Documentation Requirements

2018 MIPS MEASURES for Emergency Departments

2018 MIPS MEASURES for Emergency Departments

MIPS Measure: #76 Central Venous Catheter ‐ Maximal Sterile Technique

Many emergency physician groups have not placed a central line in years, due to increased use of interosseous infusion or the increased availability of specialists to perform the procedures.

However, when a central line is placed, this measure seeks to determine that all elements of maximal sterile barrier technique (cap, mask, sterile gown, sterile gloves and sterile full body drape) were followed, including hand hygiene, skin preparation and, if ultrasound is used, that sterile ultrasound techniques were followed.

Documentation Requirement

The physician must make statements to the following effect:

  1. “Maximal sterile technique was followed” during the procedure.
  2. “Sterile technique was limited due to…” (an emergent case where aseptic technique would unacceptably delay the CVC insertion, or other harm could be caused). The clinical reason for not following aseptic technique must be clear in the record.

MIPS Measure #415: CT Use for Closed Head Injury

This measure determines whether patients with mild closed head injuries that do not fall within the ACEP 2008 recommendations for CT or MRI imaging are actually receiving such studies without a medically necessary reason. It applies to all patients reporting an emergency department visit level with a diagnosis that is within the code range of closed head injuries.

Documentation Requirement

The physician must make statements to the following effect:

At least 3 pieces of information must be identifiable in your documentation. We can apply various performance or exclusion codes based on the answers to these questions, but without this information we might have to report that the performance criteria was not met.

  1. Did the patient present for treatment for a closed head injury within 24 hours of the head injury?
  2. What was the Glasgow Coma Score?
  3. Did the treating emergency physician order the CT for a medically necessary reason?
  4. Was the head CT was ordered by someone other than the treating physician.

A simple statement documenting the medical necessity for your head CT order is most important for meeting this measure.

MIPS Measures:
#91 Acute Otitis Externa Topical Treatment Only
#93 Acute Otitis Externa Oral Antibiotic Avoidance

These two measures attempt to determine whether the emergency physician treated a patient for acute otitis externa with the clinically appropriate topical preparation rather than with oral antibiotics, with some exclusions.

Medicare patients very rarely seek emergency care for this condition, but when they do, documenting the condition and the use of topical and avoidance of oral antibiotics have a surprisingly high value for MIPS quality scoring. These are “appropriate use” measures with 2 bonus points each assigned to them.

Documentation Requirement

Information must be identifiable to the coder that answers each of the following questions:

  1. Was the patient treated for an external ear infection or small cellulitis with a topical preparation only?
  2. If not, what was the medical necessity of not treating with a topical dressing?
  3. If an oral antibiotic was prescribed, what was the clinical reason that it was used (coexisting otitis media, tympanic membrane perf, etc.)

MIPS Measure #317: Screening for Pre-Hypertension and Hypertension with Follow Up

This measure determines how often you refer patients aged 18 years or older for follow-up by another provider when the last blood pressure taken in the ED is at or above 120 systolic, 80 diastolic.

While this pressure parameter is not what most emergency physicians would use to determine the need for follow-up. It is the parameter set by the U.S Preventive Services Task Force for pre-hypertensive as well as hypertensive patients and is followed by Medicare for this measure.

Documentation Requirement

Your chart must reflect all of the following to correctly report the measure:

  1. A blood pressure must appear somewhere in the chart. If it is below the target parameters, we may report that patient as excluded from the follow-up criteria. If a pressure is not present in the parts of the chart available to us we must report that the measure was not met.
  2. If the discharge blood pressure (the one least likely to be artificially high) is at or above the target, clear assertion must be present that the patient was referred for follow-up. You do not need to designate where follow-up can be obtained. The follow-up recommendation may be found in the discharge instructions but those must be available to the coder for you to be credited for performance. We recommend that this not be a templated conditional statement.
    “If your blood pressure is…” would not be an acceptable statement.
  3. If the patient has an active diagnosis of hypertension, even if you are not treating it, the chart must reflect it so that we may report that patient as excluded from the measure requirement.
  4. If the patient presents with an urgent or emergent medical condition, we will identify this from your overall documentation and report the case as an exclusion. The measure definition does not require a follow-up recommendation in these cases.

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