#444: Medication Management for People with Asthma

Quality ID

444

NQF

1799

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Family Medicine Internal Medicine Pediatrics

Measure Description

The percentage of patients 5-64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on for at least 75% of their treatment period

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of persistent asthma 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.

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

Patients 5-64 years of age with persistent asthma and a visit during the measurement period

DENOMINATOR NOTE: *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 registry measures.

Denominator Criteria (Eligible Cases):

Patients aged 5-64 years on date of encounter

AND

Diagnosis for persistent asthma (ICD-10-CM): J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*

AND NOT

DENOMINATOR EXCLUSIONS:

Diagnosis of COPD, Emphysema, Obstructive Chronic Bronchitis, Chronic Respiratory Conditions Due to Fumes/Vapors, Cystic Fibrosis, or Acute Respiratory Failure any time during the patient’s history through the end of the measurement year: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3

OR

Any patients who had no asthma controller medications dispensed during the measurement year: G9808

OR

Patients who use hospice services any time during the measurement period: G9809

 

Numerator

The number of patients who achieved a proportion of days (PDC) of at least 75% for their asthma controller medications during the measurement year

Definition:

PDC- The proportion of days covered by at least one asthma controller medication prescription, divided by the number of days in the treatment period. The treatment period is the period of time beginning on the earliest prescription dispensing date for any asthma controller medication during the measurement year through the last day of the measurement year.

Table MMA-B: Asthma Controller Medications

Description

 

Prescriptions

 

Antiasthmatic combinations

Dyphylline-guaifenesin

Guaifenesin-theophylline

 

Antibody inhibitor

Omalizumab

  

Inhaled steroid combinations

Budesonide-formoterol

Fluticasone-salmeterol

Mometasone-formoterol

Inhaled corticosteroids

Beclomethasone Budesonide

Ciclesonide Flunisolide

Fluticasone CFC free Mometasone

Leukotriene modifiers

Montelukast

Zafirlukast

Zileuton

Mast cell stabilizers

Cromolyn

  

Methylxanthines

Aminophylline

Dyphylline

Theophylline

 

Numerator Options:

Performance Met: Patient achieved a PDC of at least 75% for their asthma controller medication (G9810)

OR

Performance Not Met: Patient did not achieve a PDC of at least 75% for their asthma controller medication (G9811)

 

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