2023 # 264 Sentinel Lymph Node Biopsy for Invasive Breast Cancer

CMS Measure ID: #264

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be submitted each time a procedure is performed during the performance period for patients age 18 years and older who are operated upon for invasive breast cancer that are clinically node negative (clinical stage T1N0M0 or T2N0M0) before or after neoadjuvant systemic therapy. 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 measurespecific denominator coding.

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

The percentage of clinically node negative (clinical stage T1N0M0 or T2N0M0) breast cancer patients before or after neoadjuvant systemic therapy, who undergo a sentinel lymph node (SLN) procedure

Denominator

Patients aged 18 and older with primary invasive breast cancer

Denominator Criteria (Eligible Cases): Patients aged 18 and older at date of encounter 

AND

Diagnosis for Female/Male Breast Cancer (ICD-10-CM): C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.821, C50.822, C50.829, C50.911, C50.912, C50.919, C50.921, C50.922, C50.929

AND

Patient encounter during the performance period (CPT): 19301, 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38542, 38740, 38745

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

AND

Clinically Node Negative (T1N0M0 or T2N0M0) Invasive Breast Cancer Before or After Neoadjuvant Systemic Therapy: G9911

Numerator

Patients who undergo a SLN procedure

Numerator Options:

Performance Met:

Sentinel lymph node biopsy procedure performed (G8878)

OR

Denominator Exception:

Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, preoperative biopsy proven lymph node (LN) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change) (G8880)

OR

Performance Not Met:

Sentinel lymph node biopsy procedure not performed, reason not given (G8882)