Listed below are the qualifications for Outpatient Measure Sets Initial Patient Population (IPP).
CMS Specifications:
ED-Throughput (OP-ED)
The population of the OP-18 measure is identified using 1 data element:
• E/M Code
Patients seen in a Hospital Emergency Department (E/M Code in Appendix A OP Table 1.0) are included in the OP-18 Hospital Outpatient Population and are eligible to be sampled if they have an E/M Code in Appendix A, OP Table 1.0.
Stroke (OP-Stroke)
The population of the OP-23 ED Stroke measure is identified using 4 data elements:
• E/M Code
• Outpatient Encounter Date
• Birthdate
• ICD-10-CM Principal Diagnosis Code
Patients seen in a Hospital Emergency Department (E/M Code in Appendix A, OP Table 1.0) are included in the OP-23 ED Stroke Hospital Outpatient Population and are eligible to be sampled if they have:
• A patient age on Outpatient Encounter Date (Outpatient Encounter Date minus Birthdate) ≥ 18 years, and
• An ICD-10-CM Principal Diagnosis Code for Acute Ischemic or Hemorrhagic Stroke as defined in Appendix A, OP Table 8.0.
Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk
Patients (OP-29)
Denominator Criteria (Eligible Cases):
Patients aged ≥ 50 and ≤ 75 on date of encounter
and
ICD-10-CM Diagnosis code: Z12.11
and
CPT or HCPCS: 44388, 45378, G0121
without
CPT Category I Modifiers: 52, 53, 73, 74
without
ICD-10-CM Diagnosis codes: Z83.71, Z86.010, Z80.0, Z85.038
Cataracts – Improvement in Patient’s Visual Function within 90 Days
Following Cataract Surgery (OP-31)
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years
and
CPT [(without modifiers 55, 56): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66987, 66988
TJC Specifications:
Acute Stroke Ready Outpatient (ASR-OP)
The population of the ASR-OP measure set is identified using 4 data elements:
• E/M Code
• ICD-10-CM Principal Diagnosis Code
• Outpatient Encounter Date
• Birthdate
Patients admitted to the hospital for outpatient acute care with an E/M Code as defined in Appendix A, Table 1.0, and an ICD-10-CM Principal Diagnosis Code for ischemic or hemorrhagic stroke as defined in Appendix A, Table 8.1 or Table 8.2, and a Patient Age (Outpatient Encounter Date minus Birthdate) greater than or equal to 18 years are included in the ASR-OP Initial Patient Population.
Stroke Outpatient (STK-OP)
The population of the STK-OP measure set is identified using 4 data elements:
• E/M Code
• ICD-10-CM Principal Diagnosis Code
• Outpatient Encounter Date
• Birthdate
Patients admitted to the hospital for outpatient acute care with an E/M Code as defined in Appendix A, Table 1.0, and an ICD-10-CM Principal Diagnosis Code for ischemic or hemorrhagic stroke as defined in Appendix A, Table 8.1 or Table 8.2, and a Patient Age (Outpatient Encounter Date minus Birthdate) greater than or equal to 18 years are included in the STK-OP Initial Patient Population.
Total Hip and Total Knee Replacement Outpatient (THKR-OP)
The population of the THKR-OP measure set is identified using 4 data elements:
• CPT® Codes with Modifier
• Outpatient Encounter Date
• ICD-10-CM Principal or Other Diagnosis Code
• Birthdate
Patients seen in the outpatient setting are included in the THKR-OP measure set if they have:
CPT® Codes with Modifier is at least one on Appendix A, Table 14.01b, 14.02b, 14.03b, 14.04b, a Patient Age (Outpatient Encounter Date minus Birthdate) greater than or equal to 18 years, CPT® Codes with Modifier is none on Appendix A, Table 14.05b, 14.06b, 14.07b, and an ICD-10-CM Principal or other Diagnosis Code is none on Table 14.08, 14.09.
And are eligible to be sampled for:
1 – Stratum 1 – If patients have CPT® Codes with Modifier as defined in Appendix A, Table 14.01b, 14.03b are included in the THKR-OP stratum-1 and are eligible to be sampled.
2 – Stratum 2 – If patients have CPT® Codes with Modifier on as defined in Appendix A, Table 14.02b, 14.04b.are included in the THKR-OP stratum-2 and are eligible to be sampled.
For Code Tables, please see the relevant specifications for the time period in question.
CMS Outpatient Specifications
TJC Specifications