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 249, Barrett’s Esophagus).

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 249, 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 #249 Description

Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia

This measure is to be submitted each time a patient’s surgical pathology report demonstrates Barrett’s Esophagus; however, only one quality-data code (QDC) per date of service for a patient is required. 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 249:

All surgical pathology biopsy reports for Barrett’s Esophagus

Diagnosis for Barrett’s esophagus (ICD-10-CM): K22.70, K22.710, K22.711, K22.719

Patient procedure during the performance period (CPT): 88305

Specimen site other than anatomic location of esophagus: G8797

Esophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading) (3126F)

Documentation of medical reason(s) for not submitting the histological finding of Barrett’s mucosa (e.g., malignant neoplasm or absence of intestinal metaplasia) (3126F with 1P)