CMS Measure ID: #395
Collection Type: CQM
Reporting Frequency: Every visit
Outcome: No
High Priority: Yes
NQS Domain: Communication and Care Coordination
Measure Age: > 2 years
Instructions
This measure is to be submitted each time a patient’s 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:
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
Pathology reports based on lung biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following the International Association for the Study of Lung Cancer (IASLC) guidance or classified as non-small cell lung cancer not otherwise specified (NSCLC-NOS) with an explanation included in the pathology report.
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: Yes
Capped at 7: Yes
Decile 0: 0 – 88.02
Decile 1: 88.03 – 99.99
Decile 10: 100 – 100
Denominator
Lung biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer
Denominator Criteria (Eligible Cases):
Patients ≥ 18 years of age on date of encounter
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 encounter during performance period (CPT): 88104, 88108, 88112, 88173, 88305
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSIONS:
Specimen sites other than anatomic location of lung or is not classified as primary non-small cell lung cancer: G9420
Numerator
Lung biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer classified into specific histologic type following IASLC guidance (see below) (including but not limited to squamous cell carcinoma or adenocarcinoma) OR classified as NSCLC-NOS with an explanation included in the pathology report
IASLC Guidance: The IASLC recommends the following regarding terminology for small biopsy and cytology specimens:
1. Do not use the term “large cell carcinoma”
2. Do not use the term “AIS (adenocarcinoma in situ)” or “MIA (minimally invasive adenocarcinoma)” — if a noninvasive pattern is present in a small biopsy, the term “lepidic growth” should be used instead
3. Do not use the term “BAC (bronchioloalveolar carcinoma)”
All three recommendations must be followed in order for a case to be considered Met (ie if any one of these terms is present, the case is Not Met)
Numerator Options:
Performance Met:
Primary non-small cell lung cancer lung biopsy and cytology specimen report documents classification into specific histologic type following IASLC guidance OR classified as NSCLC-NOS with an explanation (G9418)
OR
Denominator Exception:
Documentation of medical reason(s) for not including the histological type OR NSCLC-NOS classification with an explanation (e.g. Specimen insufficient or non-diagnostic, specimen does not contain cancer, or other documented medical reasons) (G9419)
OR
Performance Not Met:
Primary non-small cell lung cancer lung biopsy and cytology specimen report does not document classification into specific histologic type OR histologic type does not follow IASLC guidance OR is classified as NSCLC-NOS but without an explanation (G9421)