Percentage of patients for whom imaging of the head (CT or MRI) is obtained for the evaluation of primary headache when clinical indications are not present
This measure is to be submitted at each denominator eligible visit for patients with a diagnosis of primary headache 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.
All patients seen for evaluation of primary headache
Change in headache - A significant change in severity of the headache including changes in location or quality. Other criteria take into account most red flag symptoms and also may reflect change (if a stable primary headache were previously present) but do not reflect a previously tolerated headache that now becomes suddenly disabling in severity. Change also includes any and all new symptoms that may be associated with a headache: arm numbness, speech disturbance, etc.
Indications that would warrant imaging include:
• Head trauma
• New or change in headache above 50 years of age
• Abnormal neurologic exam
• Thunderclap headache
• Headache radiating to the neck
• Trigeminal pain
• Persistent and positional headaches
• Temporal headaches in patients over 55 years of age
• New onset headache in pre-school children or younger (<6 years of age)
• New onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
• Occipital headache in children
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.
Denominator Criteria (Eligible Cases):
All patients, regardless of age
Diagnosis for Primary Headache (ICD-10-CM): G43.001, G43.009, G43.011, G43.019, G43.101, G43.109, G43.111, G43.119, G43.4, G43.401, G43.409, G43.41, G43.411, G43.5, G43.501, G43.509, G43.511, G43.519, G43.6, G43.601, G43.609, G43.611, G43.619, G43.701, G43.709, G43.711, G43.719, G43.8, G43.801, G43.809, G43.811, G43.819, G43.821, G43.829, G43.831, G43.839, G43.901, G43.909, G43.911, G43.919, G44.019, G44.029, G44.039, G44.1, G44.209, G44.219, G44.221, G44.229, G44.52, G44.59, G44.81, G44.82, G44.89, R51
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99241*, 99242*, 99243*, 99244*, 99245*
Telehealth Modifier: GQ, GT, 95, POS 02
Patients with no clinical indications for imaging of the head: M1031
Patients for whom imaging of the head (Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)) is obtained for the evaluation of primary headache when clinical indications are not present
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
NUMERATOR NOTE: To perform well on this measure, we suggest using key words: imaging not recommended, imaging not performed, no clinical indications for imaging.
Performance Met: Imaging of the head (CT or MRI) was obtained (M1027)
Denominator Exception: Documentation of patients with primary headache diagnosis and imaging other than CT or MRI obtained (M1028)
Denominator Exception: Documentation of System reason(s) for obtaining imaging of the head (CT or MRI) (i.e., needed as part of a clinical trial; other clinician ordered the study) (G9537)
Performance Not Met: Imaging of the head (CT or MRI) was NOT obtained, Reason not given (M1029)