Measure Description
Percentage of all patients with a diagnosis of Parkinson’s Disease who were referred to physical, occupational, speech, or recreational therapy once during the measurement period.
Instructions
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of Parkinson’s 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 with a diagnosis of Parkinson’s disease
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.
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for Parkinson’s disease (ICD-10-CM): G20
AND
Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 97165, 97166, 97167, 97168, 97161, 97162, 97163, 97164, 92521, 92522, 92523, 92524, 92526, 99421, 99422, 99423, 99441, 99442, 99443, 99483
Numerator
Patients who were referred to physical, occupational, speech, or recreational therapy once during the measurement period
Numerator Options:
Performance Met: Referral to physical, occupational, speech, or recreational therapy (G0042)
OR
Denominator Exception: Patient and/or care partner decline referral (G0041)
OR
Denominator Exception: Clinician determines patient does not require referral (G0038)
OR
Denominator Exception: Patient already receiving physical/occupational/speech/recreational therapy during the measurement period (G0040)
OR
Performance Not Met: Patient not referred, reason not otherwise specified (G0039)
Rationale
For those patients with Parkinson’s disease who have impaired activities of daily living, therapy options such as physical, occupational, and speech therapy should be offered. Rehabilitative therapies play an important role in improving function and quality of life for these patients. Symptomatic therapy can provide benefit for many years. Patients with Parkinson’s disease commonly develop dysarthria.
AAN QSS Neuro Alt (April 2006) Suchowersky O, Gronseth G, Perlmutter J, Reich S, Zesiewicz T, Weiner
WJ, Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006 Apr 11; 66(7):976-82.
Factor, S. Weiner, W. Parkinson’s disease: Diagnosis and Clinical Management. 2002
Clinical Recommendation Statements
- Physiotherapy should be available for people with PD. Particular consideration should be given to:
- gait re-education, improvement of balance and flexibility; enhancement of aerobic capacity; improvement of movement initiation; improvement of functional independence, including mobility and activities of daily living;
- provision of advice regarding safety in the home environment. (Level B)(1)
- Occupational therapy should be available for people with PD. Particular consideration should be given to:
- maintenance of work and family roles, home care and leisure activities; improvement and maintenance of transfers and mobility; improvement of personal self-care activities, such as eating, drinking, washing, and dressing; cognitive assessment and appropriate intervention. (Level D)(1)
- Speech and language therapy should be available for people with PD. Particular consideration should be given to: -Improvement of vocal loudness and pitch range, including speech therapy programs such as Lee Silverman Voice Treatment (LSVT) (Level B)(1)
- For patients with Parkinson’s disease complicated by dysarthria, speech therapy may be considered to improve speech volume (Level C). Different exercise modalities, including multidisciplinary rehabilitation, active music therapy, treadmill training, balance training, and "cued" exercise training are probably effective in improving functional outcomes for patients with Parkinson’s disease. For patients with Parkinson’s disease, exercise therapy may be considered to improve function (Level C). (2)
- The results of this systematic review have suggested that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson’s disease, but carryover of these benefits may not occur in all measures of physical performance. We recommend that progressive resistance exercise should be implemented into clinical practice as a therapy for Parkinson’s disease, particularly when the aim is improving walking capacity in such people. (3)