Otolaryngology Coding Alert

Plus, don’t let Specialty Measure Set limit your physician’s maximum payment adjustment.

It’s imperative that coders, physicians, and even practice managers are on the exact same page when it comes to Merit-based Incentive Payment System (MIPS) reporting. That’s because the financial repercussions at stake are substantial. For instance, a physician’s quality reporting for 2019 could yield a +/- 7 percent payment adjustment.

That’s why it’s absolutely pertinent that otolaryngology coders are fluent with each of the numerous MIPS quality measures at their disposal.

Keep your MIPS reporting in check by considering these additional otolaryngology-specific measures.

Add These MIPS Measures to Your Coding Arsenal

First, refresh your knowledge of MIPS guidelines by going over two key MIPS reporting rules:

• “Submit collected data for at least six measures, or a complete specialty measure set; and
• “One of these measures should be an outcome measure; if you have no applicable outcome measure, you can submit another high priority measure instead.”

To consider: The MIPS measures discussed in this article are to be included along with and in addition to the measures referenced in the prior Otolaryngology Coding Alert Volume 19, Number 6 article titled “Putting MIPS to the Test.”

In addition to Quality ID #398: Optimal Asthma Control, you’ll want to have a look at Quality ID #444: Medication Management for People with Asthma:

• Description: The percentage of patients 5 to 64 years of age during the measurement year who were identified as having persistent asthma and were dispensed appropriate medications that they remained on for at least 75 percent of their treatment period
• Performance met: G9432 — Asthma well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score and results documented Performance not met: G9434 — Asthma not well-controlled based on the ACT, C-ACT, ACQ, or ATAQ score, or specified asthma control tool not used, reason not given.

Next, get acclimated with Quality ID #66: Appropriate Testing for Children with Pharyngitis:

• Description: Percentage of children 3 to 18 years of age who were diagnosed with pharyngitis, ordered an antibiotic, and received a group A streptococcus (strep) test for the episode
• Performance met: 3210F — Group A Strep Test Performed (PHAR)
• Performance not met: 3210F with modifier 8P (Reporting modifier – action not performed, reason not otherwise specified) — Group A Strep Test not Performed, reason not otherwise specified.

Misconception: As you’ll see with Quality ID #66, the list of specialties referenced under “Details” does not include the otolaryngology specialty. But not to worry; you don’t need to see your designated specialty in this section in order to report the MIPS code.

“When selecting measures, don’t feel restricted by the specialty measure set,” suggests Katherine Becker, JD, LLM, CHC, CHPC, CPC, vice president of corporate compliance at St. Luke’s Hospital in Duluth, Minnesota.

“There are often measures that are applicable for your patients that, for various reasons, CMS left out of the measure set. For example, Appropriate Testing for Children with Pharyngitis may be applicable to your patient population even though it is not listed under the Otolaryngology specialty set. Referencing the specialty measure set is a great starting point when choosing measures, but it can be helpful to look at the rest of the measures to see if there are other options that may be clinically relevant or a better choice based on the tools and resources available,” Becker advises.

Note Additional Reporting Criteria for Sleep Apnea Patients

Finally, for sleep apnea patients, you’ll want to consider Quality ID #277: Sleep Apnea: Severity Assessment at Initial Diagnosis:

• Description: Percentage of patients aged 18 years and older with a diagnosis of obstructive sleep apnea who had an apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) measured at the time of initial diagnosis
• Performance met: G8842 — Apnea hypopnea index (AHI) or respiratory disturbance index (RDI) measured at the time of initial diagnosis
• Performance not met: G8844 — Apnea hypopnea index (AHI) or respiratory disturbance index (RDI) not measured at the time of initial diagnosis, reason not given.

Additionally, for this measure, when an AHI or RDI is not measured at the time of an initial sleep apnea diagnosis, you may report G8843 (Documentation of reason(s) for not measuring an apnea hypopnea index (AHI) or a respiratory disturbance index (RDI) at the time of initial diagnosis (e.g., psychiatric disease, dementia, patient declined, financial, insurance coverage, test ordered but not yet completed)).

Consider a Few More ENT-Specific Measures

These are just a few of the measures that you should be considering including in your practice in order to optimize physician reimbursement for the upcoming calendar years (CYs). Here’s a list of a few more MIPS measures that you should be documenting under the appropriate circumstances:

• Quality ID #116 — Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis
• Quality ID #265 — Biopsy Follow-Up
• Quality ID #52 — Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy
• Quality ID #130 — Documentation of Current Medications in the Medical Record
• Quality ID #261 — Referral for Otologic Evaluation »for Patients with Acute or Chronic Dizziness.

Coder’s note: In order to fully understand what’s required for each measure, you should have a look at each respective measure’s specifications at the CMS website (https://qpp.cms.gov/mips/explore-measures/quality-measures). Here, you’ll have access to additional information including Denominator, Definitions, and Rationale.

“You may consider checking out Reg-ent, offered by the AAO-HNS,” says Barbara J. Cobuzzi, MBA, CPC, COC, CPC-P, CPC-I, CENTC, CPCO, AAPC Fellow, of CRN Healthcare in Tinton Falls, New Jersey. “The Reg-ent registry helps practices capture data that they need for MIPS — and it is focused on the Otolaryngology specialty,” explains Cobuzzi You can learn more about Reg-ent at https://www.entnet.org/content/regent-ent-clinical-data-registry.