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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
052 0102 Process No Effective Clinical Care Registry

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 a long-acting inhaled bronchodilator

Instructions

This measure is to be submitted a minimum of once per performance period for all COPD patients seen 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.

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 who were prescribed a long-acting inhaled bronchodilator

Definition

Prescribed – Includes patients who were prescribed medication at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.

Numerator Quality-Data Coding Options

Denominator Exclusion: G9696:
Patient Not Documented to have Long-Acting Inhaled Bronchodilator Prescribed for Medical,
Patient, or System Reasons
:

(Two quality-data codes [G9696, G9697, or G9698 & G8924] are required on the claim form to submit this numerator option)

Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator

OR

Denominator Exclusion: G9697:

Documentation of patient reason(s) for not prescribing along-acting inhaled bronchodilator

OR

Denominator Exclusion: G9698:

Documentation of system reason(s) for not prescribing along-acting inhaled bronchodilator

AND

G8924:

Spirometry test results demonstrate FEV1/FVC < 70%,FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing)

Performance Met: G9695:
Patient Prescribed Long-Acting Inhaled Bronchodilator Therapy

 

(Two quality-data codes [G9695 & G8924] are required on the claim form to submit this numerator option)

Long-acting inhaled bronchodilator prescribed

AND

G8924

Spirometry test results demonstrate FEV1/FVC < 70%,FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing)

Performance Not Met: G9699:
Patient not Documented to have Long Acting Inhaled Bronchodilator Prescribed, Reason Not Otherwise Specified

 

(Two quality-data codes [G9699 & G8924] are required on the claim form to submit this numerator option)

Long-Acting inhaled bronchodilator not prescribed,reason not otherwise specified

AND

G8924

Spirometry test results demonstrate FEV1/FVC < 70%,FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing)

Numerator note: The correct combination of numerator code(s) must be submitted on the claim form in order to properly submit this measure. The “correct combination” of codes may require the submission of multiple numerator codes. Denominator Exception(s) are determined on the date of the denominator eligible encounter.

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)

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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