#102: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Quality ID

102

eMeasure ID

CMS129v7

NQF

0389

High Priority Measure

No

Specifications

EHR Registry

Measure Type

Process

Specialty

General Oncology Radiation Oncology Urology

Measure description

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

 

Instructions

This measure is to be submitted once per episode of treatment (i.e., interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy) for all male patients with prostate cancer who receive interstitial prostate brachytherapy, external beam radiotherapy to the prostate, radical prostatectomy, or cryotherapy during the performance period. Each episode of radiation therapy in an eligible patient receiving external beam radiotherapy to the prostate occurring during the performance period will be counted when calculating the data completeness and performance rates. The quality-data code or equivalent needs to be submitted only once during the episode of radiation therapy (e.g., 8 weeks of therapy). It is anticipated that eligible clinicians who perform the listed procedures as specified in the denominator coding will submit this measure.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions 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.

 

Denominator

All patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy

Definitions:

Risk Strata: Very Low, Low, Intermediate, High, or Very High- Very Low Risk - PSA < 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1c; AND presence of disease in fewer than 3 biopsy cores; AND <= 50% prostate cancer involvement in any core; AND PSA density < 0.15 ng/mL/g.

Low Risk - PSA < 10 ng/mL; AND Gleason score 6; AND clinical stage T1 to T2a.

Intermediate Risk - PSA 10 to 20 ng/mL; OR Gleason score 7; OR clinical stage T2b to T2c.

Note: Patients with multiple adverse factors may be shifted into the high risk category.

High Risk - PSA > 20 ng/mL; OR Gleason score 8 to 10; OR clinically localized stage T3a.

Note: Patients with multiple adverse factors may be shifted into the very high risk category.

Very High Risk - Clinical stage T3b to T4; OR primary Gleason pattern 5; OR more than 4 cores with Gleason score 8 to 10. (NCCN, 2016)

External beam radiotherapy – external beam radiotherapy refers to 3D conformal radiation therapy (3D- CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), and proton beam therapy.

Denominator Criteria (Eligible Cases):

Any male patient, regardless of age

AND

Diagnosis for prostate cancer (ICD-10-CM): C61

AND

Patient encounter during the performance period (CPT): 55810, 55812, 55815, 55840, 55842, 55845, 55866, 55873, 55875, 77427, 77435, 77772, 77778, 77799

AND

Low (or very low) risk of recurrence, prostate cancer: G9706

 

Numerator

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer

NUMERATOR NOTE: Denominator Exception(s) are determined any time after diagnosis of Prostate Cancer.

Numerator Instructions: A higher score indicates appropriate treatment of patients with prostate cancer at low (or very low) risk of recurrence.

Numerator Options:

Performance Met: Bone scan not performed prior to initiation of treatment nor at any time since diagnosis of prostate cancer (3270F)

OR

Denominator Exception: Documentation of medical reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons) (3269F with 1P)

OR

Denominator Exception: Documentation of system reason(s) for performing a bone scan (including bone scan ordered by someone other than the reporting physician) (3269F with 3P)

OR

Performance Not Met: Bone scan performed prior to initiation of treatment or at any time since diagnosis of prostate cancer (3269F)

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