| Measure Type | High Priority Measure? | Collection Type(s) |
|---|---|---|
| Outcome | yes | MIPS CQM |
Measure Description
Patients with physician-specific risk-standardized rates of procedural complications following the first time implantation of an ICD.
Instructions
This measure is to be submitted a minimum of once per performance period for patients with a first time implantation of an ICD during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
NOTE: Include only patients that have had first time implantation through November 30 for evaluation of complications for 30 days and September 30 for evaluation of complications for 90 days post procedure within the performance period.
This will allow the evaluation of ICD implant complications within the performance period.
This is a risk adjusted measure. Please refer to the “Hierarchical logistic regression” at the end of this specification. There are 2 performance rates to be calculated for this measure:
- Complications or mortality at 30 days
AND
- Complications at 90 days
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:
- Patients with first time implants with one or more complications or mortality within 30 days
AND
- Patients with first time implants with one or more complications within 90 days
The eligible clinician should submit data on both submission criteria 1 and 2 for a patient that meets the denominator.
SUBMISSION CRITERIA 1: ALL PATIENTS WITH FIRST TIME IMPLANTS WITH ONE OR MORE OF THE IDENTIFIED COMPLICATIONS OR MORTALITY WITHIN 30 DAYS
DENOMINATOR (SUBMISSION CRITERIA 1):Patients aged ≥ 65 years of age with a first time implantation of an ICD performed ≥ 31 days prior to the end of the performance period.
Denominator Criteria (Eligible Cases):
Patient aged ≥ 65 years on date of encounter
AND
Procedure code for Implantation of ICD (ICD-10-PCS): 0JH608Z, 0JH609Z, 0JH638Z, 0HJ639Z, 0JH808Z, 0JH809Z, 0JH838Z, or 0JH839Z
AND/OR
Patient encounter during performance period (CPT): 33240 or 33249, with or without 33216 or 33217
AND NOT
DENOMINATOR EXCLUSIONS:
Procedure code for removal of prior ICD (ICD-10-PCS): 0JPT0PZ, 0JPT3PZ
AND/OR
Procedure code for removal of prior ICD (CPT): 33241, 33262, 33263, 33264
–OR–
SUBMISSION CRITERIA 2: ALL PATIENTS WITH FIRST TIME IMPLANTS WITH ONE OR MORE OF THE IDENTIFIED COMPLICATIONS WITHIN 90 DAYS
DENOMINATOR (SUBMISSION CRITERIA 2):Patients aged ≥ 65 years of age with a first time implantation of an ICD performed ≥ 91 days prior to the end of the performance period.
Denominator Criteria (Eligible Cases):
Patient aged ≥ 65 years on date of encounter
AND
Procedure code for Implantation of ICD (ICD-10-PCS): 0JH608Z, 0JH609Z, 0JH638Z, 0JH808Z, 0JH809Z, 0JH838Z, 0JH839Z
AND/OR
Patient encounter code during performance period (CPT): 33240 or 33249, with or without 33216 or 33217
AND NOT
DENOMINATOR EXCLUSIONS:
Procedure code for removal of ICD (ICD-10-PCS): 0JPT0PZ or 0JPT3PZ
AND/OR
Procedure code for removal of ICD (CPT): 33241, 33262, 33263, 33264
Numerator
THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:
- Patients with first time implants with one or more complications or mortality within 30 days
AND
- Patients with first time implants with one or more complications within 90 days
The eligible clinician should submit data on both submission criteria 1 and 2 for a patient that meets the denominator.
SUBMISSION CRITERIA 1: ALL PATIENTS WITH FIRST TIME IMPLANTS WITH ONE OR MORE OF THE IDENTIFIED COMPLICATIONS OR MORTALITY WITHIN 30 DAYS
NUMERATOR (SUBMISSION CRITERIA 1):
Number of patients with one or more of the following complications or mortality within 30 days (depending on the complication) following ICD implantation
Numerator Instructions:
INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control, and therefore an inverse measure at 100% does not qualify for submitting purposes, however any performance rate less than 100% does qualify.
Definition:
Complications measured for 30 days:
- Death
- Pneumothorax or hemothorax plus a chest tube
- Hematoma plus a blood transfusion or evacuation
- Cardiac tamponade or pericardiocentesis
Numerator Options:
Performance Met:
Documentation of patient with one or more complications or mortality within 30 days (G9267)
OR
Performance Not Met:
Documentation of patient without one or more complications and without mortality within 30 days (G9269)
–OR–
SUBMISSION CRITERIA 2: ALL PATIENTS WITH FIRST TIME IMPLANTS WITH ONE OR MORE OF THE IDENTIFIED COMPLICATIONS WITHIN 90 DAYS
NUMERATOR (SUBMISSION CRITERIA 2):
Number of patients with one or more of the following complications within 90 days (depending on the complication) following ICD implantation
Numerator Instructions:
INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control, and therefore an inverse measure at 100% does not qualify for submitting purposes, however any performance rate less than 100% does qualify.
Definition:
Complications measured for 90 days:
- Mechanical complications requiring a system revision
- Device related infection
- Additional ICD implantation
Numerator Options:
Performance Met:
Documentation of patient with one or more complications within 90 days (G9268)
OR
Performance Not Met:
Documentation of patient without one or more complications within 90 days (G9270)