| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, Registry | Efficiency | Yes | Efficiency and Cost Reduction | Neurology |
Measure Description
Percentage of patients with a diagnosis of primary headache disorder whom advanced brain imaging was not ordered
Instruction
This measure is to be reported at each denominator eligible visit for patients with a diagnosis of primary headache during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Denominator
All patients with a diagnosis of primary headache
Denominator Criteria (Eligible Cases):
All patients, regardless of age
AND
Diagnosis for Primary Headache (ICD-10-CM): G43.001, G43.009, G43.011, G43.019, G43.101, G43.109, G43.111, G43.119, G43.401, G43.409, G43.411, G43.419, G43.501, G43.509, G43.511, G43.519, G43.701, G43.709, G43.711, G43.B0, G43.B1, G43.C0, G43.C1, G43.801, G43.809,G43.811, G43.819, G43.901, G43.909, G43.911, G43.919, G44.001, G44.009, G44.011, G44.019, G44.021, G44.029, G44.031, G44.039, G44.041, G44.049, G44.051, G44.059, G44.091, G44.099, G44.1, G44.201, G44.209, G44.211, G44.219, G44.221, G44.229, G44.51, G44.52, G44.53, G44.59, G44.81, G44.83, G44.84, G44.85, G44.89
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343,99344, 99345, 99347, 99348, 99349, 99350
WITHOUT
Telehealth Modifier: GQ, GT
AND
Patients with a normal neurological examination: G9535
Numerator
Patients with a normal neurological examination for whom advanced brain imaging Computed Tomography Angiography (CTA), Computed Tomography (CT), Magnetic Resonance Angiography (MRA), or Magnetic Resonance Imaging (MRI) was NOT ordered
Definition:
Normal Neurological Examination – Absence of signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered cognition), focalneurologic deficits, ataxia, pathologic neurologic reflexes (e.g., Babinski sign, clonus), signs of meningealirritation
Numerator Options:
Performance Met: Advanced brain imaging (CTA, CT, MRA or MRI) was NOT ordered (G9534)
OR
Denominator Exception: Documentation of Medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); HIV-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms) (G9536)
OR
Denominator Exception: Documentation of System reason(s) for ordering an advanced brain imaging study (i.e., needed as part of a clinical trial; other clinician ordered the study) (G9537)
OR
Performance Not Met: Advanced brain imaging (CTA, CT, MRA or MRI) was ordered (G9538)