CMS Measure ID: #416
Collection Type: CQM
Reporting Frequency: Every visit
Outcome: No
High Priority: Yes
NQS Domain: Efficiency and Cost Reduction
Measure Age: > 2 years
Instructions
This measure is to be submitted for each denominator eligible visit for patients aged 2 through 17 years who present to the emergency department with a minor blunt head trauma during the performance period. It is anticipated that eligible clinicians who provide care in the emergency department will submit this measure.
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 emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who are classified as low risk according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for traumatic brain injury
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: No
Capped at 7: No
Decile 0: 52.39 – 100
Decile 1: 20.01 – 52.38
Minimum: 13.52 – 20
Decile 3: 7.05 – 13.51
Decile 4: 3.86 – 7.04
Decile 5: 2 – 3.85
Decile 6: 0.01 – 1.99
Decile 10: 0 – 0
Denominator
All emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider*
Definition:
Minor Blunt Head Trauma – Includes only non-penetrating injuries.
DENOMINATOR NOTE: *This measure looks to determine if an emergency care provider ordered head CT services typically provided under CPT code 70450.
Denominator Criteria (Eligible Cases):
Patients aged 2 through 17 years on date of encounter
AND
Diagnosis for minor blunt head trauma (ICD-10-CM): S00.03XA, S00.33XA, S00.431A, S00.432A, S00.439A, S00.531A, S00.532A, S00.83XA, S00.93XA, S06.A0XA, S06.A1XA, S06.0XAA, S06.0X0A, S06.0X1A, S06.0X9A, S06.1XAA, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X9A, S06.2XAA, S06.2X0A, S06.2X1A, S06.2X2A, S06.2X3A, S06.2X4A, S06.2X9A, S06.30AA, S06.300A, S06.301A, S06.302A, S06.303A, S06.304A, S06.309A, S06.31AA, S06.32AA, S06.33AA, S06.34AA, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.349A, S06.35AA, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.359A, S06.36AA, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.369A, S06.37AA, S06.38AA, S06.4XAA, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X9A, S06.5XAA, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X9A, S06.6XAA, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X9A, S06.81AA, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.819A, S06.82AA, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.829A, S06.89AA, S06.890A, S06.891A, S06.892A, S06.893A, S06.894A, S06.899A, S06.9XAA, S06.9X0A, S06.9X1A, S06.9X2A, S06.9X3A, S06.9X4A, S06.9X9A, S09.11XA, S09.19XA, S09.8XXA
AND
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
AND
Patient presented with a minor blunt head trauma and had a head CT ordered for trauma by an emergency care provider: G9594
AND NOT
DENOMINATOR EXCLUSION:
Patient has documentation of ventricular shunt, brain tumor, or coagulopathy: G9595
Numerator
Emergency department visits for patients who are classified as low risk according to the PECARN prediction rules for traumatic brain injury
Definition:
Low Risk for Traumatic Brain Injury according to PECARN predication rules – Patients can be classified as low risk if ALL of the following are met:
• No signs of altered mental status (e.g., agitation, somnolence, repetitive questioning, slow response to verbal communication) OR no GCS < 15
• No signs of basilar skull fracture (signs include haemotympanum, “raccoon” eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign)
• No loss of consciousness
• No vomiting
• No severe mechanism of injury (i.e., motor vehicle crash with patient ejection, death of another passenger, or rollover; pedestrian or bicyclist without helmet struck by a motorized vehicle; falls of more than 5 feet; or head struck by a high-impact object)
• No severe headache
Numerator Instructions:
INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
Numerator Options:
Performance Met:
Pediatric patient with minor blunt head trauma classified as low risk according to the PECARN prediction rules (G9593)
OR
Performance Met:
Pediatric patient with minor blunt head trauma and PECARN prediction criteria are not assessed (G0047)
OR
Performance Not Met:
Pediatric patient with minor blunt head trauma not classified as low risk according to the PECARN prediction rules (G9597)