2026 MIPS Measure #448: Appropriate Workup Prior to Endometrial Ablation

Percentage of patients, aged 18 years and older, who undergo endometrial sampling or hysteroscopy with biopsy and results are documented before undergoing an endometrial ablation.

This measure is to be submitted once per performance period. This measure is to be submitted by Meritbased Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

All patients aged 18 years and older who undergo an endometrial ablation procedure during the performance period

Definition:
Index Date – Date of first endometrial ablation during the performance period

All patients aged 18 years and older on date of encounter

AND

Endometrial ablation during the performance period (ICD-10-PCS): 0U5B0ZZ, 0U5B3ZZ, 0U5B4ZZ, 0U5B7ZZ, 0U5B8ZZ

AND/OR

Patient procedure during the performance period (CPT): 58353, 58356, 58563

AND NOT

DENOMINATOR EXCLUSION:

Patients who had an endometrial ablation procedure during the 12 months prior to the index date (exclusive of the index date): G9822

Patients who received endometrial sampling or hysteroscopy with biopsy and results were documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation

Performance Met: Endometrial sampling or hysteroscopy with biopsy and results documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation (G9823)

OR

Performance Not Met: Endometrial sampling or hysteroscopy with biopsy and results not documented during the 12 months prior to the index date (exclusive of the index date) of the endometrial ablation (G9824)

Prior to endometrial ablation, abnormal uterine bleeding should be evaluated, including but not limited to endometrial sampling and assessment of the uterine cavity (II-2B) [1].

Abnormal Uterine Bleeding (AUB) is a significant issue for women during their reproductive years, occurring in approximately 10-to 35% of women [2-3]. This condition can result in anemia, limit daily activities and raises concerns about uterine cancer. Five percent of women between the ages of 30 and 49 will seek medical attention for evaluation of menorrhagia [4-6]. Endometrial Ablation (EA) is a well-established, effective treatment for AUB, and is a less invasive alternative to hysterectomy, with lower complication rates. The procedure effectively reduces menstrual flow and results in high patient satisfaction [7]. Preoperative evaluations include endometrial sampling and assessment of the uterine cavity [7].

References

Laberge, P, Leyland, N., Murji, A. et al. Endometrial Ablation in the Management of Abnormal Uterine Bleeding. J. Obstet. Gynaecol. Can. 2015; 37(4):362-376.
Côté I, Jacobs P, Cumming DC. Use of health services associated with increased menstrual loss in the United States. Am J Obstet Gynecol 2003; 188:343.
Santer M, Warner P, Wyke S. A Scottish postal survey suggested that the prevailing clinical preoccupation with heavy periods does not reflect the epidemiology of reported symptoms and problems. J Clin Epidemiol 2005; 58:1206.
Shapley M, Jordan K, Croft PR. An epidemiological survey of symptoms of menstrual loss in the community. Br J Gen Pract 2004; 54:359.
Warner P, Critchley HO, Lumsden MA, et al. Referral for menstrual problems: cross sectional survey of symptoms, reasons for referral, and management. BMJ 2001; 323:24.
Vessey MP, Villard-Mackintosh L, McPherson K, et al. The epidemiology of hysterectomy: findings in a large cohort study. Br J Obstet Gynaecol 1992; 99:402.
Dilley A, Drews C, Miller C, et al. von Willebrand disease and other inherited bleeding disorders in women with diagnosed menorrhagia. Obstet Gynecol 2001; 97:630.