Reviewing Quality Measures for Changes

By CodingStrategies on March 17th, 2017

Although the list of approved quality measures was published in the final rule, the 2017 specifications for each measure were not published until late December 2016 and additional updates have been published in January and February of this year.  Finally, the Measure Specification Release Notes were published February 13, 2017 which provides a complete list of the revisions made for each measure. Even if the measures you have been reporting are still active measures, it is important to review the release notes to determine if any of your selected measures have revisions. In addition to adding/deleting CPT® and diagnosis codes, the measures frequently update the denominator and numerator to include clarifying information based on questions received throughout the prior year.   

As an example, below is a comparison of the 2016 and 2017 Measure Specifications for measure 145, the “fluoroscopy measure.” 

 

 
2016
2017
Title
Radiology: Exposure Time Reported for Procedures Using Fluoroscopy
Radiology: Exposure Dose or Time Reported for Procedures Using Fluoroscopy
Denominator Note
 
(added) * 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 registry-based measures.
Numerator Definition
Radiation exposure indices – for the purposes of this measure, radiation exposure indices should, if possible, include at least one of the following:
  1. Skin dose mapping
  2. Peak skin dose (PSD)
  3. Reference air kerma (Ka,r)
  4. Kerma-area product (PKA)

If the fluoroscopic equipment does not automatically provide any of the above radiation exposure indices, exposure time and the number of fluorographic images taken during the procedure may be used.

Radiation exposure indices – for the purposes of this measure, radiation exposure indices should, if possible, include at least one of the following:
  1. Skin dose mapping
  2. Peak skin dose (PSD)
  3. Reference air kerma (Ka,r)
  4. Kerma-area product (PKA)
When Reporting indices the report must clearly state what radiation quantity is being reported, that is only reporting dose in mGy is insufficient. PDS in mGy is very different from Ka,r in mGy. As an example, PSD = 10mGy or Ka,r = 10mGy.

If the fluoroscopic equipment does not automatically provide any of the above radiation exposure indices, exposure time and the number of fluorographic images taken during the procedure may be used.

Numerator Note
 
(added) In interventional radiology procedures with runs, dose indices are displayed on the console and in the radiation dose structured report (RDSR). For instruments without dose indicator capability, report the overall fluoroscopic time and the number of runs done where additional exposure (fluoroscopic or x-ray) occurs.

"Last image hold" is part of the fluoroscopic exam and would be included in the total fluoroscopic time. No additional radiation is involved, so the image would not be counted.

Count images where the patient received or potentially received any exposure, fluorographic or radiographic (x-ray).

CPT/HCPCS
 
(added) 22526, 36901, 36902, 36903, 36904, 36905, 36906, 37216, 37246, 37247, 37248, 37249, 61640, 62303, G0122
(deleted) 22510, 22511, 22513, 22514, 36147, 74250, 75791, 75962, 75966, 75978
Numerator Options
G9500 – Radiation exposure indices, exposure time or number of fluorographic images in final report for procedures using fluoroscopy, documented
G9501 - Radiation exposure indices, exposure time or number of fluorographic images not documented in final report for procedures using fluoroscopy, reason not given
G9500 – Radiation exposure indices OR  exposure time and number of fluorographic images in final report for procedures using fluoroscopy, documented
G9501 - Radiation exposure indices OR exposure time and number of fluorographic images not documented in final report for procedures using fluoroscopy, reason not given

 

When reviewing the changes made to the measure, in addition to the CPT® code changes and numerator reporting options, it is important to note the changes in the Numerator Definition. This section describes the documentation requirements for meeting the performance criteria.  In 2017  the statement that a numeric dose alone is not sufficient to meet the documentation requirements and that the report must contain the numeric dose and the “radiation quantity” was added for clarification.  Also added for 2017 is an additional Numerator Note that provides more guidance on counting images for interventional procedures. 

It is important to review your current documentation practice for this measure and ensure that it will continue to meet the performance criteria with these revisions. If not, this information needs to be shared with the physicians to determine how documentation can be revised going forward.