2023 # 396 Lung Cancer Reporting (Resection Specimens)

CMS Measure ID: #396

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: No

High Priority: Yes

NQS Domain: Communication and Care Coordination

Measure Age: > 2 years

Instructions

This measure is to be submitted each time a patient’s lung pathology report addresses specimens with a diagnosis of non-small cell lung cancer; however, only one quality data code (QDC) per date of service for a patient is required. This measure may be submitted by Merit-based 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.

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

Pathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer (NSCLC), histologic type.

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: Yes

Decile 10: 100 – 100

Denominator

Pathology reports for lung resection specimens for primary lung carcinoma

Denominator Criteria (Eligible Cases): 

Patients ≥18 years of age on date of encounter 

AND

Diagnosis for lung cancer (ICD-10-CM): C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92

AND

Patient procedure during 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 lung, OR classified as NSCLC-NOS: G9424

Numerator

Pathology reports based on lung resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer, histologic type (e.g. squamous cell carcinoma, adenocarcinoma and NOT NSCLC-NOS (non-small cell lung cancer, not otherwise specified))

Numerator Options:

Performance Met:

Primary lung carcinoma resection report documents pT category, pN category and for Non-small Cell Lung Cancer, Histologic Type (Squamous Cell Carcinoma, Adenocarcinoma and NOT NSCLCNOS) (G9422)

OR

Denominator Exception:

Documentation of medical reason for not including pT category, pN category and histologic type [For patient with appropriate exclusion criteria (e.g. metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] (G9423)

OR

Performance Not Met:

Primary lung carcinoma resection report does not document pT category, pN category and for Nonsmall Cell Lung Cancer, Histologic Type (Squamous Cell Carcinoma, Adenocarcinoma) (G9425)