Otolaryngology Coding Alert

We’ve provided these 6 ENT-specific measures that your practice can utilize to keep in compliance with MIPS requirements:

#398: Optimal Asthma Control – Composite measure of the percentage of pediatric and adult patients whose asthma is well-controlled as demonstrated by age appropriate patient reported outcome tools and not at risk for exacerbation. (Outcome Measure)

Component 1: Asthma well-controlled (take the most recent asthma control tool available during the measurement period)

Performance Met: G9432
Performance Not Met: G9434

Component 2: Patient not at elevated risk of exacerbation

Performance Met: G9521
Performance Not Met: G9522

#065: Appropriate Treatment for Children with Upper Respiratory Infection – Percentage of children 3 months – 18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode. (High Priority Measure)

Performance Met:  G8708Performance Not Met: G8710

#047: Care Plan – Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record or documentation in the medical record that an advance care plan was discussed but the patient did not wish — or was not able to name — a surrogate decision maker or provide an advance care plan. (Cross-Cutting Measure)

Performance Met: 1123F or 1124FPerformance Not Met: 1123F with 8P

#091: Otitis Externa (AOE): Topical Therapy – Percentage of patients aged 2 years and older with a diagnosis of AOE who were prescribed topical preparations. (High Priority Measure)

Performance Met: 4130F or 4130F with 1P or 4130F with 2P
Performance Not Met: 4130F with 8P

#331: Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse) – Percentage of patients, aged 18 years and older, with a diagnosis of acute sinusitis who were prescribed an antibiotic within 10 days after onset of symptoms. (High Priority Measure)

Performance Met: G9286 or G9505
Performance Not Met: G9287

#358: Patient-Centered Surgical Risk Assessment and Communication – Percentage of patients who underwent a non emergency surgery who had their personalized risks of postoperative complications assessed by their surgical team prior to surgery using a clinical data-based, patient-specific risk calculator and who received personal discussion of those risks with the surgeon. (High Priority Measure)

Performance Met: G9316
Performance Not Met: G9317

These six suggested measures are a few of the more practical measures for otolaryngology practices to enforce. Visit this CMS link to browse the comprehensive list of MIPS measures:

https://qpp.cms.gov/measures/quality

Note: Make sure that you are reporting these measures on at least 50 percent of your Medicare Part B patients (this increases to 60 percent of Part B patients in 2018). Additionally, you can report more than six measures and CMS will give you credit for your six highest-scoring measures.

Reporting more than one outcome measure will earn you two extra points towards your score. Meeting these requirements (or failing to) could mean a 4 percent differential in payment adjustments. This will increase to a 5 percent differential in 2018, a 7 percent differential in 2019, and a 9 percent differential from 2020 and beyond.