2017 MIPS Measure #278: Sleep Apnea: Positive Airway Pressure Therapy Prescribed

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of moderate or severe obstructive sleep apnea who were prescribed positive airway pressure therapy

Instruction

This measure is to be reported a minimum of once per performance period for patients with a diagnosis of sleep apnea 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 sleep apnea

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for sleep apnea (ICD-10-CM): G47.30, G47.33
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 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
Moderate or severe obstructive sleep apnea (apnea hypopnea index (AHI) or respiratory disturbance index (RDI) of 15 or greater): G8846

Numerator

Patients who were prescribed positive airway pressure therapy

Definition:
Moderate or severe sleep apnea – apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) greater than or equal to 15 episodes per hour of sleep

Numerator Options:
Performance Met: Positive airway pressure therapy prescribed (G8845)
OR
Denominator Exception: Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies used, patient declined, financial, insurance coverage) (G8849)
OR
Performance Not Met: Positive airway pressure therapy not prescribed, reason not given (G8850)