| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, Registry | Outcome | Yes | Person and Caregiver-Centered Experience and Outcomes | Dermatology |
Measure Description
Percentage of psoriasis patients receiving oral systemic or biologic therapy who meet minimal physician-or patient- reported disease activity levels. It is implied that establishment and maintenance of an established minimum level of disease control as measured by physician-and/or patient-reported outcomes will increase patient satisfaction with and adherence to treatment
Instruction
This measure is to be reported a minimum of once per performance period for all patients 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 psoriasis and treated with an oral systemic or biologic medication for psoriasis
Denominator Criteria (Eligible Cases):
All patients, regardless of age
AND
Diagnosis for psoriasis (ICD-10-CM): L40.0
AND
Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0438, G0439
WITHOUT
Telehealth Modifier: GQ, GT
AND
Patient has been treated with an oral systemic or biologic medication for psoriasis: G9764
Numerator
Patients who have a documented physician global assessment (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index (DLQI) that meet any one of the below specified benchmarks
Definition:
Consecutive Months – The consecutive treatment allows gaps in the medication treatment up to a total of 4 weeks during the 6 month period. Gaps can include periods in which the patient is changing or refilling medication, but regardless of the number of gaps, the total cannot be for more than 4 weeks.
Numerator Instructions: To satisfy this measure, a patient must achieve any ONE of the following:
•PGA (6-point scale) ≤ 2 (clear to mild skin disease)
•BSA < 3% (mild disease)
•PASI < 3 (no or minimal disease)
•DLQI ≤ 5 (no effect or small effect on patient’s quality of life)
Numerator Options:
Performance Met: Psoriasis assessment tool documented meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index) (DLQI)) (G9649)
OR
Denominator Exception: Documentation that the patient declined therapy change, has documented contraindications, or has not been treated with an oral systemic or biologic for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by PGA, BSA, PASI, or DLQI (G9765)
OR
Performance Not Met: Psoriasis assessment tool documented not meeting any one of the specified benchmarks (e.g., (PGA; 6-point scale), body surface area (BSA), psoriasis area and severity index (PASI) and/or dermatology life quality index) (DLQI)) or psoriasis assessment tool not documented (G9651)