2023 # 452 Patients with Metastatic Colorectal Cancer and RAS (KRAS or NRAS) Gene Mutation Spared Treatment with Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibodies

CMS Measure ID: #452

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: Yes

NQS Domain: Patient Safety

Measure Age: > 2 years

Instructions

This measure is to be submitted once per performance period for patients with colorectal cancer seen during the performance period. 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

Percentage of adult patients (aged 18 or over) with metastatic colorectal cancer and RAS (KRAS or NRAS) gene mutation spared treatment with anti-EGFR monoclonal antibodies

Denominator

Adult patients with metastatic colorectal cancer who have a RAS (KRAS or NRAS) gene mutation

Definition:

RAS mutation testing- RAS testing for this measure refers to assays that detect mutations in codons 12 and 13 of exon 2, codons 59 and 61 or exon 3 and codons 117 and 146 in exon 4 in KRAS or NRAS. Do not include results from mutations at other codons or assays for other alterations (e.g., BRAF, PI3K, PTEN genes). The College of American Pathologists (CAP) Perspectives on Emerging Technology (POET) Report on RAS mutation testing provides additional guidance on testing.

If multiple RAS mutation tests have been performed, refer to the most recent test results.

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter 

AND

Diagnosis of colon or rectal cancer (ICD-10 CM): C18.0, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20 

AND

Patient encounter during the performance period: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

AND

Two or more encounters at the reporting site

AND

Patient has metastatic disease at diagnosis: G9842

AND

RAS (KRAS or NRAS) gene mutation: G9843

Numerator

Anti-EGFR monoclonal antibody therapy not received

Definition:

Anti-EGFR monoclonal antibody – cetuximab or panitumumab

Numerator Options:

Performance Met:   

Patient did not receive anti-EGFR monoclonal antibody therapy (G9844)

OR

Performance Not Met:

Patient received anti-EGFR monoclonal antibody therapy (G9845)