AAO37: Dysphonia: Laryngeal Examination+

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High Priority Status: Yes / Care Coordination

CBE Number: N/A

 Measure Description:

Percentage of patients who were diagnosed with dysphonia who received or were referred for a laryngeal examination within 4 weeks of initial diagnosis.

Instructions:

This measure is to be submitted once for each occurrence of dysphonia during the performance period. For the purpose of submitting this measure, only unique occurrences of dysphonia episodes within the current performance period will be included. A unique occurrence of dysphonia is defined as the period of time that begins with the onset of dysphonia diagnosis and ends 90 days after the onset of diagnosing.

Denominator:

All patients diagnosed with dysphonia with symptoms lasting longer than 4 weeks.

Denominator Note:

• To be eligible for the denominator, a patient record must have:
  • Documentation of dysphonia onset date at least four weeks prior to the current encounter
  • Documentation of dysphonia during two encounters at least 4 weeks apart.
• Dysphonia definition: Dysphonia is a disorder characterized by harsh and raspy voice arising from or spreading to the larynx. For the purposes of this measure, dysphonia refers to a change or hoarseness in the patient’s voice.

 Denominator Exclusions:

None

Denominator Criteria:

            All patients ages

            AND

            Diagnosis: Dysphonia

            AND

            Symptom Duration: >4 weeks

            AND

            Patient Visit: Encounter Visit

For a list of codes that qualify as denominator eligible visits, reference Addendum attached.

Numerator:

Patients who received or were referred for laryngeal examination.*

*Note: Laryngeal examination definition – Term used to describe visualization of larynx. Examination by a qualified examiner utilizing flexible laryngoscopy, or stroboscopy to examine vocal fold/cord mobility. Examination also includes indirect laryngoscopy (visualization of the larynx), which can be done by several methods—including mirror examination, rigid rod-lens telescope examination, rigid rod-lens telescope, flexible fiber optic, or flexible distal chip scopes.

Denominator Exceptions:

• Patient refusal of laryngeal examination or plan of care for treatment.
• Acute vocal cord injury within 2 weeks of diagnosis.

Measure Classifications:

• Submission Pathway: Traditional MIPS
• Measure Type: Process
• High Priority Type: Care Coordination
• Meaningful Measures Area: Appropriate Use of Healthcare
• Care Setting(s): Ambulatory Care: Clinician Office/Clinic
• Includes Telehealth: Yes
• Number of Performance Rates: 1
  • Inverse measure: No
  • Continuous measure: No
  • Proportional measure: Yes
  • Ratio measure: No
  • Risk Adjusted measure: No

Clinical Recommendation Statement:

In the setting of new-onset dysphonia, clinicians should document the status of the voice disorder and its resolution within a few weeks of symptom onset. If there is not resolution, clinicians should perform, or refer to a specialist for, laryngoscopy (KAS 4A/4B). Rationale for referral should be clearly documented KAS 4A/4B).

Laryngoscopy is an option at any time for patients with dysphonia, but the guideline also recommends that no patient be allowed to wait >4 weeks prior to having his or her larynx examined. It is also clearly recommended that if there is a concern of an underlying serious condition, then laryngoscopy should be immediate.

Stachler, R.J., Francis, D.O., Schwartz, S.R., Damask, C.C., Digoy, G.P., Krouse, H.J., McCoy, S.J., Ouellette, D.R., Patel, R.R., Reavis, C.W., Smith, L.J., Smith, M., Strode, S.W., Woo, P. and Nnacheta, L.C. (2018), Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngology–Head and Neck Surgery, 158: S1-S42. https://doi.org/10.1177/0194599817751030

Rationale:

Dysphonia affects nearly one-third of the population at some point in its life. Dysphonia is responsible for frequent health care visits and several billion dollars in lost productivity annually from work absenteeism.12 Dysphonia is often caused by benign or self-limited conditions, but it may also be the presenting symptom of a more serious or progressive condition requiring prompt diagnosis and management.

Stachler, R.J., Francis, D.O., Schwartz, S.R., Damask, C.C., Digoy, G.P., Krouse, H.J., McCoy, S.J., Ouellette, D.R., Patel, R.R., Reavis, C.W., Smith, L.J., Smith, M., Strode, S.W., Woo, P. and Nnacheta, L.C. (2018), Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngology–Head and Neck Surgery, 158: S1-S42. https://doi.org/10.1177/0194599817751030

Supporting Clinical Practice Guideline (CPG):

For more details, reference the Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) [2018]

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The measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The measure and specifications are provided “as is” without warranty of any kind. Neither the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF), nor its members shall be responsible for any use of the measure. The AAO-HNSF and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications.

Addendum