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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
051 0091 Process Yes Effective Clinical Care Claims

Measure Description

Percentage of patients aged 18 years and older with a diagnosis of COPD who had spirometry results documented

Instructions

This measure is to be submitted a minimum of once per performance period using the most recent spirometry results in the patient record for all COPD patients seen during the performance period. Do not limit the search for spirometry results to 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.

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients with documented spirometry results in the medical record (FEV1 and FEV1/FVC)

Definition

Numerator Instructions: Look for most recent documentation of spirometry results in the medical record; do not limit the search to the performance period

Numerator Quality-Data Coding Options

Denominator Exclusion: 3023F with 1P:
Spirometry Results Not Documented for Medical, Patient, or System Reasons:

Append a modifier (1P, 2P or 3P) to CPT Category II code 3023F to submit for documented circumstances that appropriately exclude patients from the denominator.

Documentation of medical reason(s) for not documenting and reviewing spirometry results

OR

Denominator Exclusion: 3023F with 2P:

Documentation of patient reason(s) for not documenting and reviewing spirometry results

OR

Denominator Exclusion: 3023F with 3P:

Documentation of system reason(s) for not documenting and reviewing spirometry results

Performance Met: CPT II 3023F:
Spirometry Results Documented

Spirometry results documented and reviewed

Performance Not Met: 3023F with 8P:
Spirometry Results not Documented, Reason Not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 3023F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Spirometry results not documented and reviewed, reason not otherwise specified

Numerator note: Denominator Exception(s) are determined on the date of the denominator eligible encounter

Denominator

All patients aged 18 and older with a diagnosis of COPD

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – 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

 

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