CMS Measure ID: #401
Collection Type: CQM
Reporting Frequency: Once per patient per year
High Priority: No
NQS Domain: Effective Clinical Care
Measure Age: > 2 years
This measure is to be submitted a minimum of once per performance period for all patients with a diagnosis of chronic hepatitis C cirrhosis seen during the performance period. This measure is intended to reflect the quality of services provided for patients with chronic hepatitis C cirrhosis. This measure may be submitted by eligible clinicians or other qualified healthcare professionals who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
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 submissions; however, these codes may be submitted for those registries that utilize claims data.
Percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis who underwent imaging with either ultrasound, contrast enhanced CT or MRI for hepatocellular carcinoma (HCC) at least once within the 12 month submission period
All patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
Diagnosis for chronic hepatitis C (ICD-10-CM): B18.2, B19.20, B19.21
Diagnosis for cirrhosis (ICD-10-CM): K70.30, K70.31, K74.60, K74.69
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215
Patients who underwent abdominal imaging with either ultrasound, contrast enhanced CT or MRI
Patient underwent abdominal imaging with ultrasound, contrast enhanced CT or contrast MRI for HCC (G9455)
Documentation of medical or patient reason(s) for not ordering or performing screening for HCC. Medical reason: Comorbid medical conditions with expected survival <5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons. Patient reasons: Patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment) (G9456)
Performance Not Met:
Patient did not undergo abdominal imaging and did not have a documented reason for not undergoing abdominal imaging in the submission period (G9457)