2021 MIPS Measure #395: Lung Cancer Reporting (Biopsy/Cytology Specimens)

Measure Description

Pathology reports based on biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type or classified as NSCLC-NOS with an explanation included in the pathology report

Instructions

This measure is to be submitted each time a patient’s 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:

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

Biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer

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 encounter during performance period (CPT): 88104, 88108, 88112, 88173, 88305

AND NOT

DENOMINATOR EXCLUSIONS:

Specimen sites other than anatomic location of lung or is not classified as primary non-small cell lung cancer: G9420

Numerator

Biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer classified into specific histologic type (including but not limited to squamous cell carcinoma, adenocarcinoma, large cell carcinoma) OR classified as NSCLC-NOS with an explanation included in the pathology report

Numerator Options:

Performance Met:

Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type OR classified as NSCLC- NOS with an explanation (G9418)

OR

Denominator Exception:

Documentation of medical reason(s) for not including the histological type OR NSCLC-NOS classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary nonsmall cell lung cancer or other documented medical reasons) (G9419)

OR

Performance Not Met:

Primary non-small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type OR classified as NSCLC-NOS with an explanation (G9421)