Measure Description
Pathology reports based on resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer (NSCLC), histologic type
Instructions
This measure is to be submitted each time a patient’s pathology report addresses specimens with a diagnosis of non- small cell lung cancer; however, only one quality-data code (QDC) per date of service for a patient is required. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
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
Pathology reports for resection specimens for primary lung carcinoma
Denominator Criteria (Eligible Cases):
Patients ≥18 years of age on date of service
AND
Diagnosis for lung cancer (ICD-10-CM): C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30, C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92
AND
Patient procedure during performance period (CPT): 88309
AND NOT
DENOMINATOR EXCLUSION:
Specimen site other than anatomic location of lung, OR classified as NSCLC-NOS: G9424
Numerator
Pathology reports based on resection specimens with a diagnosis of primary lung carcinoma that include the pT category, pN category and for non-small cell lung cancer, histologic type (squamous cell carcinoma, adenocarcinoma and NOT NSCLC-NOS (non-small cell lung cancer, not otherwise specified))
Numerator Options:
Performance Met: Primary lung carcinoma resection report documents pT category, pN category and for Non-small Cell Lung Cancer, Histologic Type (Squamous Cell Carcinoma, Adenocarcinoma and NOT NSCLC- NOS) (G9422)
OR
Denominator Exception: Documentation of medical reason for not including pT category, pN category and histologic type [For patient with appropriate exclusion criteria (e.g. metastatic disease, benign tumors, malignant tumors other than carcinomas, inadequate surgical specimens)] (G9423)
OR
Performance Not Met: Primary lung carcinoma resection report does not document pT category, pN category and for Non- small Cell Lung Cancer, Histologic Type (Squamous Cell Carcinoma, Adenocarcinoma) (G9425)
Rationale
The TNM staging revisions (AJCC 7th edition) became effective for all new cases diagnosed after January 1, 2010. The new staging system is applicable to both NSCLC and, for the first time, small cell lung cancer (SCLC). There are significant changes in staging, particularly in T3 for NSCLC. For these reasons, we believe a gap exists in the appropriate and consistent use of the new pT standards for lung cancer. (CAP Performance Measures Working Group)
Clinical Recommendation Statements
The TNM staging system of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) is recommended for non-small cell lung cancer. Small cell lung cancer has been more commonly classified according to a separate staging system as either “limited” or “extensive” disease, but based on analysis of the International Association for the Study of Lung Cancer (IASLC) database, TNM staging is also recommended for small cell lung cancer.
The purpose of pathologic evaluation is to precisely classify the histologic type of lung cancer and to determine all staging parameters as recommended by the AJCC including tumor size, the extent of invasion (pleural and bronchial), adequacy of surgical margins, and presence or absence of lymph node metastasis.
Pathologic evaluation is performed to classify the histologic type of the lung cancer, determine the extent of invasion, determine whether it is primary lung cancer or metastatic cancer, establish the cancer involvement status of the surgical margins (i.e., positive or negative margins), and do molecular diagnostic studies to determine whether certain gene mutations are present.
A new lung cancer TNM staging system was developed by the International Association of the Study of Lung Cancer (IASLC) and adopted by the American Joint Commission for Cancer (AJCC) (7th edition, 2010). This new staging system is applicable to both NSCLC and SCLC based on studies by the IASLC which demonstrated the prognostic significance of the various stage designations in both diseases… application of the TNM system will not change how patients are treated; however, clinical research studies should begin to utilize the TNM system, because it will allow for more precise assessments of prognosis and specific therapy in the future. Therefore, the SCLC algorithm was revised in 2011 to include the TNM staging information.
The NCCN. Non-Small Cell Lung Cancer: Clinical Practice Guidelines in Oncology. Updated April 11,2012. Accessed May 9, 2012. To view the most recent and complete version of the guideline, go online to National Comprehensive Cancer Network.
The NCCN. Small Cell Lung Cancer: Clinical Practice Guidelines in Oncology. Updated June 23, 2012. Accessed May 9, 2012. To view the most recent and complete version of the guideline, go online to National Comprehensive Cancer Network.