|High Priority Measure?
|Medicare Part B Claims, MIPS CQM
Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status
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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:
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.
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
Patient procedure during the performance period (CPT): 88309
Telehealth Modifier: GQ, GT, 95, POS 02
Specimen site other than anatomic location of prostate: G8798
Radical Prostatectomy reports that include the pT category, the pN category, Gleason score and a statement about margin status
Pathology report includes pT category, pN category, Gleason score and statement about margin status (3267F)
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)
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)