2024 MIPS Measure #205: HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, and Syphilis

Quality ID 205
NQF 0409
High Priority Measure No
Specifications Registry
Measure Type Process
Specialty Infectious Disease Pediatrics

Measure Description

Percentage of patients 13 years of age and older with a diagnosis of HIV who had tests for syphilis, gonorrhea, and chlamydia performed within the performance period.

 

Instructions

This measure is to be submitted a minimum of once per performance period for patients with HIV seen during the performance period. This measure is intended to reflect the quality of services provided for the primary management of patients with HIV. 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 (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) 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 13 years of age and older at the start of the performance period with a diagnosis of HIV before the end of the performance period with an eligible encounter during the performance period

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):

Patients aged ≥ 13 years at the start of the performance period

AND

Diagnosis for HIV before the end of the performance period (ICD-10-CM): B20, B97.35, Z21

AND

Patient encounters during the performance period (CPT or HCPCS): 98966, 98967, 98968, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99384*, 99385*, 99386*, 99387*, 99394*, 99395*, 99396*, 99397*, 99429*, 99441, 99442, 99443, G0438, G0439

 

Numerator

Patients who were tested for each of the following at least once during the performance period: syphilis, gonorrhea, and chlamydia

NUMERATOR NOTE: Submit G9228 when results are documented for all of the 3 screenings

Numerator Options:

Performance Met: Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) (G9228)

OR

Performance Not Met: Chlamydia, gonorrhea, and syphilis screening results not documented as performed, reason not given (G9230)

 

Rationale

The rates of syphilis, gonorrhea, and chlamydia cases per 100,000 in the United States have steadily risen over the last decade and increased 11.2%, 5.9%, and 2.8%, respectively, from 2018 to 2019 (DHHS, 2021). People with HIV are at an increased risk of bacterial sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis (CDC, 2004). However, early detection and treatment of bacterial STIs in people with HIV can lead to a reduction in HIV transmission (CDC, 2004). Despite guidelines for at least annual screening among sexually active persons with HIV, only an estimated 55% received a syphilis test in the past year, 23% received a gonorrhea test in the past year, and 24% received a chlamydia test in the past year based on a nationally-representative survey of adults with HIV receiving medical care in the United States (Flagg et al., 2015). This measure will help providers focus their attention and quality improvement efforts towards testing and treating sexually transmitted infections in patients with HIV, thus reducing the complications to long-term syphilis infection and reducing STI incidence (Patel et al., 2012)

 

Clinical Recommendation Statements

"Routine serologic screening for syphilis is recommended at least annually for all persons with HIV infection who are sexually active, with more frequent screening (i.e., every 3-6 months) for those who have multiple or anonymous partners" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).

"Patients undergoing screening or treatment for syphilis also should be evaluated for other sexually transmitted diseases such as chlamydia and gonorrhea at anatomic sites of exposure in men and for chlamydia, gonorrhea, and trichomonas in women" (Panel on Opportunistic Infections in Adults and Adolescents with HIV, 2022, p. Y-3).

"The USPSTF recommends screening for syphilis in persons who are at increased risk for infection. When deciding which persons to screen for syphilis, clinicians should consider the prevalence of infection in the communities they serve, as well as other sociodemographic and behavioral factors that may be associated with increased risk of syphilis infection. For example, prevalence of syphilis is higher in men, men who have sex with men, persons with HIV infection, young adults, and persons with a history of incarceration, sex work, or military service…. Optimal screening frequency for persons who are at increased risk for syphilis infection is not well established. Men who have sex with men or persons with HIV infection may benefit from screening at least annually or more frequently (e.g., every 3 to 6 months) if they continue to be at high risk" (USPSTF, 2022, p. 1244-1246).

"At the initial HIV care visit, providers should screen all sexually active persons for syphilis, gonorrhea, and chlamydia, and perform screening for these infections at least annually during the course of HIV care. Specific testing includes syphilis serology and [a nucleic acid amplification test] NAAT for N. gonorrhoeae and C. trachomatis at the anatomic site of exposure" (Workowski et al., 2021, p. 26).

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