2020 MIPS Measure #459: Back Pain After Lumbar Discectomy/Laminectomy

Quality ID

459

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Neurosurgery Orthopedic Surgery

Measure Description

For patients 18 years of age or older who had a lumbar discectomy/laminectomy procedure, back pain is rated by the patients as less than or equal to 3.0 OR an improvement of 5.0 points or greater on the Visual Analog Scale (VAS) Pain scale at three months (6 to 20 weeks) postoperatively

 

Instructions

This measure is to be submitted each time a patient undergoes a lumbar discectomy/laminectomy during the denominator identification 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.

NOTE: This measure is a target-based measure with two ways to meet the numerator; either a postoperative VAS Pain score that is less than or equal to 3.0 OR an improvement of 5.0 points or greater from the preoperative to postoperative score. It is expressed as a proportion or rate. Patients having received a lumbar discectomy/ laminectomy procedure who are not assessed for back pain postoperatively remain in the denominator and are considered as not meeting the target. The measure intent is that MIPS eligible clinicians will submit all denominator eligible procedures to be utilized for performance calculation.

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 18 years of age or older as of January 1 of the denominator identification period who had a lumbar discectomy/laminectomy procedure performed during the denominator identification period

Definition:

Denominator Identification Period - The twelve month period in which eligible patients have a procedure. This allows for enough time for a follow-up assessment to occur during the performance period. The denominator identification period includes dates of procedure (1/1/2019 to 12/31/2019).

Denominator Criteria (Eligible Cases):

Patients age ≥ 18 years by January 1 of the Denominator Identification Period

AND

Patient procedure during the denominator identification period (CPT): 63005, 63012, 63017, 63030, 63042 and 63047

AND NOT

DENOMINATOR EXCLUSION:

Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy: G9942

AND NOT

Patient had cancer, fracture or infection related to the lumbar spine OR patient had idiopathic or congenital scoliosis: G9945

Patients with a diagnosis of lumbar spine region cancer at the time of the procedure - The following codes would be sufficient to define the Denominator Exclusion (G9945) of lumbar spine region cancer: C41.2, C41.4, C79.51, C79.52, D16.6, D16.8, D48.0, D49.2

Patients with a diagnosis of lumbar spine region fracture at the time of the procedure - The following codes would be sufficient to define the Denominator Exclusion (G9945) of lumbar spine region fracture: M48.44XA, M48.45XA, M48.46XA, M48.47XA, M48.48XA, M48.54XA, M48.55XA, M48.56XA, M48.57XA, M48.58XA, S22.060A, S22.060B, S22.061A, S22.061B, S22.062A, S22.062B, S22.068A, S22.068B, S22.069A, S22.069B, S22.070A, S22.070B, S22.071A, S22.071B, S22.072A, S22.072B, S22.078A, S22.078B, S22.079A, S22.079B, S22.080A, S22.080B, S22.081A, S22.081B, S22.082A, S22.082B, S22.088A, S22.088B, S22.089A, S22.089B, S24.103A, S24.104A, S24.113A, S24.114A, S24.133A, S24.134A, S24.143A, S24.144A, S24.153A, S24.154A, S32.000A, S32.000B, S32.001A, S32.001B, S32.002A, S32.002B, S32.008A, S32.008B, S32.009A, S32.009B, S32.010A, S32.010B, S32.011A, S32.011B, S32.012A, S32.012B, S32.018A, S32.018B, S32.019A, S32.019B, S32.020A, S32.020B, S32.021A, S32.021B, S32.022A, S32.022B, S32.028A, S32.028B, S32.029A, S32.029B, S32.030A, S32.030B, S32.031A, S32.031B, S32.032A, S32.032B, S32.038A, S32.038B, S32.039A, S32.039B, S32.040A, S32.040B, S32.041A, S32.041B, S32.042A, S32.042B, S32.048A, S32.048B, S32.049A, S32.049B, S32.050A, S32.050B, S32.051A, S32.051B, S32.052A, S32.052B, S32.058A, S32.058B, S32.059A, S32.059B, S32.10XA, S32.10XB, S32.110A, S32.110B, S32.111A, S32.111B, S32.112A, S32.112B, S32.119A, S32.119B, S32.120A, S32.120B, S32.121A, S32.121B, S32.122A, S32.122B, S32.129A, S32.129B, S32.130A, S32.130B, S32.131A, S32.131B, S32.132A, S32.132B, S32.139A, S32.139B, S32.14XA, S32.14XB, S32.15XA, S32.15XB, S32.16XA, S32.16XB, S32.17XA, S32.17XB, S32.19XA, S32.19XB, S32.2XXA, S32.2XXB, S32.9XXA, S32.9XXB, S34.101A, S34.102A, S34.103A, S34.104A, S34.105A, S34.109A, S34.111A, S34.112A, S34.113A, S34.114A, S34.115A, S34.119A, S34.121A, S34.122A, S34.123A, S34.124A, S34.125A, S34.129A, S34.131A, S34.132A, S34.139A, S34.3XXA

Patients with a diagnosis of lumbar spine region infection at the time of the procedure - The following codes would be sufficient to define the Denominator Exclusion (G9945) of lumbar spine region infection: M46.25, M46.26, M46.27, M46.28, M46.35, M46.36, M46.37, M46.38, M46.45, M46.46, M46.47, M46.48, M46.55, M46.56, M46.57, M46.58

Patients with a diagnosis of lumbar idiopathic or congenital scoliosis - The following codes would be sufficient to define the Denominator Exclusion (G9945) of idiopathic or congenital scoliosis: M41.05, M41.06, M41.07, M41.08, M41.115, M41.116, M41.117, M41.125, M41.126, M41.127, M41.25, M41.26, M41.27, Q67.5, Q76.3

 

Numerator

All eligible patients whose back pain is less than or equal to 3.0 OR an improvement of 5.0 points or greater on the VAS Pain scale at three months (6 to 20 weeks) postoperatively

Definition:

Measure Assessment Period (Performance Period) - The period of time following the procedure date that is in which a postoperative VAS pain scale score is obtained.

Preoperative Assessment VAS Pain - A preoperative VAS pain scale score can be obtained from the patient any time up to three months preoperatively, inclusive of the date of the procedure. Assessment scores obtained via a telephone screening or more than three months before the procedure will not be used for measure calculation.

Postoperative Assessment VAS Pain - A postoperative VAS pain scale score can be obtained from the patient at three months (6 - 20 weeks) after the date of procedure. Assessment scores obtained via a telephone screening or prior to six weeks and after 20 weeks postoperatively will not be used for measure calculation.

Visual Analog Scale (VAS) - A visual analog scale is a continuous line indicating the continuum between two states of being. A copy of the tool can be obtained below or at the following link visual analog scale tool

Back Pain Target #1 - A patient who is assessed postoperatively at three months (6 to 20 weeks) after the procedure who rates their back pain as less than or equal to 3.0.

Back Pain Target #2 - A patient who does not meet Back Pain Target #1 is assessed both preoperatively within 3 months prior to the procedure AND postoperatively at three months (6 to 20 weeks) after the procedure AND the improvement is greater than or equal to 5.0 points

 

Numerator Options:

Performance Met: Back pain measured by the Visual Analog Scale (VAS) at three months (6 – 20 weeks) postoperatively was less than or equal to 3.0 OR Back pain measured by the Visual Analog Scale (VAS) within three months preoperatively AND at three months (6 – 20 weeks) postoperatively demonstrated an improvement of 5.0 points or greater (G2136)

OR

Performance Not Met: Back pain was not measured by the Visual Analog Scale (VAS) at three months (6 - 20 weeks) postoperatively (G9943)

OR

Performance Not Met: Back pain measured by the Visual Analog Scale (VAS) at three months (6 – 20 weeks) postoperatively was greater than 3.0 AND Back pain measured by the Visual Analog Scale (VAS) within three months preoperatively AND at three months (6 – 20 weeks) postoperatively demonstrated less than an improvement of 5.0 points (G2137)

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