Measure Description
Percentage of emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care clinician who have an indication for a head CT
Instructions
This measure is to be submitted for each denominator eligible visit for patients aged 18 years and older who present to the emergency department with a minor blunt head trauma during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide care in the emergency department 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 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 emergency department visits for patients aged 18 years and older who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider*
Definitions:
Minor Blunt Head Trauma – Includes only non-penetrating injuries.
DENOMINATOR NOTE: *This measure looks to determine if an emergency care provider ordered head CT services typically provided under CPT code 70450.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for minor blunt head trauma (ICD-10-CM): S00.03XA, S00.33XA, S00.431A, S00.432A, S00.439A, S00.531A, S00.532A, S00.83XA, S00.93XA, S02.0XXA, S02.101A, S02.102A, S02.109A, S02.110A, S02.111A, S02.112A, S02.113A, S02.118A, S02.119A, S02.11AA, S02.11BA, S02.11CA, S02.11DA, S02.11EA, S02.11FA, S02.11GA, S02.11HA, S02.19XA, S02.2XXA, S02.30XA, S02.31XA, S02.32XA, S02.400A, S02.401A, S02.402A, S02.40AA, S02.40BA, S02.40CA, S02.40DA, S02.40EA, S02.40FA, S02.411A, S02.412A, S02.413A, S02.42XA, S02.600A, S02.601A, S02.602A, S02.609A, S02.610A, S02.611A, S02.612A, S02.620A, S02.621A, S02.622A, S02.630A, S02.631A, S02.632A, S02.640A, S02.641A, S02.642A, S02.650A, S02.651A, S02.652A, S02.66XA, S02.670A, S02.671A, S02.672A, S02.69XA, S02.80XA, S02.81XA, S02.82XA, S02.91XA, S02.92XA, S06.0X0A, S06.0X1A, S06.0X9A, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X9A, S06.2X0A, S06.2X1A, S06.2X2A, S06.2X3A, S06.2X4A, S06.2X9A, S06.300A, S06.301A, S06.302A, S06.303A, S06.304A, S06.309A, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.349A, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.359A, S06.360A, S06.361A, S06.362A, S06.363A, S06.364A, S06.369A, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X9A, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X9A, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X9A, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.819A, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.829A, S06.890A, S06.891A, S06.892A, S06.893A, S06.894A, S06.899A, S06.9X0A, S06.9X1A, S06.9X2A, S06.9X3A, S06.9X4A, S06.9X9A, S09.10XA, S09.11XA, S09.19XA, S09.8XXA, S09.90XA, S09.92XA, S09.93XA, S10.0XXA, S10.83XA, S10.93XA
AND
Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291
AND
Patient presented with a minor blunt head trauma and had a head CT ordered for trauma by an emergency care provider: G9530
AND NOT
DENOMINATOR EXCLUSION:
Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, pregnancy, or is currently taking an antiplatelet medication including: abciximab, cangrelor, cilostazol, clopidogrel, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar: G9531
Numerator
Emergency department visits for patients who have an indication for a head CT
Definitions:
Indications for a head CT in patients presenting to the emergency department for minor blunt head trauma:
Patients with any one of the following:
• GCS score less than 15
• Severe headache
• Vomiting
• Age 65 years and older
• Physical signs of a basilar skull fracture (signs include haemotympanum, "raccoon" eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign)
• Focal neurological deficit
• Coagulopathy
• Thrombocytopenia
• Currently taking any of the following anticoagulant medications**: apixaban, argatroban, bivalirudin, dabigatran, dalteparin, desirudin, edoxaban, enoxaparin, fondaparinux, heparin, lepirudin, rivaroxaban, tinzaparin, warfarin
• Dangerous mechanism of injury (i.e., ejection from a motor vehicle, a pedestrian struck, and a fall from a height of more than 3 feet or 5 stairs)
OR
Patients with either loss of consciousness OR posttraumatic amnesia AND any one of the following:
• GCS score less than 15
• Headache
• Age 60 years and older, and less than 65 years
• Drug/alcohol intoxication
• Short-term memory deficits
• Evidence of trauma above the clavicles (physical location, any trauma to the head or neck [i.e., laceration, abrasion, bruising, ecchymosis, hematoma, swelling, fracture])
• Posttraumatic seizure
**The aforementioned list of medications/drug names is based on clinical guidelines and other evidence and may not be all-inclusive or current. Physicians and other health care professionals should refer to the FDA's web site page entitled "Drug Safety Communications" for up-to-date drug recall and alert information when prescribing medications. As part of the measure maintenance process, the measure and specifications will be updated routinely to account for newly released and FDA approved pharmacologic agents.
Numerator Options:
Performance Met: Patient with minor blunt head trauma had an appropriate indication(s) for a head CT (G9529)
OR
Performance Not Met: Patient with minor blunt head trauma did not have an appropriate indication(s) for a head CT (G9533)