CMS Measure ID: #396
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 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:
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 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.
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: Yes
Capped at 7: Yes
Decile 10: 100 – 100
Denominator
Pathology reports for lung resection specimens for primary lung carcinoma
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 procedure during performance period (CPT): 88309
WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSION:
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 (Squamous Cell Carcinoma, Adenocarcinoma and NOT NSCLCNOS) (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 Nonsmall Cell Lung Cancer, Histologic Type (Squamous Cell Carcinoma, Adenocarcinoma) (G9425)