ICD-10-CM Quality Payment Program Measures
Quality Measures are a set of tools under the Medicare program used to measure or quantify healthcare processes, outcomes, patient perceptions, and systems associated with the ability to provide high-quality health care.
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients
Description: Percentage of patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report.
High Priority: YES
Linked ICD-10 Codes:
Barrett's Esophagus
Description: Percentage of esophageal biopsy reports that document the presence of Barrett's mucosa that also include a statement about dysplasia.
High Priority: NO
Linked ICD-10 Codes:
Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older
Description: Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication.
High Priority: YES
Linked ICD-10 Codes:
Controlling High Blood Pressure
Description: Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period.
High Priority: YES
Linked ICD-10 Codes:
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.
High Priority: YES
Linked ICD-10 Codes:
Lung Cancer Reporting (Biopsy/Cytology Specimens)
Description: Pathology reports based on lung biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following the International Association for the Study of Lung Cancer (IASLC) guidance or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.
High Priority: YES
Linked ICD-10 Codes:
Lung Cancer Reporting (Resection Specimens)
Description: Pathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer (NSCLC), histologic type.
High Priority: YES
Linked ICD-10 Codes:
Melanoma Reporting
Description: Pathology reports for primary malignant cutaneous melanoma that include the pT category, thickness, ulceration and mitotic rate, peripheral and deep margin status and presence or absence of microsatellitosis for invasive tumors.
High Priority: YES
Linked ICD-10 Codes:
Osteoporosis Management in Women Who Had a Fracture
Description: The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.
High Priority: NO
Linked ICD-10 Codes:
Performing Cystoscopy at the Time of Hysterectomy for Pelvic Organ Prolapse to Detect Lower Urinary Tract Injury
Description: Percentage of patients who undergo cystoscopy to evaluate for lower urinary tract injury at the time of hysterectomy for pelvic organ prolapse.
High Priority: YES
Linked ICD-10 Codes:
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care
Description: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) whose glaucoma treatment has not failed (the most recent IOP was reduced by at least 15% from the pre-intervention level) OR if the most recent IOP was not reduced by at least 15% from the pre-intervention level, a plan of care was documented within the 12 month performance period.
High Priority: YES
Linked ICD-10 Codes:
Radical Prostatectomy Pathology Reporting
Description: Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.
High Priority: NO
Linked ICD-10 Codes:
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness
Description: Percentage of patients aged birth and older referred to a physician (preferably a physician specially trained in disorders of the ear) for an otologic evaluation subsequent to an audiologic evaluation after presenting with acute or chronic dizziness.
High Priority: YES
Linked ICD-10 Codes:
