What is MIPS or PQRS Measure?

The Physician Quality Reporting System (PQRS) was a reporting program of the Centers for Medicare and Medicaid Services (CMS). It gave eligible professionals (EPs) the opportunity to assess the quality of care they were providing to their patients, helping to ensure that patients get the right care at the right time. Now it is called as Merit-based Incentive Payment System (MIPS) Quality Measures. Today we will learn about coding Measures (Measure 052, Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy).

The Merit-based Incentive Payment System (MIPS) track of Medicare’s Quality Payment Program (QPP) includes four performance categories: quality, cost, improvement activities, and promoting interoperability (PI). The quality performance category requires clinicians to report on six measures, including at least one outcome measure. Since most family physicians will participate in MIPS and therefore are required to report quality measures, it is important they select measures appropriate for their practice needs and capabilities.

Measure specifications are detailed descriptions and instructions for each measure, and include definitions of the action/outcome required (numerator), population being measured (denominator), exceptions/exclusions to the measure, measure codes, and other details needed to correctly collect data and report the measure. Their are different Measures like Measure 052, 014, 021, 145, 146, 225 etc, which has to be coded only to specific CPT codes. We will learn specifically for each measure in detail. 

Remember: These Measures should be used only with Medicare Payer Encounters.

MIPS/PQRS Measure #052 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 an long-acting inhaled bronchodilator

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 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.

Eligible Criteria for Measure 052:

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)

Patients aged ≥ 18 years on date of encounter

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

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

Telehealth Modifier: GQ, GT, 95, POS 02

Spirometry test results demonstrate FEV1/FVC < 70%, FEV1 < 60% predicted and patient has COPD symptoms (e.g., dyspnea, cough/sputum, wheezing): G8924

Patients who were prescribed a long-acting inhaled bronchodilator

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.

Long-acting inhaled bronchodilator prescribed (G9695)

Documentation of medical reason(s) for not prescribing a long-acting inhaled bronchodilator (G9696)

Documentation of patient reason(s) for not prescribing a long-acting inhaled bronchodilator (G9697)

Documentation of system reason(s) for not prescribing a long-acting inhaled bronchodilator (G9698)