Measure Description
Percentage of patients with a diagnosis of inflammatory bowel disease (IBD) who had Hepatitis B Virus (HBV) status assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy
Instructions
This measure is to be submitted a minimum of once per performance period for all patients with a diagnosis of inflammatory bowel disease seen 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.
NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.
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
All patients, regardless of age, with a diagnosis of inflammatory bowel disease who initiated an anti-TNF agent
Definitions:
Patient receiving an anti-TNF agent - May include but is not limited to the following HCPCS codes: C9249, J0717, J0718, J0135, J1602, J1745, Q5102, S9359 or CPT codes: G8869, 86317, 86704, 86706, 90636, 90723, 90744, 90746, 90747, 90748
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 will not be counted in the denominator population for MIPS CQMs measures
Denominator Criteria (Eligible Cases):
All Patients, regardless of age
AND
Diagnosis for inflammatory bowel disease (ICD-10-CM): K50.00, K50.011, K50.012, K50.013, K50.014, K50.018, K50.019, K50.10, K50.111, K50.112, K50.113, K50.114, K50.118, K50.119, K50.80, K50.811, K50.812, K50.813, K50.814, K50.818, K50.819, K50.90, K50.911, K50.912, K50.913, K50.914, K50.918, K50.919, K51.00, K51.011, K51.012, K51.013, K51.014, K51.018, K51.019, K51.20, K51.211, K51.212, K51.213, K51.214, K51.218, K51.219, K51.30, K51.311, K51.312, K51.313, K51.314, K51.318, K51.319, K51.40, K51.411, K51.412, K51.413, K51.414, K51.418, K51.419, K51.50, K51.511, K51.512, K51.513, K51.514, K51.518, K51.519, K51.80, K51.811, K51.812, K51.813, K51.814, K51.818, K51.819, K51.90, K51.911, K51.912, K51.913, K51.914, K51.918, K51.919
AND
Patient encounter during the performance period (CPT):, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99406, 99407
AND
Patient receiving an anti-TNF agent (HCPCS): G9914
Numerator
Patients who had HBV status assessed and results interpreted prior to initiating anti-TNF therapy
Numerator Instructions:
HBV status must be assessed by one of the following: HBsAG, HBsAG neutralization, HBcAb total, HBsAB.
Numerator Options:
Performance Met: Hepatitis B Virus (HBV) status assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy (G9912)
OR
Performance Met: Patient has documented immunity to hepatitis B and initiating anti-TNF therapy (G8869)
OR
Denominator Exception: Documented reason for not assessing Hepatitis B Virus (HBV) status (e.g. patient not initiating anti-TNF therapy, patient declined) prior to initiating anti-TNF therapy (G9504)
OR
Performance Not Met: Hepatitis B Virus (HBV) status not assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy, reason not otherwise specified (G9913)
OR
Performance Not Met: No record of HBV results documented (G9915)
Rationale
Before initiating biologic anti-TNF therapy for a patient with IBD, it is essential to screen the patient for HBV, as research has documented reactivation of HBV after anti-TNF therapy. This is a patient safety measure.
Opportunity for improvement: While there are a limited number of studies that investigate gaps in care for patients with IBD, the research that does exist identifies opportunities for improvement in care areas: 1) there is a lack of adherence to documentation of HBV screening, most noticeably in the use of disease-modifying anti-TNF drugs, and variations in care by practice setting, geographic region and physician specialty.
See FDA package labeling for anti-TNF biological agents — golimumab, certolizumab pegol, infliximab and adalimumab
Reactivation of hepatitis B virus has been reported in patients who are carriers of this virus and are taking TNF blocker medicines. (Kaiser T, Moessner J, McHutchison JG, Tillmann HG. Life threatening liver disease during treatment with monoclonal antibodies. BMJ. 2009; 338:b508)
Clinical Recommendation Statements
Infliximab can reactivate latent HBV. (Esteve M, Saro C, González-Huix F, Suarez F, Forné M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease patients: need for primary prophylaxis. Gut. 2004 Sep; 53(9):1363-5.)