2024 MIPS Measure #250: Radical Prostatectomy Pathology Reporting

2024 COLLECTION TYPE:

MIPS Clinical Quality Measures (CQMS)

‌MEASURE TYPE: Process

Description

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

‌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 Merit-based Incentive Payment System (MIPS) eligible clinicians who examine prostate tissue specimens following resection in a laboratory or institution 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

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, POS 10

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)