Measure Description
Percent of asymptomatic patients undergoing Carotid Endarterectomy (CEA) or Carotid Artery Stenting (CAS) without major complication who are discharged to home no later than post-operative day #2.
Instructions
This measure is to be submitted each time a CEA or CAS is performed during the performance period. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide services of CEA or CAS, as described in the measure, based on the services provided and the measure-specific denominator coding will submit this measure.This measure may be submitted by MIPS eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
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
Patients aged 18 years and older who are asymptomatic undergoing a CEA or CAS procedure
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 18 and older
AND
Patient procedure during performance period (CPT): 35301, 37215, 37216*
AND NOT
DENOMINATOR EXCLUSIONS:
Symptomatic carotid stenosis: Ipsilateral carotid territory TIA or stroke less than 120 days prior to procedure: 9006F
OR
Other carotid stenosis: Ipsilateral TIA or stroke 120 days or greater prior to procedure or any prior contralateral carotid territory or vertebrobasilar TIA or stroke: 9007F
Numerator
Patients discharged to home no later than post-operative day 2 following CEA or CAS
Definition:
Home – For purposes of submitting this measure, “home” is the point of origin prior to hospital admission for procedure of CEA or CAS. For example, if the patient comes from a skilled facility and returns to the skilled facility post CEA or CAS, this would meet criteria for discharged to home.
Numerator Options:
Performance Met: Documentation of patient discharged to home no later than post-operative day 2 following CEA or CAS (G9255)
OR
Performance Not Met: Documentation of patient discharged to home later than post-operative day 2 following CEA or CAS (G9254)
Rationale
Surgeons performing CEA or CAS on asymptomatic patients must select patients at low risk for morbidity and perform the procedure with a very low complication rate in order to achieve benefit. Discharge to home within two days of the procedure is an indicator of patients who were not frail prior to the procedure and who did not experience a major complication (e.g., disabling stroke,myocardial infarction). The proposed measure will therefore serve as an indicator of both appropriateness and overall outcome.
Clinical Recommendation Statements
The committee recommends CEA as the first-line treatment for symptomatic low-risk surgical patients with stenosis of 50% to 99% and asymptomatic patients with stenosis of 70% to 99%. The perioperative risk of stroke and death in asymptomatic patients must be <3% to ensure benefit for the patient