#334: Adult Sinusitis: More than One Computerized Tomography (CT) Scan Within 90 Days for Chronic Sinusitis (Overuse)

Quality ID

334

High Priority Measure

No

Specifications

Registry

Measure Type

Efficiency

Specialty

Family Medicine Infectious Disease Internal Medicine Otolaryngology

Measure description

Percentage of patients aged 18 years and older with a diagnosis of chronic sinusitis who had more than one CT scan of the paranasal sinuses ordered or received within 90 days after date of diagnosis

 

Instructions

This measure may be submitted based on the actions of the submitting eligible clinician who performs the quality action, described in the measure, based on services provided within measure-specific denominator coding. This measure is to be submitted at each denominator eligible visit for patients with chronic sinusitis 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.

NOTE: Include only patients that have a diagnosis of chronic sinusitis from January 1 to September 30th of the performance period. This will allow the evaluation of 90 days after the diagnosis of chronic sinusitis within the performance period.

Measure Submission:

The listed denominator criteria are 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 chronic sinusitis

Definition:

Chronic Sinusitis/Rhinosinusitis - is defined as twelve (12) weeks or longer of two or more of the following signs and symptoms: mucopurulent drainage (anterior, posterior, or both), nasal obstruction (congestion), facial pain-pressure-fullness, or decreased sense of smell AND inflammation is documented by one or more of the following findings: purulent (not clear) mucus or edema in the middle meatus or ethmoid region, polyps in nasal cavity or the middle meatus, and/or radiographic imaging showing inflammation of the paranasal sinuses.

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for chronic sinusitis (ICD-10-CM): J32.0, J32.1, J32.2, J32.3, J32.4, J32.8, J32.9

AND

Patient encounter during 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

 

Numerator

Patients who had more than one CT scan of the paranasal sinuses ordered or received within 90 days after date of diagnosis

Numerator Instructions:

INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Numerator Options:

Performance Met: More than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given (G9352)

OR

Denominator Exception: More than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (e.g., patients with complications, second CT obtained prior to surgery, other medical reasons) (G9353)

OR

Performance Not Met: One CT scan or no CT scan of the paranasal sinuses ordered within 90 days after the date of diagnosis (G9354)

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