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 326, Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation 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 326, 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 326 Description

Percentage of patients aged 18 years and older with nonvalvular atrial fibrillation (AF) or atrial flutter who were prescribed warfarin OR another FDA-approved anticoagulant drug for the prevention of thromboembolism during the measurement period

This measure is to be submitted a minimum of once per performance period for patients with nonvalvular AF or atrial flutter 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 326:

All patients aged 18 years and older with a diagnosis of nonvalvular AF or atrial flutter who do not have a documented CHA₂DS₂-VASc risk score of 0 or 1

Patients aged ≥ 18 years on date of encounter

Diagnosis for nonvalvular atrial fibrillation or atrial flutter (ICD-10-CM): I48.0, I48.3, I48.4, I48.11, I48.19, I48.20, I48.21, I48.91, I48.92

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Patient with transient or reversible cause of AF (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac surgery): (G9929)

Patients who are receiving comfort care only: (G9930)

Documentation of CHA₂DS₂-VASc risk score of 0 or 1: (G9931)

Warfarin OR another FDA-approved oral anticoagulant is prescribed (G8967)

Documentation of medical reason(s) for not prescribing warfarin OR another FDA-approved anticoagulant (e.g., atrial appendage device in place) (G8968)

Documentation of patient reason(s) for not prescribing warfarin OR another FDA-approved oral anticoagulant that is FDA-approved for the prevention of thromboembolism (e.g., patient choice of having atrial appendage device placed) (G8969)

Documentation of system reason(s) for not prescribing warfarin OR another FDA-approved anticoagulation due to patient being currently enrolled in a clinical trial related to AF/atrial flutter treatment (G9927)