#279: Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy

Quality ID

279

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Otolaryngology

Measure description

Percentage of visits for patients aged 18 years and older with a diagnosis of obstructive sleep apnea who were prescribed positive airway pressure therapy who had documentation that adherence to positive airway pressure therapy was objectively measured

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with 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

Positive airway pressure therapy was prescribed: G8852

 

Numerator

Patient visits with documentation that adherence to positive airway pressure therapy was objectively measured

Definition:

Objectively Measured is defined as – positive airway pressure machine-generated measurement of hours of use.

Numerator Options:

Performance Met: Objective measurement of adherence to positive airway pressure therapy, documented (G8851)

OR

Denominator Exception: Documentation of reason(s) for not objectively measuring adherence to positive airway pressure therapy (e.g., patient didn’t bring data from continuous positive airway pressure [CPAP], therapy not yet initiated, not available on machine) (G8854)

OR

Performance Not Met: Objective measurement of adherence to positive airway pressure therapy not performed, reason not given (G8855)

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