Appropriate Intervention of Immune-Related Diarrhea and/or Colitis in Patients Treated
Percentage of patients aged 18 years and older, with a diagnosis of cancer, on immune checkpoint inhibitor therapy, and grade 2 or above diarrhea and/or grade 2 or above colitis, who have immune checkpoint inhibitor therapy held and corticosteroids or immunosuppressants prescribed or administered.
Last updated: January 15, 2026
🧮MIPS Score Simulator
Estimate only — actual CMS scoring may vary based on reporting method, data completeness, and annual rule updates.
📖Clinical Rationale
This measure is designed to promote appropriate intervention of managing immune-related diarrhea and colitis, as recommended by numerous clinical guidelines on the topic of toxicities in immunotherapy. The occurrence of diarrhea and colitis can be a normal and treatable toxicity (and is many times not immune-related), but if it is immune-related, it can become life-threatening if not addressed in a timely manner.
Diarrhea and colitis are the second- most commonly reported AEs (adverse events) with ICIs (immune checkpoint inhibitors), and symptoms typically develop within 6 to 8 weeks of starting treatment. Preventing diarrhea includes early recognition of symptoms. Proper grading of diarrhea is essential for proper management. Regardless of immunotherapy agent used, effective colitis and diarrhea management is accomplished by early intervention.
Colitis related mortality with immunotherapy agents has been associated with delayed reporting, nonadherence with antidiarrheal regimen, and failure to hold the immunotherapy agent. With early intervention, colitis is reversible. Incidence of diarrhea is higher among patients taking combination anti-CTLA-4/anti-PD-1 therapy (44%) than those receiving anti-CTLA4 (23–33 percent) or anti-PD-1 (≤19 percent) monotherapy.
The combinatorial approach is also associated with increased risk of grade 3-4 symptoms compared with monotherapy, and the proportion of patients experiencing high-grade symptoms is greater with ipilimumab than anti-PD-1 or antiPD-L1 agents. Diarrhea and/or colitis may recur months after discontinuation of immunotherapy and can mimic chronic inflammatory bowel disease (IBD).
The hallmark symptom of ipilimumab-associated colitis is 3-20 loose bowel movements per day with possible associated hematochezia. For patients on pembrolizumab, 16 percent of patients have diarrhea of any grade, while 1 percent of patients will have grade 3-4 diarrhea.. This quality measure will support and possibly incentivize efforts to implement these necessary improvements to practice quality in the field of immunotherapy.
This quality measure includes all FDA approved Immune Checkpoint Inhibitors and is updated annually to reflect the most up-to-date list of approved therapies.
📝Clinical Recommendations
All the five clinical guidelines below address the measure’s quality actions of holding immunotherapy and administering corticosteroids or immunosuppressant for grade 2 or above diarrhea and/or grade 2 or above colitis. The measure will enhance compliance with the clinical guidelines by ensuring the eligible provider is addressing the adverse event of diarrhea or colitis by immediately providing an intervention to prevent the adverse event from worsening.
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. Telehealth: TELEHEALTH ELIGIBLE: This measure is appropriate for and applicable to the telehealth setting. Patient encounters conducted via telehealth using encounter code(s) found in the denominator encounter criteria are allowed for this measure.
Therefore, if the patient meets all denominator criteria for a telehealth encounter, it would be appropriate to include them in the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.
Measure Submission: The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic.
When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
For the purposes of MIPS implementation, this episode measure is submitted once for each occurrence of immune-related diarrhea and/or colitis during the performance period.
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