#435: Quality of Life Assessment For Patients With Primary Headache Disorders

Quality ID

435

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Neurology

Measure Description

Percentage of patients with a diagnosis of primary headache disorder whose health related quality of life (HRQoL) was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved

 

Instructions

This measure is to be submitted at least once per performance period 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 disorder

Denominator Criteria (Eligible Cases):

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

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

At Least Two Visits during the Performance Period

 

Numerator

Patient whose health related quality of life was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved

NUMERATOR NOTE: The two assessments must be separated by at least 90 days for MIDAS and at least 4 weeks for any other tool. It is expected that the QoL score or ranking will stay the same or improve in order for this measure to be successfully completed. Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met: Health-related quality of life assessed with tool during at least two visits and quality of life score remained the same or improved (G9634)

OR

Denominator Exception: Health-related quality of life not assessed with tool for documented reason(s) (e.g., patient has a cognitive or neuropsychiatric impairment that impairs his/her ability to complete the HRQoL survey, patient has the inability to read and/or write in order to complete the HRQoL questionnaire) (G9635)

OR

Performance Not Met: Health-related quality of life not assessed with tool during at least two visits or quality of life score declined (G9636)

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