICD-10-CM): O20.0, O20.8, O20.9, O44.30, O44.50, O44.31, O44.51, O45.001, O45.009, O45.011, O45.019, O45.021, O45.029, O45.091, O45.099, O45.8X1, O45.8X9, O45.90, O45.91, O46.001, O46.009, O46.011, O46.019, O46.021, O46.029, O46.091, O46.8X1, O46.8X9, O46.90, O46.91, O46.099
AND
Patient has any emergency department encounter during the performance period with Place of Service Indicator 23: G0035
(The claim form Place of Service field must indicate emergency department)
OR
Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
Numerator
Patients who receive a trans-abdominal or trans-vaginal ultrasound with documentation of pregnancy location in medical record
Numerator Instructions:
This measure is to be submitted each time a patient meets the requirements as indicated in the denominator. If the clinician documents that the clinical event surrounding the patient, with or without performance of trans-abdominal or trans-vaginal ultrasound, does not meet the intent of the measure, submit quality-data code G8807.
Numerator Options:
Performance Met:
Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented (G8806)
OR
Denominator Exception:
Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ED multiple times within 72 hours, patient has a documented intrauterine pregnancy [IUP]) (G8807)
OR
Performance Not Met:
Trans-abdominal or trans-vaginal ultrasound not performed, reason not given (G8808)