#275: Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy

Quality ID

275

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Gastroenterology Infectious Disease

Measure description

Percentage of patients with a diagnosis of inflammatory bowel disease (IBD) who had Hepatitis B Virus (HBV) status assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy

 

Instructions

This measure is to be submitted a minimum of once per performance period for all patients with a diagnosis of inflammatory bowel disease seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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, regardless of age, with a diagnosis of inflammatory bowel disease who initiated an anti-TNF agent

Definitions:

Patient receiving an anti-TNF agent - May include but is not limited to the following HCPCS codes: C9249, J0717, J0718, J0135, J1602, J1745, Q5102, S9359 or CPT codes: G8869, 86317, 86704, 86706, 90636, 90723, 90744, 90745, 90746, 90747, 90748

Denominator Criteria (Eligible Cases):

All Patients, regardless of age

AND

Diagnosis for inflammatory bowel disease (ICD-10-CM): K50.00, K50.011, K50.012, K50.013, K50.014, K50.018, K50.019, K50.10, K50.111, K50.112, K50.113, K50.114, K50.118, K50.119, K50.80, K50.811, K50.812, K50.813, K50.814, K50.818, K50.819, K50.90, K50.911, K50.912, K50.913, K50.914, K50.918, K50.919, K51.00, K51.011, K51.012, K51.013, K51.014, K51.018, K51.019, K51.20, K51.211, K51.212, K51.213, K51.214, K51.218, K51.219, K51.30, K51.311, K51.312, K51.313, K51.314, K51.318, K51.319, K51.40, K51.411, K51.412, K51.413, K51.414, K51.418, K51.419, K51.50, K51.511, K51.512, K51.513, K51.514, K51.518, K51.519, K51.80, K51.811, K51.812, K51.813, K51.814, K51.818, K51.819, K51.90, K51.911, K51.912, K51.913, K51.914, K51.918, K51.919

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99406, 99407

AND

Patient receiving an anti-TNF agent (HCPCS): G9914

 

Numerator

Patients who had HBV status assessed and results interpreted prior to initiating anti-TNF therapy

Numerator Instructions: HBV status must be assessed by one of the following: HBsAG, HBsAG neutralization, HBcAb total, HBsAB.

Numerator Options:

Performance Met: Hepatitis B Virus (HBV) status assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy (G9912)

OR

Performance Met: Patient has documented immunity to hepatitis B and initiating anti-TNF therapy (G8869)

OR

Denominator Exception: Documented reason for not assessing Hepatitis B Virus (HBV) status (e.g. patient not initiating anti-TNF therapy, patient declined) prior to initiating anti-TNF therapy (G9504)

OR

Performance Not Met: Hepatitis B Virus (HBV) status not assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy, reason not otherwise specified (G9913)

OR

Performance Not Met: No record of HBV results documented (G9915)

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