Measure Description
Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia
Instructions
This measure is to be submitted each time a patient’s surgical pathology report demonstrates Barrett’s Esophagus; 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
All surgical pathology biopsy reports for Barrett’s Esophagus
Denominator Criteria (Eligible Cases):
Diagnosis for Barrett’s Esophagus (ICD-10-CM): K22.70, K22.710, K22.711, K22.719
AND
Patient procedure during the performance period (CPT): 88305
AND NOT
DENOMINATOR EXCLUSION:
Specimen site other than anatomic location of esophagus: G8797
Numerator
Esophageal biopsy report documents the presence of Barrett’s mucosa and includes a statement about dysplasia
Numerator Options:
Performance Met: Esophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading) (3126F)
OR
Denominator Exception: Documentation of medical reason(s) for not submitting the histological finding of Barrett’s mucosa (e.g., malignant neoplasm or absence of intestinal metaplasia) (3126F with 1P)
OR
Performance Not Met: Pathology report with the histological finding of Barrett’s mucosa that does not contain a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading), reason not otherwise specified (3126F with 8P)
Rationale
Endoscopy is the technique of choice used to identify suspected Barrett’s esophagus and to diagnose complications of GERD. Biopsy must be added to confirm the presence of Barrett’s epithelium and to evaluate for dysplasia (ACG, 2016; AGA, 2011).
There is a rapidly rising incidence of adenocarcinoma of the esophagus in the United States. A diagnosis of Barrett’s esophagus increases a patient’s risk for esophageal adenocarcinoma by 30 to 125 times that of people without Barrett’s esophagus (although this risk is still small 0.4% to 0.5% per year)(Conteduca et al 2012, Intl J Onc). Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective. A diagnosis of Barrett’s esophagus could allow for appropriate screening of at risk patients as recommended by the American College of Gastroenterology.
Standard endoscopy with biopsy currently is the most reliable means of establishing a diagnosis of Barrett’s esophagus. The definitive diagnosis of Barrett’s esophagus requires a pathologist’s review of an esophageal biopsy. Dysplasia is the first step in the neoplastic process, and information about dysplasia is crucial for clinical decision-making directing therapy. The presence and grade of dysplasia cannot be determined by routine endoscopy, and pathologist’s review of a biopsy is essential for recognition of dysplasia, especially given that there are no recommended biomarkers for Barrett’s esophagus. Endoscopic surveillance detects curable neoplasia in patients with Barrett’s esophagus.
Clinical Recommendation Statements
The diagnosis of Barrett’s esophagus requires systematic biopsy of the abnormal-appearing esophageal mucosa to document intestinal metaplasia and to detect dysplasia (ACG, 2016).