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2020 MIPS Measure #394: Immunizations for Adolescents

Quality ID

394

NQF

1407

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Family Medicine Pediatrics

Measure Description

The percentage of adolescents 13 years of age who had the recommended immunizations by their 13th birthday

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. Performance for this measure is not limited to 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 services provided and the measure-specific denominator coding.

This measure will be calculated with 4 performance rates:

1) Patients who had one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays
2) Patients who had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays
3) Patients who have completed the HPV vaccine series with different dates of service on or between the patient’s 9th and 13th birthdays
4) All patients who are compliant for Meningococcal, Tdap and HPV during the specified timeframes

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 (Submission Criteria for all rates)

Adolescents who turn 13 years of age during the measurement period

DENOMINATOR NOTE: The same denominator is used for all rates.

Denominator Criteria (Eligible Cases):

Patients who turn 13 years of age during the measurement period

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402

AND NOT

DENOMINATOR EXCLUSIONS:

Meningococcal, Tdap and/or HPV vaccine contraindicated OR patient allergic to the meningococcal, Tdap, and/or HPV vaccine

OR

Encephalopathy due to Tdap vaccine

OR

Patients who use hospice services any time during the measurement period: G9761

 

Numerator (Submission Criteria 1)

Adolescents who had one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays

Numerator Options:

Performance Met: Patient had one dose of meningococcal vaccine (serogroups A, C, W, Y) on or between the patient’s 11th and 13th birthdays (G9414)

OR

Performance Not Met: Patient did not have one dose of meningococcal vaccine on or between the patient’s 11th and 13th birthdays (G9415)

 

Numerator (Submission Criteria 2)

Adolescents who had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays

Numerator Options:

Performance Met: Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9416)

OR

Performance Not Met: Patient did not have one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) on or between the patient’s 10th and 13th birthdays (G9417)

 

Numerator (Submission Criteria 3)

Adolescents who had at least three HPV vaccines on or between the patient’s 9th and 13th birthdays

Numerator Options:

Performance Met: Patient had at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9762)

OR

Performance Not Met: Patient did not have at least two HPV vaccines (with at least 146 days between the two) OR three HPV vaccines on or between the patient’s 9th and 13th birthdays (G9763)

 

Numerator (Submission Criteria 4)

Adolescents who are numerator compliant for Rates 1, 2 and 3

 

Rationale

Adolescent immunization rates have historically lagged behind early childhood immunization rates in the United States. In 2000, the American Academy of Pediatrics (AAP) reported that 3 million adolescents failed to receive at least one recommended vaccination. Low immunization rates among adolescents have the potential to cause outbreaks of preventable diseases and to establish reservoirs of disease in adolescents that can affect other populations including infants, the elderly, and individuals with chronic conditions. Immunization recommendations for adolescents have changed in recent years. In addition to assessing for immunizations that may have been missed, there are new vaccines targeted specifically to adolescents.

This measure follows the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) guidelines for immunizations.


Clinical Recommendation Statements

Receiving recommended vaccinations is the best defense against vaccine-preventable diseases. However, as children get older, the protection they received from some of their childhood vaccinations begins to wear off and they need booster shots. Adolescents are also at risk for vaccine-preventable diseases (e.g., meningococcal meningitis) that are not typically vaccinated against as children.

The tetanus, diphtheria toxoids, and acellular pertussis (Tdap) vaccine is given to adolescents as a booster shot to increase the protection they received in childhood vaccinations. Diphtheria, tetanus, and pertussis are serious diseases that can cause life-threatening illnesses. Diphtheria can cause breathing difficulties, heart problems, nerve damage, pneumonia, and even death. Tetanus can cause seizures and severe muscle spasms strong enough to cause bone fractures of the spine, and causes death in 30 to 40 percent of cases. Pertussis can cause severe coughing spells that can interfere with breathing, as well as pneumonia, long-lasting bronchitis, seizures, brain damage, and death.

Meningococcal disease occurs when the protective membranes covering the brain and spinal cord become infected and swell, and can cause serious complications, such as brain damage, hearing loss, or learning disabilities.

Meningococcal disease is caused by the bacterium Neisseria meningitides, or meningococcus, and is the leading cause of bacterial meningitis in the United States (U.S.).

A meningococcal infection can spread quickly, killing an otherwise healthy adolescent in 48 hours. Although not all cases of meningococcal disease progress into meningitis, 15 percent of the cases that do progress result in death.

Each year, many adolescents miss their recommended vaccinations, leaving them needlessly vulnerable to disease, suffering and death.

Vaccine-preventable diseases are expensive for society as a whole, costing more than $10 billion in direct medical costs and indirect societal costs.

In 2012, pertussis outbreaks were reported in a majority of states, with more than 32,000 cases and 16 deaths.

Outbreaks can occur in workplaces, schools, and homes, and can result in physical, economic, and social costs.

Bacterial meningitis remains a major global health threat, with an estimated 500,000 cases reported worldwide each year, accounting for at least 50,000 deaths. According to preliminary data, meningitis was responsible for 606 deaths in the U.S. in 2011.

Vaccines are a safe and effective way to protect adolescents against potentially deadly diseases and help them develop into healthy adults. Vaccines can protect their family and their community as well.

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