#410: Psoriasis: Clinical Response to Oral Systemic or Biologic Medications

Quality ID

410

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Dermatology

Measure description

Percentage of psoriasis vulgaris patients receiving oral systemic or biologic therapy who meet minimal physician-or patient- reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment.

 

Instructions

This measure is to be submitted a minimum of once per performance period for all patients 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 with a diagnosis of psoriasis vulgaris and treated with an oral systemic or biologic medication

DENOMINATOR NOTE: A patient would be considered denominator eligible for Measure #410 for submission purposes, if the patient meets the denominator criteria with a diagnosis of ONLY psoriasis vulgaris (L40.0) AND is on an oral systemic or biologic medication 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.

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Diagnosis for psoriasis vulgaris (ICD-10-CM): L40.0

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0438, G0439

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Patient has been treated with an oral systemic or biologic medication for psoriasis vulgaris: G9764

 

Numerator

Patients who have a documented physician global assessment (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI) that meet any one of the below specified benchmarks

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter if there are patient or medical reason(s) for not meeting specified benchmarks (e.g. patient declined therapy change, patient experience adverse effects, etc.) as further specified below.

Definition:

Consecutive Months - The consecutive treatment allows gaps in the medication treatment up to a total of 4 weeks during the 6 month period. Gaps can include periods in which the patient is changing or refilling medication, but regardless of the number of gaps, the total cannot be for more than 4 weeks.

Numerator Instructions:

To satisfy this measure, a patient must achieve any ONE of the following:

  • PGA (6-point scale) ≤ 2 (clear to mild skin disease)
  • BSA < 3% (mild disease)
  • PASI < 3 (no or minimal disease)
  • DLQI ≤ 5 (no effect or small effect on patient’s quality of life)

Numerator Options:

Performance Met: Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index) (DLQI)) (G9649)

OR

Denominator Exception: Documentation that the patient declined therapy change or alternative therapies were unavailable, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI (G9765)

OR

Performance Not Met: Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index) (DLQI)) or psoriasis assessment tool not documented (G9651)

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