2020 Measure Specifications

CMS ID

Measure Title*

Denominator*

Numerator*

Denominator Exclusions*

 Denominator Exceptions*

Numerator Exclusions*

QCDR Measure Type*

NQF ID Number
(if applicable)

Is the QCDR measure a high priority measure?*

High Priority Type*

Measure Type*

NQS Domain*

Which Meaningful Measure Area applies to this measure?*

Inverse Measure*

Proportional Measure*

Continuous Variable Measure*

Ratio Measure*

Number of performance rates to be calculated and submitted*

Performance Rate Description(s)

Risk-Adjusted*

REGCLR1

Heel Pain Treatment Outcomes for Adults

All patients aged 18 years and older on date of encounter
AND
Diagnosis for heel pain (ICD-10-CM):
M77.31, M77.32, M72.2
AND
Patients who have had at least two visits during the reporting period

Patients in the denominator who had a visit with heel pain as a diagnosis within the past 12 months._x000D_
_x000D_
Definition: _x000D_
Heel Pain Evaluation – Consists of a documented evaluation of patient reported pain level utilizing a standardized pain scale _x000D_
_x000D_
Performance Met:  _x000D_
Heel Pain Decreased Mildly (MX003)_x000D_
Heel Pain Decreased Moderately (MX004)_x000D_
Heel Pain Decreased Significantly (MX005)_x000D_
OR_x000D_
Performance Not Met:_x000D_
Heel Pain level not documented (MX006)_x000D_
Heel Pain not decreased (MX007)"

Clinician documented that the patient was not an eligible candidate for evaluation of heel pain. For example, the patient has a condition that would not allow them to accurately respond to a pain level exam (Dementia, Alzheimer's, patient has previously documented diabetic peripheral neuropathy with loss of protective senstation)

N/A

N/A

Existing Approved QCDR Measure With No Changes

0

Yes

Outcome

Patient Reported Outcome (PRO)

Effective Clinical Care

Functional Outcomes

No

Yes

No

No

1

Patients with heel pain that demonstrate improvement in pain level

Yes

MEX2

Heel Pain Treatment Outcomes for Pediatric Patients

All patients aged 6 to 18 years on the date of initial encounter.
AND
Diagnosis for heel pain (ICD-10-CM):
M77.31, M77.32, M72.2
AND

Patients who had a visit with heel pain as a diagnosis within the past 12 months.

Definition:
Heel Pain Evaluation – Consists of a documented evaluation of patient reported pain level utilizing a standardized pain scale.

Performance Met: 
Heel Pain Decreased Mildly (1 on the pain scale) (MX010)
Heel Pain Decreased Moderately (2 or 3 on the pain scale) (MX011)
Heel Pain Decreased Significantly (4 or more on the pain scale) (MX012)
OR
Performance Not Met:
Heel Pain Level Not Documented (MX013)
Heel Pain Not Decreased (MX014)

Clinician documented that the patient was not an eligible candidate for evaluation of heel pain. For example, the patient has condition that would not allow them to accurately respond to a pain level exam or the patient has previously documented peripheral neuropathy with loss of protective sensation.

None

None

Existing Approved QCDR Measure With Changes

0

Yes

Outcome

Patient Reported Outcome (PRO)

Effective Clinical Care

Care is Personalized and Aligned with Patient’s Goals

No

Yes

No

No

1

Percentage of patients aged 6 to 18 years with a diagnosis of heel pain who experience a decrease in heel pain.

No

MEX4

Bunion Outcome - Adult and Adolescent

All patients with a contracted hallux or digit hallux valgus
Denominator Criteria (Eligible Cases)
Diagnosis for hallux deformity 
M20.11, M20.12, M20.21, M20.22, M20.5X2, M20.31, M20.32, Q74.2, Q66.6, Q66.3
AND
Patients who have had at least two visits during the reporting period
WITHOUT
Telehealth Modifier: GQ, GT

Patients who were evaluated for hallux deformity
Definition:
Evaluation for Bunion– Includes a foot examination documenting structural findings 

Numerator Options:
Performance Met: Patient experienced less pain by pain scale 181A
Denominator Exception: Clinician documented that the patient was not an eligible candidate for treatment of hallux deformity 181B
Performance Not Met: Patient did not experience either improvement in pain scale or improvement in foot function index. 181C

None

Clinician documented that patient was not an eligible candidate for treatment of hallux deformity 182D

None

Existing Approved QCDR Measure With No Changes

0

Yes

Outcome

Patient Reported Outcome (PRO)

Effective Clinical Care

Functional Outcomes

No

Yes

No

No

1

Patient who have a complete eveluation for treatment of Hallux Valgus and experience a decrease in Hallux Valugs Pain

No

MEX5

Hammer Toe Outcome

All patients with a contracted lesser digit
Denominator Criteria (Eligible Cases)
Diagnosis for contracted digit
Q66.89, M20.41, M20.42, M20.51, M20.5x2, M20.61, M20.62
AND
Patients who have had at least two visits during the reporting period
WITHOUT
Telehealth Modifier: GQ, GT

Patients who were evaluated for hammer toe
Definition:
Evaluation for Hammer Toe – Includes a foot examination documenting structural findings

Numerator Options:
Performance Met: Patient experienced less pain by pain scale 183A
Denominator Exception: Clinician documented that patient was not an eligible candidate for treatment of hammer toe 183B
OR
Performance Not Met: Patient did not experience either improvement in pain scale or improvement in foot function index. 183C

N/A

Clinician documented that patient was not an eligible candidate for treatment of hammer toe 183D

None

Existing Approved QCDR Measure With No Changes

0

Yes

Outcome

Patient Reported Outcome (PRO)

Effective Clinical Care

Functional Outcomes

No

Yes

No

No

1

Proper Evaluation of a Hammer Toe is critical to proper treatment.  Percentage of patients who are evaluated for a hammer toe and expericne a decrease in pain

No