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2020 MIPS Measure #436: Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques

Quality ID

436

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Diagnostic Radiology

Measure Description

Percentage of final reports for patients aged 18 years and older undergoing CT with documentation that one or more of the following dose reduction techniques were used
• Automated exposure control
• Adjustment of the mA and/or kV according to patient size
• Use of iterative reconstruction technique

 

Instructions

This measure is to be submitted each time a patient has a computed tomography scan during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the professional component of diagnostic imaging studies for computed tomography will submit this measure.

Measure Submission Type:

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 Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. 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 final reports for patients aged 18 years and older undergoing CT

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):

Patients aged ≥ 18 years on date of encounter

AND

Patient procedure during the performance period (CPT or HCPCS): 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74263*, 75571, 75572, 75573, 75574, 75635, 76380, 76497, 77011, 77012, 77013, 77014, 77078, 0042T, G0297

 

Numerator

Final reports with documentation that indicate an individualized dose optimization technique was used for the performed procedure, Dose optimization techniques include the following:

• Automated exposure control
• Adjustment of the mA and/or kV according to patient size
• Use of iterative reconstruction technique

NUMERATOR NOTE: Per exam/report: An individualized exposure protocol/optimization technique per scanner can be included in the report using a macro associated with the exam or procedure.

Attestation: Alternatively, a general attestation statement in the final report can suffice to meet the measure; however there should be a written policy in place describing the process that ensures dose optimization techniques are used appropriately per instrument/room, as well as a method for validating that their use occurs for each patient, e.g. periodic audits.

Example statement:

All CT scans at “location” are performed using dose optimization techniques as appropriate to a performed exam including the following:

• Automated exposure control
• Adjustment of the mA and/or kV according to patient size (this includes techniques or standardized protocols for targeted exams where dose is matched to indication / reason for exam; i.e. extremities or head )
• Use of iterative reconstruction technique

Numerator Options:

Performance Met: Final reports with documentation of one or more dose reduction techniques (e.g., Automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique) (G9637)

OR

Performance Not Met: Final reports without documentation of one or more dose reduction techniques (e.g., Automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique) (G9638)

 

Rationale

Mettler et al. estimate that CT scans account for 17% of total imaging procedures performed in the United States each year and 49% of the collective radiation dose from imaging procedures. Current advances in technology have resulted in several methods to reduce radiation dose for patients undergoing CT. Studies show that the use of CT dose optimization techniques can reduce radiation dose by 40%-50% without sacrificing image quality or diagnostic ability.


Clinical Recommendation Statements

CT examinations should be performed only for a valid medical reason and with the minimum exposure that provides the image quality necessary for adequate diagnostic information. (ACR, 2011)

Radiologists, medical physicists, registered radiologist assistants, radiologic technologists, and all supervising physicians have a responsibility for safety in the workplace by keeping radiation exposure to staff, and to society as a whole, “as low as reasonably achievable” (ALARA) and to assure that radiation doses to individual patients are appropriate, taking into account the possible risk from radiation exposure and the diagnostic image quality necessary to achieve the clinical objective. (ACR, 2011)

Facilities, in consultation with the medical physicist, should have in place and should adhere to policies and procedures, in accordance with ALARA, to vary examination protocols to take into account patient body habitus, such as height and/or weight, body mass index, or lateral width.

The dose reduction devices that are available on imaging equipment should be active; if not; manual techniques should be used to moderate the exposure while maintaining the necessary diagnostic image quality. Periodically, radiation exposures should be measured and patient radiation doses estimated by a medical physicist in accordance with the appropriate ACR Technical Standard. (ACR, 2011)

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