2023 # 320 Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients

CMS Measure ID: #320

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 seen during the performance period. Performance for this measure is not limited to the performance period. 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 services provided and the measure specific denominator coding. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into the measure.

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 aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: Yes
Capped at 7: Yes

Decile 0: 0 – 1.76
Decile 1: 1.77 – 77.37
Minimum: 77.38 – 91.29
Decile 3: 91.3 – 96.29
Decile 4: 96.3 – 97.71
Decile 5: 97.72 – 98.69
Decile 6: 98.7 – 99.43
Decile 7: 99.44 – 99.99
Decile 10: 100 – 100

Denominator

All patients aged 45 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy

Denominator Instructions: Eligible clinicians who indicate that the colonoscopy procedure is incomplete or was discontinued should use the procedure number and the addition (as appropriate) of modifier 52, 53, 73, or 74. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into this measure.

Denominator Criteria (Eligible Cases):

Patients aged 45 to 75 on date of encounter

AND

Patient undergoing screening for malignant neoplasm of colon (ICD-10-CM): Z12.11

AND

Patient procedure during the performance period (CPT or HCPCS): 44388, 45378, G0121

WITHOUT

Modifiers: 52, 53, 73, or 74

WITHOUT

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

Numerator

Patients who had recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

Numerator Options

Performance Met:

Recommended follow-up interval for repeat colonoscopy of at least 10 years documented in colonoscopy report (0528F)

OR

Denominator Exception:
Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is ≥ 66 years old, or life expectancy < 10 years, other medical reasons) (0528F with 1P)

OR

Performance Not Met:
At least 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified (0528F with 8P)