Measure 176
Tuberculosis Screening Prior to First Course Biologic and/or Immune Response Modifier Therapy
DESCRIPTION:
If a patient has been newly prescribed a biologic and/or immune response modifier that includes a warning for potential reactivation of a latent infection, then the medical record should indicate TB testing in the preceding 12-month period.
| MEASURE ID: | 176 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | Yes |
| High priority: | No |
| Topped out: | Yes |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 7 |
MEASURE PURPOSE:
This measure encourages tuberculosis (TB) prevention for patients receiving a first course of therapy using a biologic and/or immune response modifier. Physicians should ensure TB prevention prior to treatment either through documenting a previous TB test or performing a TB test (PPD, IFN-gamma release assays, or other appropriate method) in the medical record in the 12 months preceding the biologic prescription.
Measure 176 FAQs
Q. Is this measure reportable via claims?
A. No.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes, encounters coded with GQ, GT, 95, POS 02, or POS 10 modifiers are allowable.
Q. What is the numerator?
A. Patients for whom any record of TB testing is documented or performed (PPD, IFN-gamma release assays, or other appropriate method) in the medical record in the 12 months preceding the biologic and/or immune response modifier prescription.
Q. What is the denominator?
A. All patients aged 18 years and older who are receiving a first course of therapy using a biologic and/or immune response modifier that includes a warning for potential reactivation of a latent infection.
Q. Are there any exceptions for this measure?
A. Yes. The following are exceptions for the measure:
Patient is positive for TB and there is documentation of past treatment
Patient recently completed a course of anti-TB therapy
Q. What are some applicable biologic and/or immune response modifier medications?
A.
Abatacept (Orencia)
Adalimumab (HUMIRA)
Adalimumab-aacf (Idacio)
Adalimumab-aaty (Yuflyma)
Adalimumab-adaz (Hyrimoz)
Adalimumab-adbm (Cyltezo)
Adalimumab-afzb (Abrilada)
Adalimumab-aqvh (Yusimry)
Adalimumab-atto (Amjevita)
Adalimumab-bwwd (Hadlima)
Adalimumab-fkjp (Hulio)
Anakinra (Kineret)
Baricitinib (Olumiant)
Brodalumab (Siliq)
Canakinumab (ILARIS)
Certolizumab pegol and lyophilized certolizumab pegol (CIMZIA)
Etanercept (Enbrel)
Golimumab (Simponi)
Guselkumab (Tremfya)
Infliximab (REMICADE)
Infliximab-abda (Renflexis)
Infliximab-axxq (Avsola)
Infliximab-dyyb (Inflectra)
Ixekizumab (Taltz)
Risankizumab-rzaa (Skyrizi)
Sarilumab (KEVZARA)
Secukinumab (Cosentyx)
Tildrakizumab (Ilumya)
Tocilizumab (ACTEMRA)
Tofacitinib (XELJANZ)
Upadacitinib (RINVOQ)
Ustekinumab (STELARA)
Calculation
The numerator: Patients for whom any record of TB testing is documented or performed (PPD, IFN-gamma release assays, or other appropriate method) in the medical record in the 12 months preceding the biologic and/or immune response modifier prescription.
The denominator: All patients aged 18 years and older who are receiving a first course of therapy using a biologic and/or immune response modifier (such as kinase inhibitors) that includes a warning for potential reactivation of a latent infection.
Measure calculation example
Dr. Lynch saw 42 patients during the reporting period who are receiving a first course of therapy using a biologic and/or immune response modifier. This is the denominator. Of the 42 patients, Dr. Lynch documented performed TB screening 26 times. This is the numerator.
Quality of patient care = 26/42. Dr. Lynch has a score of 61.9% for this measure. This translates to 2.0 to 2.9 points.
Important note
Physicians who achieve a 99.99% score receive 5.9 points. They must score a perfect 100% to earn the full 7 points available. Clinicians score 3 points even if they report on only one patient. This is applicable only to small practices with 15 providers or fewer.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
Benchmarks for registry submissions
The table below shows CMS benchmarks for registry submissions.
| Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 |
|---|---|---|---|---|---|---|---|
Performance rate |
5.26 - 51.27 | 51.28 - 80.16 |
80.17 - 90.47 |
90.48 - 95.82 |
95.83 - 99.99 |
-- |
100 |
Points |
1.0 - 1.9 | 2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
-- |
7 |
