| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, Registry | Process | No | Effective Clinical Care |
Measure Description
Percentage of patients aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%) and who have an FEV1 less than 60% predicted and have symptoms who were prescribed an long-acting inhaled bronchodilator
Instruction
This measure is to be reported a minimum of once per performance period for all COPD patients seen 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 aged 18 years and older with a diagnosis of COPD (FEV1/FVC < 70%), who have an FEV1 < 60% predicted and have symptoms (e.g., dyspnea, cough/sputum, wheezing)
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for COPD (ICD-10-CM): J41.0, J41.1, J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, J44.9
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212,
99213, 99214, 99215
WITHOUT
Telehealth Modifier: GQ, GT
AND
Spirometry test results demonstrate FEV1/FVC < 70%, FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): G8924
Numerator
Patients who were prescribed a long-acting inhaled bronchodilator
Definition:
Prescribed – Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.
Numerator Options:
Performance Met: Long-acting inhaled bronchodilator prescribed (G9695)
OR
Denominator Exception: Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (G9696)
OR
Denominator Exception: Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (G9697)
OR
Denominator Exception: Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (G9698)
OR
Performance Not Met:
Long-acting inhaled bronchodilator not prescribed, reason not otherwise specified (G9699)