| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Registry | Outcome | Yes | Effective Clinical Care | Allergy/Immunology, General Practice/Family Medicine |
Measure Description
Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by one of three age appropriate patient reported outcome tools and not at risk for exacerbation
Instruction
This measure is to be reported a minimum of once per performance period for all patients with a diagnosis of asthma seen during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure for the primary management of patients with asthma based on the services provided and the measure-specific denominator coding.
Denominator
This measure will be calculated with 7 performance rates:
1.Overall Percentage for patients (aged 5-50 years) with well-controlled asthma, without elevated risk of exacerbation.
2.Percentage of pediatric patients (aged 5-17 years) with well-controlled asthma, without elevated risk of exacerbation.
3.Percentage of adult patients (aged 18-50 years) with well-controlled asthma, without elevated risk of exacerbation.
4.Asthma well-controlled (take the most recent ACT) for patients 5 to 17 with Asthma
5.Asthma well-controlled (take the most recent ACT) for patients 18 to 50 with Asthma
6.Patient not at elevated risk of exacerbation for patients 5 to 17 with Asthma
7.Patient not at elevated risk of exacerbation for patients 18 to 50 with Asthma
DENOMINATOR (REPORTING CRITERIA 1):
Patients ages 5 to 17 with asthma
Denominator Criteria (Eligible Cases) 1:
Patients aged 5-17 years
AND
Diagnosis for asthma (ICD-10-CM): J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
AND
At least two visits for asthma over the last two years with at least one visit for any reason in
the last 12 months
AND NOT
DENOMINATOR EXCLUSIONS:
Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure (ICD-10-CM): E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3
OR
Patient died prior to the end of the measurement period
OR
Patient was a permanent nursing home resident
OR
Patient was in hospice or receiving palliative care services at any time during the measurement period
DENOMINATOR (REPORTING CRITERIA 2):
Patients ages 18 to 50 with asthma
Denominator Criteria (Eligible Cases) 2:
Patients aged 18-50 years
AND
Diagnosis for asthma (ICD-10-CM): J45.20, J45.21, J45.22, J45.30, J45.31, J45.32, J45.40, J45.41, J45.42, J45.50, J45.51, J45.52, J45.901, J45.902, J45.909, J45.990, J45.991, J45.998
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
AND
At least two visits for asthma over the last two years with at least one visit for any reason in
the last 12 months
AND NOT
DENOMINATOR EXCLUSIONS:
Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure (ICD-10-CM): E84.0, E84.11, E84.19, E84.8, E84.9, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9, J68.4, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.2, J98.3
OR
Patient Died Prior to the End of the Measurement Period
OR
Patient was a Permanent Nursing Home Resident
OR
Patient was in Hospice or Receiving Palliative Care Services at any time During the Measurement Period
Numerator
This measure will be calculated with 7 performance rates:
1.Overall Percentage for patients (aged 5-50 years) with well-controlled asthma, without elevated risk of exacerbation.
2.Percentage of pediatric patients (aged 5-17 years) with well-controlled asthma, without elevated risk of exacerbation.
3.Percentage of adult patients (aged 18-50 years) with well-controlled asthma, without elevated risk of exacerbation.
4.Asthma well-controlled (take the most recent ACT) for patients 5 to 17 with Asthma
5.Asthma well-controlled (take the most recent ACT) for patients 18 to 50 with Asthma
6.Patient not at elevated risk of exacerbation for patients 5 to 17 with Asthma
7.Patient not at elevated risk of exacerbation for patients 18 to 50 with Asthma
NUMERATOR (ALL OR NOTHING):
The number of asthma patients who meet ALL of the following targets
Numerator Options:
Each component should be reported in order to determine the data completeness and performance rate for the overall percentage of patients that meet ALL targets represented as the numerator.
COMPONENT 1:
Asthma well-controlled (take the most recent asthma control tool available during the measurement period)
• Asthma Control TestTM (ACT) score of 20 or above – ages 12 and older
• Childhood Asthma Control Test (C-ACT) score of 20 or above – ages 11 and younger
• Asthma Control Questionnaire (ACQ) score of 0.75 or lower – ages 17 and older
• Asthma Therapy Assessment Questionnaire (ATAQ) score of 0 – Pediatric (ages 5 – 17) or Adult (ages 18 and older)
Component Options:
Performance Met: Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented (G9432)
OR
Performance Not Met: Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, OR specified asthma control tool not used, reason not given (G9434)
AND
COMPONENT 2:
Patient not at elevated risk of exacerbation
NUMERATOR NOTE: To meet performance for this component, documentation of the sum of the patients reported values for the following questions must be less than two:
• Number of emergency department visits not resulting in a hospitalization due to asthma in last 12 months
• Number of inpatient hospitalizations requiring an overnight stay due to asthma in last 12 months.
Component Options:
Performance Met: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months (G9521)
OR
Performance Not Met: Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months OR patient not screened, reason not given (G9522)
–OR–
NUMERATOR (ALL OR NOTHING):
The number of asthma patients who meet ALL of the following targets
Numerator Options:
Each component should be reported in order to determine the data completeness and performance rate for the overall percentage of patients that meet ALL targets represented as the numerator.
COMPONENT 1:
Asthma well-controlled (take the most recent asthma control tool available during the measurement period)
•Asthma Control TestTM (ACT) score of 20 or above – ages 12 and older
•Asthma Control Questionnaire (ACQ) score of 0.75 or lower – ages 17 and older
•Asthma Therapy Assessment Questionnaire (ATAQ) score of 0 – Pediatric (ages 5 – 17) or Adult(ages 18and older)
Component Options:
Performance Met: Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented (G9432)
OR
Performance Not Met: Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, OR specified asthma control tool not used, reason not given (G9434)
AND
COMPONENT 2:
Patient not at elevated risk of exacerbation
NUMERATOR NOTE: To meet performance for this component, documentation of the sum of the patients reported values for the following questions must be less than two:
• Number of emergency department visits not resulting in a hospitalization due to asthma in last 12 months
• Number of inpatient hospitalizations requiring an overnight stay due to asthma in last 12 months
Component Options:
Performance Met: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months (G9521)
OR
Performance Not Met: Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months OR patient not screened, reason not given (G9522)