High Priority MeasureNo
Percentage of patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy with documentation of iron stores within 60 days prior to initiating erythropoietin therapy
This measure is to be submitted a minimum of once per performance period for all myelodysplastic syndrome (MDS) patients seen during the performance period, regardless of when erythropoietin therapy is initiated; the quality action being measured is that iron stores were documented for each MDS patient receiving erythropoietin therapy within 60 days of starting erythropoietin therapy, regardless of how far back the erythropoietin therapy initiated. It is anticipated that eligible clinicians who provide services for patients with the diagnosis of myelodysplastic syndromes will submit this measure.
The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions 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.
All patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures
Erythropoietin Therapy – Includes the following medications: epoetin and darbepoetin for the purpose of this measure.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
Diagnosis for MDS (ICD-10-CM): D46.0, D46.1, D46.20, D46.21, D46.22, D46.4, D46.9, D46.A, D46.B, D46.C, D46.Z
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*
Telehealth Modifier: GQ, GT, 95, POS 02
Patient receiving erythropoietin therapy: 4090F
Patients with documentation of iron stores within 60 days prior to initiating erythropoietin therapy
NUMERATOR NOTE: Denominator Exception(s) are determined during the 60 days prior to initiating erythropoietin therapy.
Documentation of Iron Stores – Includes either: 1) bone marrow examination including iron stain OR 2) serum iron measurement including ferritin, serum iron and total iron-binding capacity (TIBC).
Performance Met: Documentation of iron stores prior to initiating erythropoietin therapy (3160F)
Denominator Exception: Documentation of system reason(s) for not documenting iron stores prior to initiating erythropoietin therapy (3160F with 3P)
Performance Not Met: Iron stores prior to initiating erythropoietin therapy not documented, reason not otherwise specified (3160F with 8P)