#278: Sleep Apnea: Positive Airway Pressure Therapy Prescribed

Quality ID

278

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Otolaryngology

Measure description

Percentage of patients aged 18 years and older with a diagnosis of moderate or severe obstructive sleep apnea who were prescribed positive airway pressure therapy

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of sleep apnea 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-based 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 sleep apnea

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for sleep apnea (ICD-10-CM): G47.30, G47.33

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Moderate or severe obstructive sleep apnea (apnea hypopnea index (AHI) or respiratory disturbance index (RDI) of 15 or greater): G8846

 

Numerator

Patients who were prescribed positive airway pressure therapy

Definition:

Moderate or severe sleep apnea - apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) greater than or equal to 15 episodes per hour of sleep

Numerator Options:

Performance Met: Positive airway pressure therapy prescribed (G8845)

OR

Denominator Exception: Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies used, patient declined, financial, insurance coverage) (G8849)

OR

Performance Not Met: Positive airway pressure therapy not prescribed, reason not given (G8850)

 

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