2023 # 250 Radical Prostatectomy Pathology Reporting

CMS Measure ID: #250

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be submitted each time a radical prostatectomy surgical pathology examination is performed during the performance period for prostate patients. It is anticipated that eligible clinicians who examine prostate tissue specimens following resection in a laboratory or institution will submit this measure.

Measure Submission Type:

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 for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: Yes

Decile 0: 0 – 97.77
Decile 1: 97.78 – 99.99
Decile 10: 100 – 100

Denominator

All radical prostatectomy surgical pathology examinations performed during the measurement period for primary prostate cancer

Denominator Criteria (Eligible Cases):

Diagnosis for malignant neoplasm of prostate (ICD-10-CM): C61

AND

Patient procedure during the performance period (CPT): 88309

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

AND NOT

DENOMINATOR EXCLUSION:

Specimen site other than anatomic location of prostate: G8798

Numerator

Radical Prostatectomy reports that include the pT category, the pN category, Gleason score and a statement about margin status

Numerator Options:

Performance Met:

Pathology report includes pT category, pN category, Gleason score and statement about margin status (3267F)

OR

Denominator Exception:

Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report (e.g., specimen originated from other malignant neoplasms, transurethral resections of the prostate (TURP), or secondary site prostatic carcinomas) (3267F with 1P)

OR

Performance Not Met: pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified (3267F with 8P)