#069: Hematology: Multiple Myeloma: Treatment with Bisphosphonates

Quality ID

069

NQF

0380

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

N/A

Measure description

Percentage of patients aged 18 years and older with a diagnosis of multiple myeloma, not in remission, who were prescribed or received intravenous bisphosphonate therapy within the 12 month reporting period

 

Instructions

This measure is to be submitted a minimum of once per performance period for all multiple myeloma (not in remission) patients seen during the performance period. It is anticipated that eligible clinicians who provide services for the patients with the diagnosis of multiple myeloma (not in remission) will submit this measure.

Measure Submission:

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.

 

Denominator

All patients aged 18 years and older with a diagnosis of multiple myeloma, not in remission

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

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for multiple myeloma – not in remission (ICD-10-CM): C90.00, C90.02

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

 

Numerator

Patients who were prescribed or received intravenous bisphosphonate therapy within the 12 month reporting period

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Definitions:

Bisphosphonate Therapy – Includes the following medications: pamidronate and zoledronate.

Prescribed – Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.

Numerator Options:

Performance Met: Bisphosphonate therapy, intravenous, ordered or received (4100F)

OR

Denominator Exception: Documentation of medical reason(s) for not prescribing bisphosphonates (eg, patients who do not have bone disease, patients with dental disease, patients with renal insufficiency) (4100F with 1P)

OR

Denominator Exception: Documentation of patient reason(s) for not prescribing bisphosphonates (4100F with 2P)

OR

Performance Not Met: Bisphosphonate therapy, intravenous, not ordered or received, reason not otherwise specified (4100F with 8P)

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