2024 MIPS Measure #401: Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis

2024 COLLECTION TYPE:

MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process

Description

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.

Instructions

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 Merit-based Incentive Payment System (MIPS) 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 (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

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

AND

Diagnosis for chronic Hepatitis C (ICD-10-CM): B18.2, B19.20, B19.21

AND

Diagnosis for cirrhosis (ICD-10-CM): K70.30, K70.31, K74.60, K74.69

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

Numerator

Patients who underwent abdominal imaging with either ultrasound, contrast enhanced CT or MRI

Numerator Options:

Performance Met: Patient underwent abdominal imaging with ultrasound, contrast enhanced CT or contrast MRI for HCC (G9455)

OR

Denominator Exception: 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)

OR

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)