#224: Melanoma: Overutilization of Imaging Studies in Melanoma

Quality ID

224

NQF

0562

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Dermatology

Measure description

Percentage of patients, regardless of age, with a current diagnosis of Stage 0 through IIC melanoma or a history of melanoma of any stage, without signs or symptoms suggesting systemic spread, seen for an office visit during the one-year measurement period, for whom no diagnostic imaging studies were ordered

 

Instructions

This measure is to be submitted once per performance period for patients with a current diagnosis of stage 0 through IIC melanoma or a history of melanoma who are seen for an office visit during the performance period. This measure is intended to reflect the quality of services provided for the primary management of patients with melanoma who have an office visit during the performance period.

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.

 

THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:

1) Patients with a diagnosis of Stage 0 through IIC melanoma without signs or symptoms suggesting systemic spread

OR

2) Patients with a history of any stage melanoma without signs or symptoms suggesting systemic spread

 

SUBMISSION CRITERIA 1: PATIENTS WITH A CURRENT DIAGNOSIS OF STAGE 0 THROUGH IIC MELANOMA WITHOUT SIGNS OR SYMPTOMS SUGGESTING SYSTEMIC SPREAD

Denominator (Submission Criteria 1)

All patients, regardless of age, with a current diagnosis of Stage 0 through IIC melanoma, without signs or symptoms suggesting systematic spread, seen for an office visit during the one-year measurement period

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.

Definitions:

Signs – For the purposes of this measure, signs include tenderness, jaundice, localized neurologic signs such as weakness, or any other sign.

Symptoms – For the purposes of this measure, symptoms include cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread.

Denominator Criteria (Eligible Cases) 1:

Diagnosis for melanoma (ICD-10-CM): C43.0, C43.10, C43.11, C43.12, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.11, D03.12, D03.20, D03.21, D03.22, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

AJCC Melanoma Cancer Stage 0 through IIC Melanoma: G8944

AND

Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma): G8749

 

Numerator (Submission Criteria 1)

Patients for whom no diagnostic imaging studies were ordered

Numerator Instructions: A higher score indicates appropriate treatment of patients with melanoma without additional signs or symptoms.

NUMERATOR NOTE: For Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or system reason(s) for ordering an imaging study (e.g. patient has co-morbid condition that warrant imaging or studies were ordered by another provider, etc.) as further specified below.

Definition:

Diagnostic Imaging Studies – Chest x-ray (CXR), Computed Tomography (CT), Ultrasound, Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), and nuclear medicine scans. Ordering any of these imaging studies during the one year measurement period is considered a failure of the measure, unless a justified reason is documented through use of a medical or system reason for exception.

Numerator Options:

Performance Met: None of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (3320F)

OR

Denominator Exception: Documentation of medical reason(s) for ordering diagnostic imaging studies (e.g., patient has co-morbid condition that warrants imaging, other medical reasons) (3319F with 1P)

OR

Denominator Exception: Documentation of system reason(s) for ordering diagnostic imaging studies (e.g., requirement for clinical trial enrollment, ordered by another provider, other system reasons) (3319F with 3P)

OR

Performance Not Met: One of the following diagnostic imaging studies ordered; chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (3319F)

 

OR

 

SUBMISSION CRITERIA 2: PATIENTS WITH A HISTORY OF ANY STAGE MELANOMA WITHOUT SIGNS OR SYMPTOMS SUGGESTING SYSTEMIC SPREAD

Denominator (Submission Criteria 2)

All patients, regardless of age, with a history of melanoma of any stage, without signs or symptoms suggesting systemic spread, seen for an office visit during the one-year measurement period

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.

Definitions:

Signs – For the purposes of this measure, signs include tenderness, jaundice, localized neurologic signs such as weakness, or any other sign.

Symptoms – For the purposes of this measure, symptoms include cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread.

Denominator Criteria (Eligible Cases) 2:

Diagnosis for history of melanoma (ICD-10-CM): Z85.820

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND

Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma): G8749

 

 

Numerator (Submission Criteria 2)

Patients for whom no diagnostic imaging studies were ordered

Numerator Instructions: A higher score indicates appropriate treatment of patients with melanoma without additional signs or symptoms.

NUMERATOR NOTE: Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or system reason(s) for ordering an imaging study (e.g. patient has co-morbid condition that warrant imaging or studies were ordered by another provider, etc.).

Definition:

Diagnostic Imaging Studies – CXR, CT, Ultrasound, MRI, PET, and nuclear medicine scans. Ordering any of these imaging studies during the one year measurement period is considered a failure of the measure, unless a justified reason is documented through use of a medical or system reason for exception.

Numerator Options:

Performance Met: None of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (3320F)

OR

Denominator Exception: Documentation of medical reason(s) for ordering diagnostic imaging studies (e.g., patient has co-morbid condition that warrants imaging, other medical reasons) (3319F with 1P)

OR

Denominator Exception: Documentation of system reason(s) for ordering diagnostic imaging studies (e.g., requirement for clinical trial enrollment, ordered by another provider, other system reasons) (3319F with 3P)

OR

Performance Not Met: One of the following diagnostic imaging studies ordered; chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans (3319F)

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