2023 # 451 RAS (KRAS and NRAS) Gene Mutation Testing Performed for Patients with Metastatic Colorectal Cancer who receive Anti-epidermal Growth Factor Receptor (EGFR) Monoclonal Antibody Therapy

CMS Measure ID: #451

Collection Type: CQM

Reporting Frequency: Once per patient per year

Outcome: No

High Priority: No

NQS Domain: Effective Clinical Care

Measure Age: > 2 years

Instructions

This measure is to be submitted once per performance period for patients with colorectal cancer seen during 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 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

Percentage of adult patients (aged 18 or over) with metastatic colorectal cancer who receive anti-epidermal growth factor receptor monoclonal antibody therapy for whom RAS (KRAS and NRAS) gene mutation testing was performed

Denominator

Adult patients with metastatic colorectal cancer who receive anti-EGFR monoclonal antibody therapy

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter 

AND

Diagnosis of Initial colon or rectal cancer diagnosis (ICD-10 CM): C18.0, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20

AND

Patient Encounter during the performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215

WITHOUT
Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

AND

Two or more encounters at the reporting site

AND

Patient has metastatic disease at diagnosis: G9838

AND

Anti-EGFR monoclonal antibody therapy: G9839

Numerator

RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb

Definition:

RAS mutation testing – RAS testing for this measure refers to assays that detect mutations in codons 12 and 13 of exon 2, codons 59 and 61 or exon 3 and codons 117 and 146 in exon 4 in KRAS or NRAS.  Do not include results from mutations at other codons or assays for other alterations (e. g., BRAF, PI3K, PTEN genes). The College of American Pathologists (CAP) Perspectives on Emerging Technology (POET) Report on RAS mutation testing provides additional guidance on testing. 

If multiple RAS mutation tests have been performed, refer to the most recent test results. 

Anti-EGFR monoclonal antibody includes cetuximab or panitumumab

Numerator Instructions: In the absence of any documentation regarding testing for the RAS (KRAS and NRAS) gene mutation, submit G9841: RAS (KRAS and NRAS) gene mutation testing not performed before initiation of anti-EGFR MoAb. Report G9840: RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb, if the report indicates a mutation within codons 12 and 13 of exon 2, codons 59 and 61 of exon 3 and codons 117 and 146 in exon 4 in KRAS or NRAS, where KRAS or NRAS gene was detected in the DNA extracted from the colon tumor specimen. 

Numerator Options:

Performance Met:

RAS (KRAS and NRAS) gene mutation testing performed before initiation of anti-EGFR MoAb (G9840)

OR

Performance Not Met:

RAS (KRAS and NRAS) gene mutation testing not performed before initiation of anti-EGFR MoAb (G9841)