Measure Description
Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status
Instructions
This measure is to be submitted each time a radical prostatectomy surgical pathology examination is performed during the performance period for prostate patients. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who examine prostate tissue specimens following resection in a laboratory or institution 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 radical prostatectomy surgical pathology examinations performed during the measurement period for prostate cancer patients
Denominator Criteria (Eligible Cases):
Diagnosis for malignant neoplasm of prostate (ICD-10-CM): C61
AND
Patient procedure during the performance period (CPT): 88309
AND NOT
DENOMINATOR EXCLUSION:
Specimen site other than anatomic location of prostate: G8798
Numerator
Radical Prostatectomy reports that include the pT category, the pN category, Gleason score and a statement about margin status
Numerator Options:
Performance Met: Pathology report includes pT category, pN category, Gleason score and statement about margin status (3267F)
OR
Denominator Exception: Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report (e.g., specimen originated from other malignant neoplasms, transurethral resections of the prostate (TURP), or secondary site prostatic carcinomas) (3267F with 1P)
OR
Performance Not Met: pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified (3267F with 8P)
Rationale
Therapeutic decisions for prostate cancer management are stage driven and cannot be made without a complete set of pathology descriptors. Incomplete pathology reports for prostate cancer may result in misclassification of patients, rework and delays, and suboptimal management. The College of American Pathologists Cancer Committee has produced an evidence-based protocol/checklist of essential pathologic parameters that are recommended to be included in prostate cancer resection pathology reports. Conformance of pathology reports with the CAP checklist is a requirement for Cancer Center certification by the ACS.
The protocol recommends the use of the TNM Staging System for carcinoma of the prostate of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) (AJCC, 2017). The radical prostatectomy checklist also includes extraprostatic extension.
In a study of cancer recurrence following radical prostatectomy, it was noted that “The relatively high proportion of patients who have biopsy-proven local recurrence who have organ-confined disease is probably inaccurate and, in large part, reflects under sampling and under recognition of extraprostatic extension” (Ripple et al 2000 Mod Path).
The CAP Q probes data (2006) indicate that 11.6% of prostate pathology reports had missing elements. Extent of invasion (pTNM) was most frequently missing (52.1% of the reports missing elements), and extraprostatic extension was the second most frequently missing (41.7% of the reports missing elements). Margin status was missing in 8.3% of reports.
A sampling from prostate cancer cases in 2000 through 2001 from the College of Surgeons National Cancer Data Base found only 48.2% of surgical pathology reports for prostate cancer documented pathologic stage similar to the more recent data from the CAP Q probes study. The NCDB data showed the Gleason score was present 86.3% of the time, slightly less than the 100% compliance found in the CAP Q probes study and that margin status was present in 84.9% of reports.
Clinical Recommendation Statements
Patient management and treatment guidelines promote an organized approach to providing quality care. The (American College of Surgeons Committee on Cancer) CoC requires that 90% of pathology reports that include a cancer diagnosis contain the scientifically validated data elements outlined in the surgical case summary checklist of the College of American Pathologists (CAP) publication Reporting on Cancer Specimens. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.
Pathologic staging is usually performed after surgical resection of the primary tumor. Pathologic staging depends on pathologic documentation of the anatomic extent of disease, whether or not the primary tumor has been completely removed.