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  2. CQM-7684

Request adding Endobronchial Valve Insertion to Potentially Planned Procedures or Always Planned list for MIPS measure 484

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
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    • Ben Chappell
    • University of Colorado Medicine
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      Unfortunately, this question is out of scope for the eCQM Issues Tracker. Please contact the QPP Service Center at QPP@cms.hhs.gov for questions about administrative claims measures for MIPS reporting. You will be contacted by their team, and assigned a customer service representative who will work to resolve your inquiry.
      Show
      Unfortunately, this question is out of scope for the eCQM Issues Tracker. Please contact the QPP Service Center at QPP@cms.hhs.gov for questions about administrative claims measures for MIPS reporting. You will be contacted by their team, and assigned a customer service representative who will work to resolve your inquiry.
    • CMS0002v14
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      The omission of this procedure from the planned procedures list negatively impacts performance on MIPS #484 in all iterations of MIPS participation, as well as negatively impacting performance in programs who have adopted the codesets and rationale of MIPS #484.
      Show
      The omission of this procedure from the planned procedures list negatively impacts performance on MIPS #484 in all iterations of MIPS participation, as well as negatively impacting performance in programs who have adopted the codesets and rationale of MIPS #484.

      It has come to our attention that patients who are admitted electively for endobronchial valve (EBV) procedures are being captured as acute hospital admissions.  EBVs are only placed when a patient's COPD is clinically stable.  This is not an indicator of poor primary or specialty care, but an indicator of advanced cutting-edge, high-quality care for patients with the severe end-stage COPD. The procedure requires inpatient hospitalization, with patients typically admitted for 3-5 days.  At our institution, the primary diagnoses for the admissions are ICD-10 J44.9, J43.9, J43.2.

       

      As per the Measure Information for the Multiple Chronic Care Conditions (MCC) Risk-standardized Hospital Admission Rates for Patients for the Merit-based Incentive Payment System (MIPS) Groups

      Performance Year (PY) 2025 MCC Measure Code Specifications, January 1 – December 31, 2025

      From: CU Medicine and University of Colorado Hospital

       

       

      Consistent with the approach CMS has taken for other admission and readmission measures, the measure excludes planned hospital admissions because planned admissions are not a signal of poor-quality care. Planned admissions are those planned by providers and patients for anticipated medical treatment or procedures that must be provided in the inpatient setting. Most planned admissions are part of ongoing clinical care and do not represent acute events that could have been prevented by high-quality care. Moreover, for ambulatory patients with chronic diseases, admissions for certain planned procedures (e.g., placement of a cardiac device designed to prolong life) are consistent with the highest quality of care. For these reasons, planned admissions are not counted in the measure outcome.

       

      Endobronchial Insertion Procedure Codes to be added the always planned or potentially planned procedures.

       

      Table PAA1 Planned admission algorithm: always planned procedures
      Table PAA2 Planned admission algorithm: always planned diagnoses
      Table PAA3 Planned admission algorithm: potentially planned procedures
      Table PAA4 Planned admission algorithm: acute diagnoses

       

      We believe this is an oversight as the procedure is relatively new and some hospitals do not have physicians who perform the procedure. 

       

      List of the Endobronchial Valve Insertion CPT codes: 31647, 31648, 31649, 31651

       

       

      Thank you for your consideration.

       

      Sincerely,

      Lisa Schilling and Ben Chappell

            AIR EC eCQM Team AIR EC eCQM Team
            Ben Chappell Benjamin Chappell
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