#419: Overuse Of Neuroimaging For Patients With Primary Headache And A Normal Neurological Examination

Quality ID

419

High Priority Measure

Yes

Specifications

Registry

Measure Type

Efficiency

Specialty

Neurology

Measure description

Percentage of patients with a diagnosis of primary headache disorder whom advanced brain imaging was not ordered

 

Instructions

This measure is to be submitted at each denominator eligible visit for patients with a diagnosis of primary headache 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 submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients with a diagnosis of primary headache

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Diagnosis for Primary Headache (ICD-10-CM): G43.001, G43.009, G43.011, G43.019,G43.101, G43.109, G43.111, G43.119, G43.401, G43.409, G43.411, G43.419, G43.501, G43.509,G43.511, G43.519, G43.701, G43.709, G43.711, G43.B0, G43.B1, G43.C0, G43.C1, G43.801, G43.809,G43.811, G43.819, G43.901, G43.909, G43.911, G43.919, G44.001, G44.009, G44.011, G44.019,G44.021, G44.029, G44.031, G44.039, G44.041, G44.049, G44.051, G44.059, G44.091, G44.099, G44.1, G44.201, G44.209, G44.211, G44.219, G44.221, G44.229, G44.51, G44.52, G44.53, G44.59, G44.81,G44.83, G44.84, G44.85, G44.89

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 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

Patients with a normal neurological examination: G9535

 

Numerator

Patients with a normal neurological examination for whom advanced brain imaging Computed Tomography Angiography (CTA), Computed Tomography (CT), Magnetic Resonance Angiography (MRA), or Magnetic Resonance Imaging (MRI) was NOT ordered

Definition:

Normal Neurological Examination - Absence of signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered cognition), focalneurologic deficits, ataxia, pathologic neurologic reflexes (e.g., Babinski sign, clonus), signs of meningeal irritation

Numerator Options:

Performance Met: Advanced brain imaging (CTA, CT, MRA or MRI) was NOT ordered (G9534)

OR

Denominator Exception: Documentation of Medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); HIV-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms) (G9536)

OR

Denominator Exception: Documentation of System reason(s) for ordering an advanced brain imaging study (i.e., needed as part of a clinical trial; other clinician ordered the study) (G9537)

OR

Performance Not Met: Advanced brain imaging (CTA, CT, MRA or MRI) was ordered (G9538)

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