2019 MIPS Measure #347: Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) Who Are Discharged Alive

Quality ID 347
NQF 1534
High Priority Measure Yes
Specifications Registry
Measure Type Outcome
Specialty Vascular Surgery

Measure Description

Percent of patients undergoing endovascular repair of small or moderate non-ruptured infrarenal abdominal aortic aneurysms (AAA) who are discharged alive

 

Instructions

This measure is to be submitted each time an EVAR is performed during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide services of EVAR, as described in the measure, based on the services provided and the measure-specific denominator coding will submit this measure. This measure may be submitted by 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

Patients aged 18 and older with infrarenal non-ruptured endovascular AAA repairs

Denominator Criteria (Eligible Cases):

Patients aged 18 and older

AND

Diagnosis for infrarenal non-ruptured AAA (ICD-10-CM): I71.4

AND

Patient procedure during performance period (CPT): 34701, 34703, 34705

AND NOT

DENOMINATOR EXCLUSIONS:

For women:

Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted CT or minor diameter on axial formatted CT: 9003F

OR

Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted CT or minor diameter on axial formatted CT: 9004F

OR

For men:

Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted CT or minor diameter on axial formatted CT: 9004F

 

Numerator

Patients who are discharged alive following endovascular AAA repair

Numerator Options:

Performance Met: Documentation of patient discharged alive following endovascular AAA repair (G9263)

OR

Performance Not Met: Documentation of patient death in the hospital following endovascular AAA repair (G9262)

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