2020 MIPS Measure #461: Leg Pain After Lumbar Discectomy/ Laminectomy

Quality ID

461

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, leg pain is rated by the patient as 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

 

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 leg 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 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 of 1/1/2019 to 12/31/2019.

Denominator Criteria (Eligible Cases):

Patients aged ≥ 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: G9948

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 leg 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 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 pre-operatively, 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 three months (6 to 20 weeks) after the date of the procedure. Assessment scores obtained via a telephone screening or prior to 6 weeks and after 20 weeks postoperatively will not be used for measure calculation.

Visual Analog Scale - 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.

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

Leg Pain Target #2 - A patient who does not meet Leg 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 NOTE: It is recommended that both a preoperative and postoperative be administered to the patient increasing the chances that one of the numerator targets will be met. The following situations are those in which the numerator target cannot be reached and Performance Not Met G9949 is submitted.

  • VAS Pain Scale is not administered postoperatively at three months (6 to 20 weeks)
  • Leg pain is measured using a different patient reported tool or via telephone screening
  • Postoperative VAS Pain Scale is administered less than six weeks or more than 20 weeks (3 month window)
  • Postoperative VAS value is greater than 3.0 and no valid preop to measure change
  • Preoperative VAS Pain Scale (to measure change) is administered beyond the three month timeframe prior to and including the date of procedure (e.g. 6 months before procedure)

 

Numerator Options:

Performance Met: Leg pain measured by the Visual Analog Scale (VAS) at three months (6 – 20 weeks) postoperatively was less than or equal to 3.0 OR Leg 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 (G2140)

OR

Performance Not Met: Leg pain was not measured by the Visual Analog Scale (VAS) at three months (6 – 20 weeks) postoperatively (G9949)

OR

Performance Not Met: Leg pain measured by the Visual Analog Scale (VAS) at three months (6 – 20 weeks) postoperatively was greater than 3.0 AND Leg 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 (G2141)

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