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 195).

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 10, 195, 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 are should be reported only with the Medicare Payer Encounters.

How to code MIPS/PQRS Measure #195?

Measure Description: Percentage of final reports for carotid imaging studies (neck magnetic resonance angiography [MRA], neck computed tomography angiography [CTA], neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement.

For coding Measure 95, the Below CPT codes are only eligible to code. If any of the below CPT codes are missing then Measure 95 should not be coded.

36221, 36222, 36223, 36224, 37215, 37216*, 37217, 37218, 70498, 70547, 70548, 70549, 93880, 93882

Below post will help to know more about the above CPT codes.

Carotid Doppler CPT code 93880 & 93882 Coding guide

Coding guide for upper extremity catheterization CPT codes

The Measure 195 is used mainly to report the percentage or range of percentages of carotid stenosis.

If the Carotid imaging study report includes direct (  ICA stenosis of 50-60% by NASCET criteria) or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, Report code 3100F

Carotid imaging study report did not include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, reason not otherwise specified, Report code 3100F with 8P

If the finding are documented as  “No Stenosis” for carotid artery which is  determined through NASCET Criteria or comparable methodology, then also it can be considered as measurable performance, can be reported with 3100F code only. Below you can get the full information about NASCET Criteria.

Diagnostic criteria for examination, based on the NASCET Criteria (for Measure 195):

1. Normal: ICA PSV of 125 cm/s, no plaque, ICA/CCA PSV ratio <2.0, ICA EDV < 40 cm/s.
2. < 50% stenosis: ICA PSV of <125 cm/s, plaque estimate < 50%, ICA/CCA PSV ratio <2.0, ICA EDV < 40
cm/s.
3. 50-69% stenosis: ICA PSV of 125-230 cm/s, plaque estimate > 50%, ICA/CCA PSV ratio 2.0-4.0 , ICA EDV 40-100 cm/s.
4. Greater than or equal to 70% stenosis but less than occlusion: ICA PSV of >230 cm/s, plaque estimate > 50%, ICA/CCA PSV ratio >4.0 , ICA EDV >100 cm/s.