MIPS Clinical Quality Measures (CQMS)
MEASURE TYPE: Process – High Priority
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.
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
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
Pathology reports for lung resection specimens for primary lung carcinoma
Denominator Criteria (Eligible Cases):
Patients ≥18 years of age on date of service
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, POS 10
AND NOT
Denominator Exclusions:
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 (e.g. Squamous Cell Carcinoma, Adenocarcinoma and NOT NSCLC- NOS) (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 Non- small Cell Lung Cancer, Histologic Type (e.g. Squamous Cell Carcinoma, Adenocarcinoma) (G9425)
Stay updated with the latest news regarding MACRA and MIPS
The Healthmonix Advisor is a free news source that connects you to the latest in the value-based care industry!