2024 MIPS Measure #496: Cardiovascular Disease (CVD) Risk Assessment Measure – Proportion of Pregnant/Postpartum Patients that Receive CVD Risk Assessment with a Standardized Instrument

2024 COLLECTION TYPE:

MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process

Description

Percentage of pregnant or postpartum patients who received a cardiovascular disease (CVD) risk assessment with a standardized instrument.

‌Instructions

This measure is to be submitted a minimum of once per performance period for all patients seen for pregnancy or postpartum care during the performance period. This measure is intended to reflect the quality of services provided for pregnant and postpartum patients. 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.

NOTE: The aim of this measure is that 100 percent of eligible pregnant/postpartum patients undergo CVD risk assessment using a standardized tool. Every patient should be assessed for CVD risk at least once and as needed, additional times if symptoms present during the pregnancy postpartum period.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.

‌Measure Submission Type

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. 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 by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

‌Denominator

Patients who have an office visit for prenatal or postpartum care, regardless of gestational age or prior prenatal care at other sites, for any age (including pregnant and postpartum minors), within outpatient obstetric (OB) visit at the hospital or in affiliated clinics; and labor and delivery (L&D)

Definition:

Not eligible for a cardiovascular disease (CVD) risk assessment with a standardized instrument – Patients with a prior history of known CVD. For the purposes of this measure, prior history of known CVD, is represented by code M1256.

The following codes would be sufficient to define CVD (ICD-10-CM): I05.2, I20.9, I21.09, I21.3, I21.B, I24, I24.0, I24.1, I24.81, I24.89, I24.9, I25.10, I25.42, I25.2, I25.84, I25.85, I25.9, I27, I27.0, I27.1, I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.81, I27.82, I27.83, I27.89, I27.9, I34, I34.0, I34.1, I34.2, I34.81, I34.89, I34.9, I35, I35.0, I35.1, I35.2, I35.8, I35.9, I36, I36.0, I36.1, I36.2, I36.8, I36.9, I37, I37.0, I37.1, I37.2, I37.8, I37.9, I38, I42.0, I42.2, I42.8, I45, I45.0, I45.10, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81, I45.89, I45.9, I47.1, I47.10, I47.11, I47.19, I47.2, I47.20, I47.21, I47.29, I48.91, I48.92, I49.1, I49.3, I49.8, I49.9, I50.30, I50.9, I77.810, I97.190, M30.3, O90.3, O99.411, O99.412, O99.413, O99.419, Q20.0, Q20.1, Q20.3, Q20.4, Q20.8, Q21.0, Q21.20, Q21.3, Q22.1, Q23.0, Q23.2, Q24.5, Q25.0, Q25.1, Q25.44, Q25.5, Q25.6, Q26.3, Q87.40, Q87.89, Z82.49, Z86.79, Z87.74, Z86.79, Z87.74

DENOMINATOR NOTE: The intent of the measure is to have all pregnant and/or postpartum patients undergo CVD risk assessment at least once during the pregnancy episode.

Denominator Criteria (Eligible Cases):

All patients regardless of age

AND

Diagnosis for Pregnancy or Postpartum (ICD-10-CM): Z37, Z37.0, Z37.1, Z37.2, Z37.3, Z37.4, Z37.5, Z37.50, Z37.51, Z37.52, Z37.53, Z37.54, Z37.59, Z37.6, Z37.60, Z37.61, Z37.62, Z37.63, Z37.64, Z37.69, Z37.7, Z37.9

AND

Encounter for pregnancy (CPT): 59400, 59409, 59410, 59412, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620

OR

Patient visits during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239

Denominator Exclusions:

Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an OB provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere): M1255

OR

Prior history of known CVD: M1256

Numerator

Patients who are assessed for CVD risk via California Maternal Quality Care Collaborative (CMQCC) standardized algorithm. A completed CVD risk assessment will determine the patient to be at low risk or high risk of CVD. Patients will be assessed at their initial encounter with their healthcare provider for pregnancy-related care [prenatal visit, L&D, postpartum visit] and may need to repeat assessments if new symptoms develop.

Definition:

CMQCC CVD risk assessment algorithm is an example of a standardized CVD risk assessment algorithm. This is currently the only pregnancy specific algorithm. The CMQCC CVD risk assessment tool kit can be found at https://www.cmqcc.org/resources-toolkits/toolkits/improving-health-care-response-cardiovascular-disease-pregnancy-and.

Numerator Options:

Performance Met: CVD risk assessment performed, have a documented calculated risk score (M1258)

OR

‌Performance Not Met: CVD risk assessment not performed or incomplete (e.g., CVD risk assessment was not documented), reason not otherwise specified) (M1257)