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2021 MIPS Measure #398: Optimal Asthma Control

Quality ID 398
High Priority Measure Yes
Specifications Registry
Measure Type Outcome
Specialty Allergy/Immunology Family Medicine Internal Medicine Otolaryngology Pediatrics Pulmonology

Measure Description

Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by one of three age appropriate patient reported outcome tools and not at risk for exacerbation

 

Instructions

This measure is to be submitted a minimum of once per performance period for all patients with a diagnosis of asthma 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 for the primary management of patients with asthma based on the services provided and the measure-specific denominator coding.

This measure will be calculated with 7 performance rates:
1) Overall Percentage for patients (aged 5-50 years) with well-controlled asthma, without elevated risk ofexacerbation
2) Percentage of pediatric patients (aged 5-17 years) with well-controlled asthma, without elevated risk ofexacerbation
3) Percentage of adult patients (aged 18-50 years) with well-controlled asthma, without elevated risk ofexacerbation
4) Asthma well-controlled (submit the most recent specified asthma control tool result) for patients 5 to 17 withAsthma
5) Asthma well-controlled (submit the most recent specified asthma control tool result) for patients 18 to 50 withAsthma
6) Patient not at elevated risk of exacerbation for patients 5 to 17 with Asthma
7) Patient not at elevated risk of exacerbation for patients 18 to 50 with Asthma

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 (Submission Criteria 1)

Patients ages 5 to 17 with asthma

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.

Visits to a primary care setting, regardless of the reason for the visit or the scheduling status of the visit (e.g., walk-in) are to be included. In a multi-specialty clinic setting, patients who have visits from both the primary care setting and the urgent care setting during the performance period are to be included. M1021 may be used if the patient is only evaluated at an urgent care visit and is not considered an established patient to allow for care coordination or follow up.

Denominator Criteria (Eligible Cases) 1:

Patients aged 5-17 years

AND

Diagnosis for asthma (ICD-10-CM): J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998

AND

Patient had a diagnosis of asthma with any contact during the current or prior performance period OR had asthma present on an active problem list any time during the performance period

AND

Established patient office visit during the performance period (CPT): 99211, 99212, 99213, 99214, 99215, 99392*, 99393*, 99394*, 99395*, 99396*

AND NOT

DENOMINATOR EXCLUSIONS:

Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure

- The following codes would be sufficient to define the Denominator Exclusion of chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3.
- For historical reference purposes, these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure: 277.00, 277.01, 277.02, 277.03, 277.09, 491.20,
491.21, 491.22, 492.0, 492.8, 493.20, 493.21, 493.22, 496, 506.4, 518.1, 518.2, 518.81

OR

Patient died prior to the end of the performance period

OR

Patient was a permanent nursing home resident any time during the performance period

OR

Patient was in hospice or receiving palliative care services at any time during the performance period

OR

Patient had only urgent care visits during the performance period: M1021

 

Numerator (All or nothing)

The number of asthma patients who meet ALL of the following targets

Numerator Options:

Each component should be submitted in order to determine the data completeness and performance rate for the overall percentage of patients that meet ALL targets represented as the numerator.

COMPONENT 1:
Asthma well-controlled (submit the most recent asthma control tool result available during the measurement period)

  • Asthma Control TestTM (ACT) result of 20 or above - ages 12 and older
  • Childhood Asthma Control TestTM (C-ACT) result of 20 or above - ages 11 and younger
  • Asthma Control Questionnaire (ACQ) result of 0.75 or lower - ages 17 and older
  • Asthma Therapy Assessment Questionnaire (ATAQ) result of 0 – Pediatric (ages 5 – 17) or Adult (ages 18 and older)

Component Options:

Performance Met: Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented (G9432)

OR

Performance Not Met: Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, OR specified asthma control tool not used, reason not given (G9434)

AND COMPONENT 2:

Patient not at elevated risk of exacerbation

NUMERATOR NOTE: To meet performance for this component, documentation of the sum of the patient’s submitted values for the following questions must be less than two:

  • Number of emergency department visits not resulting in a hospitalization due to asthma in last 12 months
  • Number of inpatient hospitalizations requiring an overnight stay due to asthma in last 12 months.

Component Options:

Performance Met: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months (G9521)

OR

Performance Not Met: Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months OR patient not screened, reason not given (G9522)

 

Denominator (Submission Criteria 2)

Patients ages 18 to 50 with asthma

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.

Visits to a primary care setting, regardless of the reason for the visit or the scheduling status of the visit (e.g., walk-in) are to be included. In a multi-specialty clinic setting, patients who have visits from both the primary care setting and the urgent care setting during the performance period are to be included. M1021 may be used if the patient is only evaluated at an urgent care visit and is not considered an established patient to allow for care coordination or follow up.

Denominator Criteria (Eligible Cases) 2:

Patients aged 18-50 years

AND

Diagnosis for asthma (ICD-10-CM): J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998

AND

Patient had a diagnosis of asthma with any contact during the current or prior performance period OR had asthma present on an active problem list any time during the performance period

AND

Established patient office visit during the performance period (CPT): 99211, 99212, 99213, 99214, 99215, 99392*, 99393*, 99394*, 99395*, 99396*

AND NOT

DENOMINATOR EXCLUSIONS:

Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure
- The following codes would be sufficient to define the Denominator Exclusion of chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure: E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3.
- For historical reference purposes, these ICD-9 codes if documented would be sufficient to define the Denominator Exclusion of chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure: 277.00, 277.01, 277.02, 277.03, 277.09, 491.20, 491.21, 491.22, 492.0, 492.8, 493.20, 493.21, 493.22, 496, 506.4, 518.1, 518.2, 518.81

OR

Patient died prior to the end of the performance period

OR

Patient was a permanent nursing home resident any time during the performance period

OR

Patient was in hospice or receiving palliative care services at any time during the performance period

OR

Patient had only urgent care visits during the performance period: M1021

 

Numerator (All or nothing)

The number of asthma patients who meet ALL of the following targets

Numerator Options:

Each component should be submitted in order to determine the data completeness and performance rate for the overall percentage of patients that meet ALL targets represented as the numerator.

COMPONENT 1:

Asthma well-controlled (submit the most recent asthma control tool result available during the measurement period)

  • Asthma Control TestTM (ACT) result of 20 or above - ages 12 and older
  • Asthma Control Questionnaire (ACQ) result of 0.75 or lower - ages 17 and older
  • Asthma Therapy Assessment Questionnaire (ATAQ) result of 0 – Pediatric (ages 5 – 17) or Adult (ages 18 and older)

Component Options:

Performance Met: Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented (G9432)

OR

Performance Not Met: Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, OR specified asthma control tool not used, reason not given (G9434)

AND COMPONENT 2:

Patient not at elevated risk of exacerbation

NUMERATOR NOTE: To meet performance for this component, documentation of the sum of the patient’s submitted values for the following questions must be less than two:

  • Number of emergency department visits not resulting in a hospitalization due to asthma in last 12 months
  • Number of inpatient hospitalizations requiring an overnight stay due to asthma in last 12 months

Component Options:

Performance Met: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months (G9521)

OR

Performance Not Met: Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months OR patient not screened, reason not given (G9522)

 

Rationale

Roughly 7% of adults and children in Minnesota are currently living with asthma. Asthma is a chronic disease associated with familial, infectious, allergenic, socioeconomic, psychosocial, and environmental factors. It is not curable but is treatable. Despite improvements in diagnosis and management, and an increased understanding of the epidemiology, immunology, and biology of the disease, asthma prevalence has progressively increased over the past 15 years.

 

Clinical Recommendation Statements

From the National Quality Forum’s 2013 report, Patient Reported Outcomes (PROs) in Performance Measurement:
Patient and family engagement is increasingly acknowledged as a key component of a comprehensive strategy, (along with performance improvement and accountability), to achieve a high quality, affordable health system. Emerging evidence affirms that patients who are engaged in their care tend to experience better outcomes and choose less costly but effective interventions.

Historically, with the exception of collecting feedback on satisfaction or experience with care, patients remain an untapped resource in assessing the quality of healthcare and of long-term support services. Patients are a valuable and, arguably, the authoritative source of information on outcomes beyond experience with care. These include health-related quality of life, functional status, symptom and symptom burden, and health behaviors.

Patient Reported Outcome Measures (PROMs) are standardized instruments that capture patients’ self-assessment of their health and can provide timely information on patient health status, function, and symptoms over time that can be used to improve patient-centered care and inform clinical decision-making.

The Asthma Control TestTM (ACT) is a validated self-administered survey utilizing 5 questions to assess asthma control on a scale from 0 (poor control) to 5 (total control) in individuals 12 years and older. © 2002 by QualityMetric Incorporated. Asthma Control Test is a trademark of QualityMetric Incorporated.

The Childhood Asthma Control Test (C-ACT) is a caregiver-assisted, child-completed tool that can be used with or without lung function assessment to assess pediatric asthma control at home or in clinical practice for children ages 4-11 years. It consists of 7 questions of which 4 are child-reported and 3 are caregiver-reported questions. ©2007 The GlaxoSmithKline Group of Companies.

The Asthma Control Questionnaire (ACQ) is a validated, self-administered survey available in various formats from the developer, Elizabeth F. Juniper, MCSP, MSc. Link to ACQ Survey

The Asthma Therapy Assessment Questionnaire (ATAQ) is available in a version for adults (18 and over) and a version for children and adolescents (5 – 17). © 2005 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc.

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