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 226, Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention).

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 226, 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 #226 Description

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user.

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure is intended to reflect the quality of services provided for preventive screening for tobacco use. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who provided the measure-specific denominator coding. For this implementation of the measure, the 24 month look back period includes the program year and the year prior. For Quality Payment Program (QPP) 2020, the 24 month period would be from 1/1/2019-12/31/2020.

Eligible Criteria for Measure 226:

All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period

Patients aged ≥ 18 years

At least two patient encounters during the performance period (CPT): 90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004, 92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557, 92625, 96156, 96158, 97165, 97166, 97167, 97168, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

OR

At least one preventive encounter during the performance period (CPT or HCPCS): 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, G0438, G0439

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Patient screened for tobacco use AND identified as a tobacco user (G9902)

Patient screened for tobacco use AND identified as a tobacco non-user (G9903)

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) (G9904)

Patient not screened for tobacco use, reason not given (G9905)

Patient identified as a tobacco user received tobacco cessation intervention (counseling and/or pharmacotherapy) (G9906)

Documentation of medical reason(s) for not providing tobacco cessation intervention (e.g., limited life expectancy, other medical reason) (G9907)

Patient identified as tobacco user did not receive tobacco cessation intervention (counseling and/or pharmacotherapy), reason not given (G9908)

Patient screened for tobacco use AND received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (4004F)

Current tobacco non-user (1036F)

Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason) (4004F with 1P)

Documentation of medical reason(s) for not providing tobacco cessation intervention if identified as a tobacco user (e.g., limited life expectancy, other medical reason) (G9909)