Measure Description
Percentage of final reports for abdominal imaging studies for patients aged 18 years and older with one or more of the following noted incidentally with follow‐up imaging recommended
• Liver lesion ≤ 0.5 cm
• Cystic kidney lesion < 1.0 cm
• Adrenal lesion ≤ 1.0 cm
Instructions
This measure is to be submitted each time a patient undergoes an imaging study with an incidental abdominal lesion finding during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who provide the professional component of diagnostic imaging studies will submit this measure.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. 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 by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All final reports for abdominal imaging studies for patients aged 18 years and older with one or more of the following noted: Liver lesion ≤ 0.5 cm, Cystic kidney lesion < 1.0 cm or Adrenal lesion ≤ 1.0 cm
DENOMINATOR NOTE: The intent of this measure is to ensure patients with incidental findings that are highly likely to be benign do not receive follow up imaging routinely. Denominator eligible patients would be those for whom one or more of the following incidental findings is noted in the final report:
• Liver lesion ≤ 0.5 cm
• Cystic kidney lesion < 1.0 cm
• Adrenal lesion ≤ 1.0 cm
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Patient procedure during the performance period (CPT): 74150, 74160, 74170, 74176, 74177, 74178, 74181, 74182, 74183, 76700, 76705, 76770, 76775
AND
Incidental finding: Liver lesion ≤ 0.5 cm, Cystic kidney lesion < 1.0 cm or Adrenal lesion ≤ 1.0 cm: G9547
Numerator
Final reports for abdominal imaging studies with follow-up imaging recommended
Numerator Instructions:
INVERSE MEASURE - A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
Numerator Options:
Performance Met: Final reports for abdominal imaging studies with follow- up imaging recommended (G9548)
OR
Denominator Exception: Documentation of medical reason(s) that follow-up imaging is indicated (eg, patient has a known malignancy that can metastasize, other medical reason(s) such as fever in an immunocompromised patient) (G9549)
OR
Performance Not Met: Final reports for abdominal imaging studies with follow-up imaging not recommended (G9550)