#195: Radiology: Stenosis Measurement in Carotid Imaging Reports

Quality ID

195

NQF

0507

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Diagnostic Radiology

Measure description

Percentage of final reports for carotid imaging studies (neck magnetic resonance angiography [MRA], neck computed tomography angiography [CTA], neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement

 

Instructions

This measure is to be submitted each time a carotid imaging study is performed during the performance period for all patients, regardless of age. There is no diagnosis associated with this measure. Eligible clinicians who provide the professional component of diagnostic imaging studies of the carotids 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 final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

Denominator Criteria (Eligible Cases):

Patient procedure during the performance period (CPT): 36221, 36222, 36223, 36224, 37215, 37216*, 37217, 37218, 70498, 70547, 70548, 70549, 93880, 93882

 

Numerator

Final reports for carotid imaging studies that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement

Numerator Instructions: This measure requires that the estimate of stenosis included in the report of the imaging study employ a method such as the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method for calculating the degree of stenosis. The NASCET method calculates the degree of stenosis with reference to the lumen of the carotid artery distal to the stenosis.

For duplex imaging studies the reference is indirect, since the degree of stenosis is inferred from velocity parameters and cross referenced to published or self-generated correlations among velocity parameters and results of angiography or other imaging studies which serve as the gold standard. In Doppler ultrasound, the degree of stenosis can be estimated using Doppler parameter of the peak systolic velocity (PSV) of the internal carotid artery (ICA), with concordance of the degree of narrowing of the ICA lumen. Additional Doppler parameters of ICA-to-common carotid artery (CCA) PSV ratio and ICA end-diastolic velocity (EDV) can be used when degree of stenosis is uncertain from ICA PSV. (Grant et al, 2003)

A short note can be made in the final report, such as:

  • Severe left ICA stenosis of 70-80% by NASCET criteria” or
  • “Severe left ICA stenosis of 70-80% by criteria similar to NASCET” or
  • “70% stenosis derived by comparing the narrowest segment with the distal luminal diameter as related to the submitted measure of arterial narrowing” or
  • “Severe stenosis of 70-80% - validated velocity measurements with angiographic measurements, velocity criteria are extrapolated from diameter data as defined by the Society of Radiologists in Ultrasound Consensus Conference Radiology 2003; 229;340-346”.

NOTE: In cases where the carotid imaging exam findings result in no stenosis and that determination is included in the final report, the measure can be submitted as “performance met” since “no stenosis” is considered a NASCET category.

In a small number of denominator cases the distal ICA may not be viewed e.g. an innominate artery or common carotid injection. Performance would be met if there is documentation, for example, that indicates “stenosis measurements are made with reference to the distal lumen”, as a matter of process and consistent practice method.

Definition:

“Direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement” – includes direct angiographic stenosis calculation based on the distal lumen as the denominator for stenosis measurement OR an equivalent validated method referenced to the above method (e.g., for duplex ultrasound studies, velocity parameters that correlate with anatomic measurements that use the distal internal carotid lumen as the denominator for stenosis measurement).

Numerator Options:

Performance Met: Carotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement) (3100F)

OR

Performance Not Met: Carotid imaging study report did not include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, reason not otherwise specified (3100F with 8P)

 

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