2021 MIPS Measure #138: Melanoma: Coordination of Care

Measure Description

Percentage of patient visits, regardless of age, with a new occurrence of melanoma that have a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis

Instructions

This measure is to be submitted at each denominator eligible visit occurring during the performance period ending November 30th for melanoma patients seen during the performance period. It is anticipated that eligible clinicians providing care for patients with melanoma will submit this measure.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:

• All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma during excision of malignant lesion OR
• All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma evaluated in an outpatient setting

SUBMISSION CRITERIA 1: ALL VISITS FOR PATIENTS, REGARDLESS OF AGE, DIAGNOSED WITH A NEW OCCURRENCE OF MELANOMA DURING EXCISION OF MALIGNANT LESION

DENOMINATOR (SUBMISSION CRITERIA 1):

All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma

Denominator Criteria (Eligible Cases) 1:

Diagnosis for melanoma (ICD-10-CM): C43.0, C43.10, C43.111, C43.112, C43.121, C43.122, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.111, D03.112, D03.121, D03.122, D03.20, D03.21, D03.22, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9

AND

Patient encounter for excision of malignant melanoma (CPT): 11600, 11601, 11602, 11603, 11604, 11606, 11620, 11621, 11622, 11623, 11624, 11626, 11640, 11641, 11642, 11643, 11644, 11646, 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061, 14301, 17311, 17313

–OR–

SUBMISSION CRITERIA 2: ALL VISITS FOR PATIENTS, REGARDLESS OF AGE, DIAGNOSED WITH A NEW OCCURRENCE OF MELANOMA EVALUATED IN AN OUTPATIENT SETTING

DENOMINATOR: (SUBMISSION CRITERIA 2):

All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma

DENOMINATOR NOTE: For providers who do surveillance, pathology would have to be completed for melanoma to be diagnosed after the initial visit. The diagnosis of the melanoma can be attributed to the initial encounter in which the biopsy occurred to be eligible for this measure. If outpatient visit and excision occur in the same visit, then it would be expected that the clinician would submit measure data via submission criteria one.

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases) 2:

Diagnosis for melanoma (ICD-10-CM): C43.0, C43.10, C43.111, C43.112, C43.121, C43.122, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.111, D03.112, D03.121, D03.122, D03.20, D03.21, D03.22, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

Numerator

THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:

• All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma during excision of malignant lesion OR
• All visits for patients, regardless of age, diagnosed with a new occurrence of melanoma evaluated in an outpatient setting

SUBMISSION CRITERIA 1: ALL VISITS FOR PATIENTS, REGARDLESS OF AGE, DIAGNOSED WITH A NEW OCCURRENCE OF MELANOMA DURING EXCISION OF MALIGNANT LESION

NUMERATOR (SUBMISSION CRITERIA 1):

Patient visits with a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis

Numerator Instructions: A treatment plan should include the following elements: diagnosis, tumor thickness, and plan for surgery or alternate care.

NUMERATOR NOTE:For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or system reason(s) for not communicating the treatment plan (e.g. patient asks for treatment plan not to be communicated or patient does not have a Primary Care or referring Physician).

Definition:

Communication – Communication may include: documentation in the medical record that the physician(s) treating the melanoma communicated (e.g., verbally, by letter, copy of treatment plan sent) with the physician(s) providing the continuing care OR a copy of a letter in the medical record outlining whether the patient was or should be treated for melanoma.

Numerator Options:

Performance Met:

Treatment plan communicated to provider(s) managing continuing care within 1 month of diagnosis (5050F)

OR

Denominator Exception:

Documentation of patient reason(s) for not communicating treatment plan to the Primary Care Physician(s) (PCP) (s) (e.g., patient asks that treatment plan not be communicated to the physician(s) providing continuing care) (5050F with 2P)

OR

Denominator Exception:

Documentation of system reason(s) for not communicating treatment plan to the PCP(s) (eg, patient does not have a primary care physician or referring physician) (5050F with 3P)

OR

Performance Not Met:

Treatment plan not communicated, reason not otherwise specified (5050F with 8P)

–OR–

SUBMISSION CRITERIA 2: ALL VISITS FOR PATIENTS, REGARDLESS OF AGE, DIAGNOSED WITH A NEW OCCURRENCE OF MELANOMA EVALUATED IN AN OUTPATIENT SETTING

NUMERATOR (SUBMISSION CRITERIA 2):

Patient visits with a treatment plan documented in the chart that was communicated to the physician(s) providing continuing care within one month of diagnosis

Numerator Instructions: A treatment plan should include the following elements: diagnosis, tumor thickness, and plan for surgery or alternate care.

NUMERATOR NOTE: Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or system reason(s) for not communicating the treatment plan to the patient’s Primary Care Physician (e.g. patient asks for treatment plan not to be communicated or patient does not have a Primary Care or referring Physician.

Definition:

Communication – Communication may include: documentation in the medical record that the physician(s) treating the melanoma communicated (e.g., verbally, by letter, copy of treatment plan sent) with the physician(s) providing the continuing care OR a copy of a letter in the medical record outlining whether the patient was or should be treated for melanoma.

Numerator Options:

Performance Met:

Treatment plan communicated to provider(s) managing continuing care within 1 month of diagnosis (5050F)

OR

Denominator Exception:

Documentation of patient reason(s) for not communicating treatment plan to the Primary Care Physician(s) (PCP)(s) (e.g., patient asks that treatment plan not be communicated to the physician(s) providing continuing care) (5050F with 2P)

OR

Denominator Exception:

Documentation of system reason(s) for not communicating treatment plan to the PCP(s) (eg, patient does not have a primary care physician or referring physician) (5050F with 3P)

OR

Performance Not Met:

Treatment plan not communicated, reason not otherwise specified (5050F with 8P)