| Measure Type | High Priority Measure? | NQS Domain |
|---|---|---|
| Efficiency | No | Efficiency and Cost Reduction |
| Data Submission Method(s) | ||
| Claims, Registry | ||
Measure Description
Percentage of patients with a diagnosis of primary headache disorder whom advanced brain imaging was not ordered
Instructions
This measure is to be submitted at each denominator eligible visit for patients with a diagnosis of primary headache during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission:
The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.
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, 95, POS 02
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), focal neurologic deficits, ataxia, pathologic neurologic reflexes (e.g., Babinski sign, clonus), signs of meningeal irritation
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)