High Priority MeasureNo
SpecialtyDermatology Family Medicine Infectious Disease Internal Medicine
Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient’s history to determine if they have had appropriate management for a recent or prior positive test
This measure is to be submitted a minimum of once per performance period for patients with psoriasis and/or psoriatic arthritis and/or rheumatoid arthritis 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.
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.
All patients with a diagnosis of psoriasis and/or psoriatic arthritis and/or rheumatoid arthritis who are on a biologic immune response modifier
DENOMINATOR NOTE: A patient would be considered denominator eligible for Measure #337 for submission purposes, if the patient meets the denominator criteria with diagnosis of psoriasis or psoriatic arthritis or rheumatoid arthritis AND is on a biologic immune response modifier PRESCRIBED BY THE PROVIDER BEING EVALUATED FOR THE MEASURE.
*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 registrybased measures.
Biologic Immune Response Modifier –
1. TNF-alpha inhibitors, to include, but not limited toInfliximab (Remicade), Adalimumab (Humira), Etanercept (Enbrel), or Golimumab (Simponi), Certolizumab (Cimzia).
2. Inhibitors of IL-12 and/or IL-23 or their receptors to include but not limited to Ustekinumab (Stelara).
3. B7 inhibitors, to include but not limited to Abatacept (Orencia).
4. Inhibitors of IL-17 family members or their receptors.
Denominator Criteria (Eligible Cases):
All patients, regardless of age
Diagnosis for psoriasis (ICD-10-CM): L40.0, L40.1, L40.2, L40.3, L40.4, L40.8, L40.9
Diagnosis for psoriatic arthritis (ICD-10-CM): L40.50, L40.51, L40.52, L40.53, L40.54, L40.59
Diagnosis for rheumatoid arthritis (ICD-10-CM): M05.10, M05.111, M05.112, M05.119, M05.121, M05.122, M05.129, M05.131, M05.132, M05.139, M05.141, M05.142, M05.149, M05.151, M05.152, M05.159, M05.161, M05.162, M05.169, M05.171, M05.172, M05.179, M05.19, M05.20, M05.211, M05.212, M05.219, M05.221, M05.222, M05.229, M05.231, M05.232, M05.239, M05.241, M05.242, M05.249, M05.251, M05.252, M05.259, M05.261, M05.262, M05.269, M05.271, M05.272, M05.279, M05.29, M05.30, M05.311, M05.312, M05.319, M05.321, M05.322, M05.329, M05.331, M05.332, M05.339, M05.341, M05.342, M05.349, M05.351, M05.352, M05.359, M05.361, M05.362, M05.369, M05.371, M05.372, M05.379, M05.39, M05.40, M05.411, M05.412, M05.419, M05.421, M05.422, M05.429, M05.431, M05.432, M05.439, M05.441, M05.442, M05.449, M05.451, M05.452, M05.459, M05.461, M05.462, M05.469, M05.471, M05.472, M05.479, M05.49, M05.50, M05.511, M05.512, M05.519, M05.521, M05.522, M05.529, M05.531, M05.532, M05.539, M05.541, M05.542, M05.549, M05.551, M05.552, M05.559, M05.561, M05.562, M05.569, M05.571, M05.572, M05.579, M05.59, M05.60, M05.611, M05.612, M05.619, M05.621, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.9, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.1, M06.20, M06.211, M06.212, M06.219, M06.221, M06.222, M06.229, M06.231, M06.232, M06.239, M06.241, M06.242, M06.249, M06.251, M06.252, M06.259, M06.261, M06.262, M06.269, M06.271, M06.272, M06.279, M06.28, M06.29, M06.30, M06.311, M06.312, M06.319, M06.321, M06.322, M06.329, M06.331, M06.332, M06.339, M06.341, M06.342, M06.349, M06.351, M06.352, M06.359, M06.361, M06.362, M06.369, M06.371, M06.372, M06.379, M06.38, M06.39, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.9
Patient encounter during performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, G0402
Telehealth Modifier: GQ, GT, 95, POS 02
Biologic immune response modifier prescribed: G9506
Patients who have a documented negative annual TB screening or have documentation of the management of a positive TB screening test with no evidence of active tuberculosis, confirmed through use of radiographic imaging (i.e., chest x-ray, CT)
NUMERATOR NOTE: For Denominator Exception(s) , patients are ineligible for this measure if at the time of follow-up there are patient reason(s) for not documenting TB test results (e.g. patient did not return for Mantoux (PPD) skin test evaluation).
Documentation – To satisfy this measure, documentation will incorporate the following:
- Initials of the clinician that prescribed the biologic
- Initials of clinician that administered the TB test
- Initials of the clinician that performed the skin test evaluating the results note in the medical record that results are negative OR that results are positive and is confirmed via results from radiographic imaging (chest x-ray, CT)
If TB test is administered by a provider other than the biologic prescriber, confirmation of the above mentioned must be obtained via letter or other written means from the administering provider.
Performance Met: Documentation of negative or managed positive TB screen with further evidence that TB is not active within one year of patient visit (G9359)
Denominator Exception: Documentation of patient reasons(s) for not having records of negative or managed positive TB screen (e.g., patient does not return for Mantoux (PPD) skin test evaluation) (G9932)
Performance Not Met: No documentation of negative or managed positive TB screen (G9360)