QCDR measure AAD 21
Actinic Keratosis: Appropriate Documentation and Shared Decision Making of AK
DESCRIPTION:
Percentage of adult patients (18 years old and older) diagnosed with Actinic Keratosis (AK) whose healthcare provider has recorded the following information in the patient’s medical record 1) documentation of the number or range of AKs, 2) location(s) of AK, 3) documentation of prior squamous cell carcinoma, or prior keratinocyte carcinomas and types if known, 4) age, 5) gender, and 6) immunosuppression and have engaged in bi-directional communication with the patient regarding the risk of malignant transformation and a discussion of at least two options for managing AK.
| MEASURE ID: | AAD21 |
|---|---|
| Type: | Patient Reported Outcome-Based Performance Measure (PRO-PM) |
CMS Derm Specialty Set: | N/A |
| High priority: | Yes |
| Topped out: | No |
| Telehealth Eligible: | No |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
Documenting key disease characteristics and risk factors ensures appropriate clinical assessment, while engaging patients in a bi-directional discussion regarding malignant transformation risk and treatment options promotes informed, patient-centered care aligned with AAD clinical guidelines.
AAD21 FAQs
Q. Is this measure reportable via claims?
A. No. This measure can only be reported via a registry, such as DataDerm.
Q. Are patient encounters conducted via telehealth allowable?
A. No. Only in-person encounters during the reporting period are eligible.
Q. What is the numerator?
A. The numerator includes patients for whom the following documentation has been completed during the eligible encounter:
Number or range of AK lesions
Location(s) of AK lesions
History of prior squamous cell carcinoma or keratinocyte carcinomas, including types if known
Age
Gender
Immunosuppression status
Additionally, the dermatologist must have engaged in shared decision making with the patient, which includes:
Counseling on the risk of malignant transformation of AK
Discussion of at least two treatment or management options (e.g., cryosurgery, topical therapies, other FDA-approved therapies, or surveillance), including risks, benefits, and alternative therapies
Documentation of possible outcomes of each option
Documentation of the final management decision
Q. What is the denominator?
A. All adult patients (≥18 years old) with an encounter during the reporting period in which an AK diagnosis was made (ICD-10-CM: L57.0). Eligible encounter CPT codes include: 99202–99205, 99211–99215, 99242–99245, 17000, 17003, 17004, 96567, 96573, 96574.
Q. Are there any exclusions for this measure?
A. Yes. Patients are excluded if they are being seen for a follow-up examination for previously prescribed AK treatment, or if the patient declines or is unable to participate in shared decision making due to cognitive deficits or other limitations.
Q. Are there any exceptions for this measure?
A. No additional exceptions are specified beyond the exclusions above.
Q. Is this an inverse measure?
A. No. A higher performance rate indicates better compliance with documentation and shared decision making.
Q. How is the numerator data collected?
A. Data is collected through documentation in the patient’s medical record. This includes:
AK lesion count and location
History of prior keratinocyte carcinomas
Patient demographics (age, gender, immunosuppression)
Shared decision-making discussion covering risks, treatment options, outcomes, and final plan
Q. Can this measure be reported by a dermatologist who treats Actinic Keratosis?
A. Yes. Any dermatologist who diagnoses and manages AK, engages in shared decision making, and documents the required data elements may report this measure.
Q. What outcomes are being assessed?
A. The measure assesses proper documentation of AK characteristics and shared decision making with patients regarding treatment options, ensuring informed, patient-centered care and discussion of malignant transformation risk.
Calculation
The numerator: Adult patients (18 years old and older) diagnosed with Actinic Keratosis (L57.0) during a denominator-eligible encounter who meet both of the following criteria: 1) Appropriate Documentation of AK and 2) Shared Decision Making (SDM).
The denominator: All adult patients (18 years old and older) with a diagnosis of Actinic Keratosis (L57.0) during the reporting period and a qualifying encounter (including applicable E/M, procedural, or photodynamic therapy CPT codes).
Measure calculation example
Dr. Brown saw 188 adult patients with a diagnosis of AK. The denominator is 188.
Of these patients, 170 have complete documentation of AKs and shared decision-making discussion.
Quality of patient care = 170/188. Dr. Brown has a score of 90.4% for this measure. This translates to a minimum of 7 points.
Important note
For new measures in their first year in the program, if the clinician meets data completeness, they earn at least 7 points and upwards of 10 points.
