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 320, Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients).

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 320, 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 320 Description

Percentage of patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. Performance for this measure is not limited to 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 services provided and the measure specific denominator coding. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into the measure.

Eligible Criteria for Measure 320:

All patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy

Patients aged 50 to 75 on date of encounter

Patient undergoing screening for malignant neoplasm of colon (ICD-10-CM): Z12.11

Patient procedure during the performance period (CPT or HCPCS): 44388, 45378, G0121

WITHOUT

Modifiers: 52, 53, 73, or 74

Recommended follow-up interval for repeat colonoscopy of at least 10 years documented in colonoscopy report (0528F)

Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is ≥ 66 years old, or life expectancy < 10 years old, other medical reasons) (0528F with 1P)