Merit-based Incentive Payment System (MIPS) Value Pathway G0053 is titled “Advancing Rheumatology Patient Care,” and it focuses on the clinical theme of providing fundamental treatment and management of rheumatology conditions. One of the Quality Measures (QM) that may be reported for MVP G0053 is QM 177, which is titled “Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity.”
Measure QM 177 assesses if physicians are utilizing a standardized, systematic approach for evaluating the level of disease activity for each patient at least for ≥50% of total number of outpatient RA encounters. The scales/instruments listed are the American College of Rheumatology (ACR)-preferred tools that should be used:
-Clinical Disease Activity Index (CDAI)
-Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein) (DAS-28)
-Patient Activity Score-II (PAS-II)
-Routine Assessment of Patient Index Data with 3 measures (RAPID 3)
-Simplified Disease Activity Index (SDAI).
A result within the range of the selected tool qualifies for meeting numerator performance as long as a result is captured at ≥50% of each patient’s qualified encounters.
DOCUMENTATION GUIDELINES:
The clinical documentation for patients diagnosed with RA, should include the following:
- Rheumatoid Factor Status:
- Seropositive
- Seronegative.
- Manifestations of RA:
- Felty’s syndrome (i.e., RA with splenoadenomegaly and leukopenia)
- Rheumatoid Bursitis
- Rheumatoid Carditis with RA
- Rheumatoid Endocarditis with RA
- Rheumatoid Lung disease with RA
- Rheumatoid Myocarditis with RA
- Rheumatoid Myopathy with RA
- Rheumatoid Nodule
- Rheumatoid Pericarditis with RA
- Rheumatoid Polyneuropathy with RA
- Rheumatoid Vasculitis with RA
- RA with involvement of other organ or system: specify the organ or body system and the manifestation.
- Anatomical Sites of RA:
- Ankle
- Elbow
- Foot
- Hand
- Hip
- Knee
- Metatarsal bone(s)
- Phalanx/phalanges
- Shoulder
- Tarsal bone(s)
- Vertebrae
- Wrist
- Other Anatomical Site: specify the anatomical site(s).
- Laterality of Anatomical Site(s):
- Left
- Right
- Bilateral.
The denominator options included in the QM 177 specification are used to submit the quality actions allowed by the measure, and the eligible denominator criteria include the following RA ICD-10-CM diagnosis codes:
M05.00, M05.011, M05.012, M05.019, M05.021, M05.022, M05.029, M05.031, M05.032, M05.039, M05.041, M05.042, M05.049, M05.051, M05.052, M05.059, M05.061, M05.062, M05.069, M05.071, M05.072, M05.079, M05.09, M05.10, M05.111, M05.112, M05.119, M05.121, M05.122, M05.129, M05.131, M05.132, M05.139, M05.141, M05.142, M05.149, M05.151, M05.152, M05.159, M05.161, M05.162, M05.169, M05.171, M05.172, M05.179, M05.19, M05.20, M05.211, M05.212, M05.219, M05.221, M05.222, M05.229, M05.231, M05.232, M05.239, M05.241, M05.242, M05.249, M05.251, M05.252, M05.259, M05.261, M05.262, M05.269, M05.271, M05.272, M05.279, M05.29, M05.30, M05.311, M05.312, M05.319, M05.321, M05.322, M05.329, M05.331, M05.332, M05.339, M05.341, M05.342, M05.349, M05.351, M05.352, M05.359, M05.361, M05.362, M05.369, M05.371, M05.372, M05.379, M05.39, M05.40, M05.411, M05.412, M05.419, M05.421, M05.422, M05.429, M05.431, M05.432, M05.439, M05.441, M05.442, M05.449, M05.451, M05.452, M05.459, M05.461, M05.462, M05.469, M05.471, M05.472, M05.479, M05.49, M05.50, M05.511, M05.512, M05.519, M05.521, M05.522, M05.529, M05.531, M05.532, M05.539, M05.541, M05.542, M05.549, M05.551, M05.552, M05.559, M05.561, M05.562, M05.569, M05.571, M05.572, M05.579, M05.59, M05.60, M05.611, M05.612, M05.619, M05.621, M05.622, M05.629, M05.631, M05.632, M05.639, M05.641, M05.642, M05.649, M05.651, M05.652, M05.659, M05.661, M05.662, M05.669, M05.671, M05.672, M05.679, M05.69, M05.7A, M05.70, M05.711, M05.712, M05.719, M05.721, M05.722, M05.729, M05.731, M05.732, M05.739, M05.741, M05.742, M05.749, M05.751, M05.752, M05.759, M05.761, M05.762, M05.769, M05.771, M05.772, M05.779, M05.79, M05.8A, M05.80, M05.811, M05.812, M05.819, M05.821, M05.822, M05.829, M05.831, M05.832, M05.839, M05.841, M05.842, M05.849, M05.851, M05.852, M05.859, M05.861, M05.862, M05.869, M05.871, M05.872, M05.879, M05.89, M05.9, M06.0A, M06.00, M06.011, M06.012, M06.019, M06.021, M06.022, M06.029, M06.031, M06.032, M06.039, M06.041, M06.042, M06.049, M06.051, M06.052, M06.059, M06.061, M06.062, M06.069, M06.071, M06.072, M06.079, M06.08, M06.09, M06.20, M06.211, M06.212, M06.219, M06.221, M06.222, M06.229, M06.231, M06.232, M06.239, M06.241, M06.242, M06.249, M06.251, M06.252, M06.259, M06.261, M06.262, M06.269, M06.271, M06.272, M06.279, M06.28, M06.29, M06.30, M06.311, M06.312, M06.319, M06.321, M06.322, M06.329, M06.331, M06.332, M06.339, M06.341, M06.342, M06.349, M06.351, M06.352, M06.359, M06.361, M06.362, M06.369, M06.371, M06.372, M06.379, M06.38, M06.39, M06.8A, M06.80, M06.811, M06.812, M06.819, M06.821, M06.822, M06.829, M06.831, M06.832, M06.839, M06.841, M06.842, M06.849, M06.851, M06.852, M06.859, M06.861, M06.862, M06.869, M06.871, M06.872, M06.879, M06.88, M06.89, M06.9.
For more information download the MVP G0053, the QM 177 MIPS CQM Specification, and/or contact LolitaMJ@iQueryData.com.