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.

Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use

Description: Percentage of patients aged 2 years and older with a diagnosis of AOE who were not prescribed systemic antimicrobial therapy.

High Priority: YES

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Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Description: Percentage of patients aged 50 years and older with a diagnosis of age-related macular degeneration (AMD) who had a dilated macular examination performed which included documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage AND the level of macular degeneration severity during one or more office visits within the 12 month performance period.

High Priority: NO

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Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

Description: Percentage of patients aged 50 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

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Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy

Description: Percentage of patients aged 18 years and older with nonvalvular atrial fibrillation (AF) or atrial flutter who were prescribed warfarin OR another FDA-approved oral anticoagulant drug for the prevention of thromboembolism during the measurement period.

High Priority: NO

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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

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Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy

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.

High Priority: NO

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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

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Controlling High Blood Pressure

Description: Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

High Priority: YES

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Diabetes: Eye Exam

Description: Percentage of patients 18-75 years of age with diabetes and an active diagnosis of retinopathy overlapping the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or diabetics with no diagnosis of retinopathy overlapping the measurement period who had a retinal or dilated eye exam by an eye care professional during the measurement period or in the 12 months prior to the measurement period.

High Priority: NO

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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

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Emergency Medicine: Emergency Department Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years

Description: Percentage of emergency department visits for patients aged 2 through 17 years who presented with a minor blunt head trauma who had a head CT for trauma ordered by an emergency care provider who are classified as low risk according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for traumatic brain injury.

High Priority: YES

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Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy

Description: Percentage of all patients of childbearing potential (12 years and older) diagnosed with epilepsy who were counseled at least once a year about how epilepsy and its treatment may affect contraception and pregnancy.

High Priority: NO

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Lung Cancer Reporting (Biopsy/Cytology Specimens)

Description: Pathology reports based on biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.

High Priority: YES

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Lung Cancer Reporting (Resection Specimens)

Description: Pathology reports based on 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

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Melanoma Reporting

Description: Pathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness, ulceration and mitotic rate.

High Priority: YES

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Osteoporosis Management in Women Who Had a Fracture

Description: The percentage of women age 50-85 who suffered a fracture in the six months prior to the performance period through June 30 of the performance period and who either had a bone mineral density test or received a prescription for a drug to treat osteoporosis in the six months after the fracture.

High Priority: NO

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Overuse of Imaging for the Evaluation of Primary Headache

Description: Percentage of patients for whom imaging of the head (CT or MRI) is obtained for the evaluation of primary headache when clinical indications are not present.

High Priority: YES

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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

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Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Description: Percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 months.

High Priority: NO

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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

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Quality of Life Assessment For Patients With Primary Headache Disorders

Description: Percentage of patients with a diagnosis of primary headache disorder whose health related quality of life (HRQoL) was assessed with a tool(s) during at least two visits during the 12 month measurement period AND whose health related quality of life score stayed the same or improved.

High Priority: YES

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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

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Radiology: Inappropriate Use of "Probably Benign" Assessment Category in Screening Mammograms

Description: Percentage of final reports for screening mammograms that are classified as "probably benign".

High Priority: YES

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Radiology: Reminder System for Screening Mammograms

Description: Percentage of patients undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram.

High Priority: YES

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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

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Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain

Description: Percentage of pregnant female patients aged 14 to 50 who present to the emergency department (ED) with a chief complaint of abdominal pain or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound to determine pregnancy location.

High Priority: NO

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Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older

Description: Percentage of female patients aged 65 years and older with a diagnosis of urinary incontinence with a documented plan of care for urinary incontinence at least once within 12 months.

High Priority: YES

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