#337: Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier

Quality ID

337

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Dermatology Family Medicine Internal Medicine

Measure Description

Percentage of patients, regardless of age, with psoriasis, psoriatic arthritis and rheumatoid arthritis on a biological immune response modifier whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient’s history to determine if they have had appropriate management for a recent or prior positive test

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with psoriasis and/or psoriatic arthritis and/or rheumatoid arthritis seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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, regardless of age, with a diagnosis of psoriasis and/or psoriatic arthritis and/or rheumatoid arthritis who are on a biologic immune response modifier

Definition:

Biologic Immune Response Modifier –

1. TNF-alpha inhibitors, to include, but not limited toInfliximab (Remicade), Adalimumab (Humira), Etanercept (Enbrel), or Golimumab (Simponi), Certolizumab (Cimzia).
2. Inhibitors of IL-12 and/or IL-23 or their receptors to include but not limited to Ustekinumab (Stelara).
3. B7 inhibitors, to include but not limited to Abatacept (Orencia).
4. Inhibitors of IL-17 family members or their receptors.

DENOMINATOR NOTE: A patient would be considered denominator eligible for Measure #337 for submission purposes, if the patient meets the denominator criteria with diagnosis of psoriasis or psoriatic arthritis or rheumatoid arthritis AND is on a biologic immune response modifier 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 MIPS CQMs.

Examples of Applicable Medications

Brand Name

Chemical Name

Mechanism of Action/ Type of Biologic

Orencia

abatacept

Blocks T cell activation

Rituxan

rituximab

CD 20 directed antibody

Kineret

anakinra

Interleukin (IL)-1 inhibitors

Actemra

tocilizumab

IL-6 inhibitor

Kevzara

Sarilumab

IL-6 inhibitor

Stelara

ustekinumab

IL-12 and IL-23 inhibitors

Cosentyx

secukinumab

IL-17 inhibitors

Siliq

brodalumab

IL-17 inhibitors

Taltz

ixekizumab

IL-17 inhibitors

Tremfya

guselkumab

IL-23 inhibitors

Ilumya

Tildrakizumab

Selective (IL)-23p19 inhibitor

Amjevita

adalimumab-atto

TNF-alpha inhibitors

Cimzia

certolizumab

TNF-alpha inhibitors

Cyltezo

adalimumab-adbm

TNF-alpha inhibitors

Enbrel

etanercept

TNF-alpha inhibitors

Erelzi

etanercept-szzs

TNF-alpha inhibitors

Humira

adalimumab

TNF-alpha inhibitors

Inflectra

infliximab-dyyb

TNF-alpha inhibitors

Remicade

infliximab

TNF-alpha inhibitors

Renflexis

infliximab-abda

TNF-alpha inhibitors

Simponi and Simponi Aria

golimumab

TNF-alpha inhibitors

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Diagnosis for psoriasis (ICD-10-CM): L40.0, L40.1, L40.2, L40.3, L40.4, L40.8, L40.9

OR

Diagnosis for psoriatic arthritis (ICD-10-CM): L40.50, L40.51, L40.52, L40.53, L40.54, L40.59

OR

Diagnosis for rheumatoid arthritis (ICD-10-CM): M05.10, M05.111, M05.112, M05.119, M05.121, M05.122, M05.129, M05.131, M05.132, M05.139, M05.141, M05.142, M05.149, M05.151, M05.152, M05.159, M05.161, M05.162, M05.169, M05.171, M05.172, M05.179, M05.19, M05.20, M05.211, M05.212, M05.219, M05.221, M05.222, M05.229, M05.231, M05.232, M05.239, M05.241, M05.242, M05.249, M05.251, M05.252, M05.259, M05.261, M05.262, M05.269, M05.271, M05.272, M05.279, M05.29, M05.30, M05.311, M05.312, M05.319, M05.321, M05.322, M05.329, M05.331, M05.332, M05.339, M05.341, M05.342, M05.349, M05.351, M05.352, M05.359, M05.361, M05.362, M05.369, M05.371, M05.372, M05.379, M05.39, M05.40, M05.411, M05.412, M05.419, M05.421, M05.422, M05.429, M05.431, M05.432, M05.439, M05.441, M05.442, M05.449, M05.451, M05.452, M05.459, M05.461, M05.462, M05.469, M05.471, M05.472, M05.479, M05.49, M05.50, M05.511, M05.512, M05.519, M05.521, M05.522, M05.529, M05.531, M05.532, M05.539, M05.541, M05.542, M05.549, M05.551, M05.552, M05.559, M05.561, M05.562, M05.569, M05.571, M05.572, M05.579, M05.59, M05.60, M05.611, M05.612, M05.619, M05.621, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.9, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.1, M06.20, M06.211, M06.212, M06.219, M06.221, M06.222, M06.229, M06.231, M06.232, M06.239, M06.241, M06.242, M06.249, M06.251, M06.252, M06.259, M06.261, M06.262, M06.269, M06.271, M06.272, M06.279, M06.28, M06.29, M06.30, M06.311, M06.312, M06.319, M06.321, M06.322, M06.329, M06.331, M06.332, M06.339, M06.341, M06.342, M06.349, M06.351, M06.352, M06.359, M06.361, M06.362, M06.369, M06.371, M06.372, M06.379, M06.38, M06.39, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.9

AND

Patient encounter during performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, G0402

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Biologic immune response modifier prescribed: G9506

 

Numerator

Patients who have a documented negative annual TB screening or have documentation of the management of a positive TB screening test with no evidence of active tuberculosis, confirmed through use of radiographic imaging (i.e., chest x-ray, CT)

Definition:

Documentation – To satisfy this measure, documentation will incorporate the following:

• Initials of the clinician that prescribed the biologic
• Initials of clinician that administered the TB test
• Initials of the clinician that performed the skin test evaluating the results note in the medical record that results are negative OR that results are positive and is confirmed via results from radiographic imaging (chest x-ray, CT)

If TB test is administered by a provider other than the biologic prescriber, confirmation of the above mentioned must be obtained via letter or other written means from the administering provider.

NUMERATOR NOTE: For Denominator Exception(s): patients are ineligible for this measure if at the time of follow-up there are patient reason(s) for not documenting TB test results (e.g. patient did not return for Mantoux (PPD) skin test evaluation).

Numerator Options:

Performance Met: Documentation of negative or managed positive TB screen with further evidence that TB is not active within one year of patient visit (G9359)

OR

Denominator Exception: Documentation of patient reasons(s) for not having records of negative or managed positive TB screen (e.g., patient does not return for Mantoux (PPD) skin test evaluation) (G9932)

OR

Performance Not Met: No documentation of negative or managed positive TB screen (G9360)

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