#262: Image Confirmation of Successful Excision of Image-Localized Breast Lesion

Quality ID

262

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

N/A

Measure description

Image confirmation of lesion(s) targeted for image guided excisional biopsy or image guided partial mastectomy in patients with nonpalpable, image-detected breast lesion(s). Lesions may include: microcalcifications, mammographic or sonographic mass or architectural distortion, focal suspicious abnormalities on magnetic resonance imaging (MRI) or other breast imaging amenable to localization such as positron emission tomography (PET) mammography, or a biopsy marker demarcating site of confirmed pathology as established by previous core biopsy

 

Instructions

This measure is to be submitted each time an image guided excisional biopsy or wire localized partial mastectomy is performed in patients with non-palpable, image-detected breast lesions. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measurespecific denominator coding.

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

Number of patients aged 18 years and older on date of encounter with non-palpable, image-detected (by mammogram, ultrasound, or breast MRI, PET mammography or other imaging modality) breast lesion requiring localization of lesion (benign or malignant) for targeted resection (either excisional biopsy or partial mastectomy)

Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date on encounter

AND

Diagnosis for Breast Lesion (ICD-10-CM): C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.821, C50.822, C50.829, C50.911, C50.912, C50.919, C50.921, C50.922, C50.929, C79.81, D05.01, D05.02, D05.11, D05.12, D24.1, D24.2, D24.9, D48.61, D48.62, D49.3, N60.01, N60.02, N60.09, N60.11, N60.12, N60.19, N60.21, N60.22, N60.29, N60.31, N60.32, N60.39, N60.41, N60.42, N60.49, N60.81, N60.82, N60.89, N60.91, N60.92, N60.99, N61.0, N61.1, N62, N63.0, N63.10, N63.11, N63.12, N63.13, N63.14, N63.20, N63.21, N63.22, N63.23, N63.24, N63.31, N63.32, N63.41, N64.0, N64.1, N64.2, N64.3, N64.4, N64.51, N64.52, N64.53, N64.59, N64.81, N64.82, N64.89, N64.9, R92.0, R92.1, R92.2, R92.8, T85.44XA, T85.44XD, T85.44XS

AND

Patient encounter during the performance period (CPT): 19125, 19301, 19302

AND NOT

DENOMINATOR EXCLUSION:

Patients with needle localization specimens which are not amenable to intraoperative imaging such as MRI needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site): G8873

 

Numerator

Patients undergoing excisional biopsy or partial mastectomy of a non-palpable lesion whose excised breast tissue was evaluated by imaging (x-ray, ultrasound, MRI, PET mammography or other imaging modality) intraoperatively to confirm successful inclusion of targeted lesion

Numerator Options:

Performance Met: Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion (G8872)

OR

Performance Not Met: Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion, reason not given (G8874)

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