2021 MIPS Measure #410: Psoriasis: Clinical Response to Oral Systemic or Biologic Medications

Measure Description

Percentage of psoriasis vulgaris patients receiving systemic medication who meet minimal physician-or patient- reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment

Instructions

This measure is to be submitted a minimum of once per performance period for all patients during the performance period. The most recent denominator eligible encounter in which the numerator action was performed should be used. 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 with a diagnosis of psoriasis vulgaris and treated with a systemic medication

DENOMINATOR NOTE: For this measure, the patient must ONLY be diagnosed with psoriasis vulgaris (L40.0) and no other concurrent psoriasis diagnosis. Therefore, patients meet criteria when they have been diagnosed with psoriasis vulgaris AND are on a systemic medication PRESCRIBED BY THE PROVIDER BEING EVALUATED FOR THE MEASURE.

*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.

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Diagnosis for psoriasis vulgaris (ICD-10-CM): L40.0

AND

Patient encounter during the performance period (CPT or HCPCS): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0438, G0439

AND

Patient has been treated with a systemic medication for psoriasis vulgaris: G9764

Examples of Applicable Medications

Numerator

Patients who have a documented physician global assessment (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI) that meet any one of the below specified benchmarks

Definition:

Consecutive Months - The consecutive treatment allows gaps in the medication treatment up to a total of 4 weeks during the 6 month period. Gaps can include periods in which the patient is changing or refilling medication, but regardless of the number of gaps, the total cannot be for more than 4 weeks.

Numerator Instructions:

To satisfy this measure, a patient must achieve any ONE of the following:

• PGA (5-point OR 6-point scale) ≤ 2 (clear to mild skin disease)
• BSA < 3% (mild disease)
• PASI < 3 (no or minimal disease)
• DLQI ≤ 5 (no effect or small effect on patient’s quality of life)

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or medical reason(s) for not meeting specified benchmarks (e.g. patient declined change in medication, patient experience adverse effects, etc.) as further specified below.

Numerator Options:

Performance Met: Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (PGA; 5-point OR 6- point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) (G9649)

OR

Denominator Exception: Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI (G9765)

OR

Performance Not Met: Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 5-point OR 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI)) or psoriasis assessment tool not documented (G9651)

Rationale

A significant proportion of psoriasis patients who are receiving treatment remain unsatisfied with their therapies due to various reasons including lack of or loss of efficacy, side effects, and inconvenience, among others. Treatment dissatisfaction also contributes to patients discontinuing their medication. This measure evaluates the proportion of psoriasis vulgaris patients receiving systemic medication who meet minimal physician or patient-reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment.

Clinical Recommendation Statements

1. Treatment goals (assessment after 10 to 16 weeks, and every 8 weeks thereafter): PASI 75 or PGA of ‘clear’ or ‘almost clear’; or DLQI of 0 or 1 (Pathirana, 2009).
2. Minimum efficiency (‘lowest hurdle’): PASI 50; DLQI<5 or improvement by at least 5 points (Pathirana, 2009).
3. Continue therapy if PASI 75 response (or if PASI 50 response and DLQI≤5) (Mrowietz, 2011).
4. Adequate response to treatment is defined as either:
   1. PASI 50 response (or ≥50% improvement in BSA) and ≥5-point improvement in DLQI; or
   2. PASI 75 response (Smith, 2009).
5. Treatment ‘success’ defined as PASI 75 response (or PASI 50 response and DLQI≤5) (Baker, 2013).