Measure Description
Percentage of patients with a mRs score of 0 to 2 at 90 days following endovascular stroke intervention
Instructions
This measure is to be submitted each time an endovascular stroke intervention procedure is performed 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: Include only patients that have cerebrovascular accidents through September 30 of the performance period. This will allow the evaluation of at least 90 days after the cerebrovascular accident within the performance period.
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 with CVA undergoing endovascular stroke treatment
Denominator Criteria (Eligible Cases):
All patients, regardless of age
AND
Diagnosis for ischemic stroke (ICD-10-CM): I63.00, I63.011, I63.012, I63.013, I63.019, I63.02, I63.031, I63.032, I63.033, I63.039, I63.09, I63.10, I63.111, I63.112, I63.113, I63.119, I63.12, I63.131, I63.132, I63.133, I63.139, I63.19, I63.20, I63.211, I63.212, I63.213, I63.219, I63.22, I63.231, I63.232, I63.233, I63.239, I63.29, I63.30, I63.311, I63.312, I63.313, I63.319, I63.321, I63.322, I63.323, I63.329, I63.331, I63.332, I63.333, I63.339, I63.341, I63.342, I63.343, I63.349, I63.39, I63.40, I63.411, I63.412, I63.413, I63.419, I63.421, I63.422, I63.423, I63.429, I63.431, I63.432, I63.433, I63.439, I63.441, I63.442, I63.443, I63.449, I63.49, I63.50, I63.511, I63.512, I63.513, I63.519, I63.521, I63.522, I63.523, I63.529, I63.531, I63.532, I63.533, I63.539, I63.541, I63.542, I63.543, I63.549, I63.59, I63.81, I63.89 I63.9
AND
Patient procedure during the performance period (CPT): 36223, 36224, 36225, 36226, 61645
Numerator
Patients with a mRs of 0 to 2 at 90 days
Definition:
The Modified Rankin Scale (mRs) -
The scale runs from 0-6, running from perfect health without symptoms to death.
0 - No symptoms
1 - No significant disability. Able to carry out all usual activities, despite some symptoms
2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities
3 - Moderate disability. Requires some help, but able to walk unassisted
4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted
5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent
6 - Dead
Numerator Options:
Performance Met: Patients with 90 day mRs score of 0 to 2 (G9646)
OR
Denominator Exception: Patients in whom mRs score could not be obtained at 90 day follow-up (G9647)
OR
Performance Not Met: Patients with 90 day mRs score greater than 2 (G9648)
Rationale
Patient outcomes following endovascular stroke therapy can be assessed using the mRS, a simple to administer scale that ascertains the degree of disability or dependence in the daily activities of patients suffering a stroke. The objective of endovascular therapy in stroke is to enable patients to maintain their independence in daily activities. Achieving a mRS of 2 or less after endovascular therapy is considered an excellent outcome following a stroke.
Clinical Recommendation Statements
The standard definition of a good clinical outcome from intra-arterial therapy is a modified Rankin Scale (mRS) score of 0-2 at 90 days as assessed by a certified examiner independent of the interventional physician. This measure is supported by the multispecialty guidelines published in 2013.