CMS Measure ID 1: Diabetes: Hemoglobin A1c Poor Control

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Description

Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

Instructions

This measure is to be submitted a minimum of once per performance period for patients with diabetes seen during the performance period. The most recent quality-data code submitted will be used for performance calculation. 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: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

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

The patient is between 18 and 75 on the date of the appointment. This information can be entered in DrChrono in the patient chart under the Demographics tab with the Patient Date of Birth field.

DENOMINATOR NOTE: To assess the age for exclusions, the patient’s age at the end of the measurement period should be used.

AND

• An ICD-10 diagnosis for diabetes was documented in one of the ICD-10 entry points. See your Healthmonix MIPSpro account, the CMS website, or the attached document for a full list.
• A relevant CPT or HCPCS code for the encounter: 97802, 97803, 97804,99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, G0270, G0271, G0438, G0439

CPT and HCPCS codes can be entered into the billing section of the encounter. Below is an example from the appointment window.

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

AND NOT

DENOMINATOR EXCLUSION:

Hospice services provided to patients at any time during the measurement period: G9687
OR

Palliative care services provided to patient any time during the measurement period: G9988

OR

Patients age 66 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period: G2081
OR
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period: G2090
OR
Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period: G2091.

Please see your Healthmonix MIPSpro account, the attached document, the CMS website, or the attached document for a full list of codes that identify frailty and/or advanced illness.

Table: Dementia Exclusion Medications

Numerator

Patients whose most recent HbA1c level (performed during the measurement period) is > 9.0%

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.

Patient is numerator compliant if most recent HbA1c level 9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. Ranges and thresholds do not meet criteria for this indicator. A distinct numeric result is required for numerator compliance. Do not include HbA1c levels reported by the patient.

Numerator Options: The following codes can be entered in the CPT code section for the visit.

Performance Met: Most recent hemoglobin A1c level > 9.0% (3046F)

OR

Performance Met: Hemoglobin A1c level was not performed during the
measurement period (12 months) (3046F with 8P)

OR

Performance Not Met: Most recent hemoglobin A1c (HbA1c) level < 7.0% (3044F)

OR

Performance Not Met: Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% (3051F)

OR

Performance Not Met: Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% (3052F)