Measure Description
Percentage of patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy with documentation of iron stores within 60 days prior to initiating erythropoietin therapy
Instructions
This measure is to be submitted a minimum of once per performance period for all myelodysplastic syndrome (MDS) patients seen during the performance period, regardless of when erythropoietin therapy is initiated; the quality action being measured is that iron stores were documented for each MDS patient receiving erythropoietin therapy within 60 days of starting erythropoietin therapy, regardless of how far back the erythropoietin therapy initiated. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide services for patients with the diagnosis of myelodysplastic syndromes will submit this measure.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy
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 MIPS CQMs.
Definition:
Erythropoietin Therapy – Includes the following medications: epoetin and darbepoetin for the purpose of this measure.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for MDS (ICD-10-CM): D46.0, D46.1, D46.20, D46.21, D46.22, D46.4, D46.9, D46.A, D46.B, D46.C, D46.Z
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
AND
Patient receiving erythropoietin therapy: 4090F
Numerator
Patients with documentation of iron stores within 60 days prior to initiating erythropoietin therapy
NUMERATOR NOTE: Denominator Exception(s) are determined during the 60 days prior to initiating erythropoietin therapy.
Definition:
Documentation of Iron Stores – Includes either: 1) bone marrow examination including iron stain OR 2) serum iron measurement including ferritin, serum iron and total iron-binding capacity (TIBC).
Numerator Options:
Performance Met: Documentation of iron stores prior to initiating erythropoietin therapy (3160F)
OR
Denominator Exception: Documentation of system reason(s) for not documenting iron stores prior to initiating erythropoietin therapy (3160F with 3P)
OR
Performance Not Met: Iron stores prior to initiating erythropoietin therapy not documented, reason not otherwise specified (3160F with 8P)