2023 # 137 Melanoma: Continuity of Care – Recall System

CMS Measure ID: #137

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: Yes

NQS Domain: Communication and Care Coordination

Measure Age: > 2 years

Instructions

This measure is to be submitted a minimum of once per performance period for patients with a current diagnosis of melanoma or a history of melanoma seen during the performance period. It is anticipated that eligible clinicians providing care for patients with melanoma or a history of melanoma will submit this measure.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

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 patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered, at least once within a 12 month period, into a recall system that includes:

A target date for the next complete physical skin exam, AND
A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 0 – 15.55
Decile 1: 15.56 – 92.15
Minimum: 92.16 – 99.99
Decile 10: 100 – 100

Denominator

All patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Diagnosis for melanoma or history of melanoma (ICD-10-CM): C43.0, C43.10, C43.111, C43.112, C43.121, C43.122, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.111, D03.112, D03.121, D03.122, D03.20, D03.21, D03.22, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9, Z85.820, Z86.006

AND

Patient encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99424, 99426

Numerator

Patients whose information is entered, at least once within a 12 month period, into a recall system that includes:

A target date for the next complete physical exam AND

A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment

Numerator Instructions:
To satisfy this measure, the recall system must be linked to a process to notify patients when their next physical exam is due, and to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment and must include the following elements at a minimum: patient identifier, patient contact information, cancer diagnosis(es), date(s) of initial cancer diagnosis (if known), and the target date for the next complete physical exam.

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are system reason(s) for not entering the patient’s information into a recall system (e.g. melanoma is being monitored by another physician provider).

Numerator Options:

Performance Met:

Patient information entered into a recall system that includes: target date for the next exam specified AND a process to follow up with patients regarding missed or unscheduled appointments (7010F)

Denominator Exception:

Documentation of system reason(s) for not entering patient’s information into a recall system (e.g., melanoma being monitored by another physician provider) (7010F with 3P)

Performance Not Met:

Recall system not utilized, reason not otherwise specified (7010F with 8P)