Optimal Asthma Care Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Summary of
Changes
Date of birth clarification
Added language to clarify date of birth range. Please note the changes in
the denominator section below.
Description
Composite (“optimal” care) measure of the percentage of pediatric and adult
patients who have asthma and meet specified targets to control their asthma.
Methodology
Population identification is accomplished via a query of a practice management
system or Electronic Medical Record (EMR) to identify the population of eligible
patients (denominator). Data elements are either extracted from an EMR
system or abstracted through medical record review. Clinics that had an EMR in
place by 07/01/2012 are required to submit data on their full population.
Rationale
Roughly 7% of adults and children in Minnesota are currently living with asthma.
Asthma is a chronic disease associated with familial, infectious, allergenic,
socioeconomic, psychosocial and environmental factors. It is not curable but is
treatable. Despite improvements in diagnosis and management, and an
increased understanding of the epidemiology, immunology, and biology of the
disease, asthma prevalence has progressively increased over the past 15
years. In addition, variation in practice from recommended clinical guidelines is
evident with only 33% of adult asthma patients in Minnesota reporting in 2005 to
having an action plan and 75% reporting instruction on what to do when having
an asthma attack. It is up to providers to assess patients, prescribe
medications, educate about self-management, help patients identify and
mitigate triggers so patients can prevent their exacerbations.
Measurement
Period
Measurement period will be a fixed 12-month period: 07/01/2013 to 06/30/2014.
Hotline: 612-746-4522 | E-mail: [email protected] | Data Portal: https://data.mncm.org/login
© MN Community Measurement, 2013. All rights reserved.
Page 1
Optimal Asthma Care Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Denominator
Established patient who meets each of the following criteria is included in the
population:
 Patient was age 5 to 50 at the start of the measurement period (date of
birth was on or between 07/01/1963 to 07/01/2008).
o Age 5-17 at the start of the measurement period (date of birth
was on or between 07/01/1995 to 07/01/2008).
o Age 18-50 at the start of the measurement period (date of birth
was one or between 07/01/1963 to 06/30/1995).
 Patient was seen by an eligible provider in an eligible specialty face-toface at least two times during the last two measurement periods
(07/01/2012 to 06/30/2014) with visits coded with an asthma ICD-9 code
(in any position, not only primary). Use this date of service range when
querying the practice management or EMR system to allow a count of
the visits within the measurement period.
 Patient was seen by an eligible provider in an eligible specialty face-toface at least one time during the measurement period (07/01/2013 to
06/30/2014) for any reason. This may or may not include one of the
face-to-face asthma visits.
 Diagnosis of Asthma; ICD-9 diagnosis codes include: 493.00-493.12,
493.81, 493.82-493.92. See Table 1.
Eligible specialties: Family Practice, General Practice, Internal Medicine,
Pediatrics, Allergy/Immunology, Pulmonology
Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Physician
Assistant (PA), Nurse Practitioner (NP)
Allowable
Exclusions





Patient was a permanent nursing home resident during the
measurement period.
Patient was in hospice at any time during the measurement period.
Patient died prior to the end of the measurement period.
Documentation that diagnosis was coded in error.
Patients with any of the following diagnoses (see Table 2):
o Cystic fibrosis (ICD-9 diagnosis codes 277.00-277.09).
o COPD (ICD-9 diagnosis codes 491.20-491.22, 493.20-493.22,
496, 506.4).
o Emphysema (ICD-9 diagnosis codes 492.0, 492.8, 518.1, 518.2).
o Acute respiratory failure (ICD-9 diagnosis codes 518.81).
Hotline: 612-746-4522 | E-mail: [email protected] | Data Portal: https://data.mncm.org/login
© MN Community Measurement, 2013. All rights reserved.
Page 2
Optimal Asthma Care Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Numerator
The number of asthma patients who meet ALL of the following targets:
A) Asthma well-controlled (take the most recent asthma control tool
available during the measurement period (07/01/2013 to 06/30/2014)):
 Patient has an Asthma Control Test (ACT) score of 20 or above
(taken from most recent Asthma Control Test on file) – for patients
12 and older
OR
 Patient has a Childhood Asthma Control Test (C-ACT) score of 20 or
above (taken from most recent C-ACT on file) – for patients 11 and
younger
OR
 Patient has an Asthma Control Questionnaire (ACQ) score of 0.75 or
lower (taken from most recent ACQ on file) – for patients 17 and
older
OR
 Patient has an Asthma Therapy Assessment Questionnaire (ATAQ)
score of 0 (taken from most recent ATAQ) – for children,
adolescents, and adults.
B) Patient not at elevated risk of exacerbation:
 Patient reports values for both of the following questions
(asked/documented within the measurement period):
o Number of emergency department visits not resulting in a
hospitalization due to asthma in last 12 months
AND
o Number of inpatient hospitalizations requiring an overnight
stay due to asthma in last 12 months.
 The total number of emergency department visits and
hospitalizations due to asthma must be less than 2.
C) Patient has been educated about his or her asthma and selfmanagement of the condition and also has a written asthma
management plan present (created or reviewed and revised within the
measurement period (07/01/2013 to 06/30/2014)):
Patient has a written asthma management plan in the chart with the
following documented:
o Plan contains information on medication doses and purposes
of these medications.
o Plan contains information on how to recognize and what to do
during an exacerbation.
o Plan contains information on the patient’s triggers.
Hotline: 612-746-4522 | E-mail: [email protected] | Data Portal: https://data.mncm.org/login
© MN Community Measurement, 2013. All rights reserved.
Page 3
Optimal Asthma Care Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Asthma Diagnosis Codes
Table 1: ICD-9 Diagnosis Codes for Identifying Asthma
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
493.00
Extrinsic asthma, unspecified
493.01
Extrinsic asthma, with status asthmaticus
493.02
Extrinsic asthma, with (acute) exacerbation
493.10
Intrinsic asthma, unspecified
493.11
Intrinsic asthma, with status asthmaticus
493.12
Intrinsic asthma, with (acute) exacerbation
493.81
Other forms of asthma; Exercise-induced bronchospasm
493.82
Other forms of asthma; Cough variant asthma
493.90
Asthma, unspecified, unspecified
493.91
Asthma, unspecified, with status asthmaticus
493.92
Asthma, unspecified, with (acute) exacerbation
Codes Used to Identify Patients who Meet Exclusion Criteria
Table 2: ICD-9 Diagnosis Codes for Identifying Patients Meeting Exclusion Criteria
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
277.00
Cystic fibrosis, without mention of meconium ileus
277.01
Cystic fibrosis, with meconium ileus
277.02
Cystic fibrosis, with pulmonary manifestations
277.03
Cystic fibrosis, with gastrointestinal manifestations (excludes with meconium
ileus)
277.09
Cystic fibrosis, with other manifestations
491.20
Obstructive chronic bronchitis without exacerbation
491.21
Obstructive chronic bronchitis, with (acute) exacerbation
491.22
Obstructive chronic bronchitis, with acute bronchitis
492.0
Emphysematous bleb
492.8
Other emphysema
493.20
Chronic obstructive asthma unspecified
493.21
Chronic obstructive asthma with status asthmaticus
Hotline: 612-746-4522 | E-mail: [email protected] | Data Portal: https://data.mncm.org/login
© MN Community Measurement, 2013. All rights reserved.
Page 4
Optimal Asthma Care Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
493.22
Chronic obstructive asthma with (acute) exacerbation
496
Chronic airway obstruction, not elsewhere classified
506.4
Chronic respiratory conditions due to fumes and vapors
518.1
Interstitial emphysema
518.2
Compensatory emphysema
518.81
Acute respiratory failure
Hotline: 612-746-4522 | E-mail: [email protected] | Data Portal: https://data.mncm.org/login
© MN Community Measurement, 2013. All rights reserved.
Page 5