Measure Description
Percentage of esophageal biopsy reports that document the presence ofBarrett’smucosa that also include a statement about dysplasia
Instructions
This measure is to be submitted each time a patient’s esophageal 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 byMerit-based Incentive Payment System (MIPS) eligible clinicianswho perform the quality actions described in the measure based on the services provided and themeasure-specific denominator coding.
Measure Submission Type:
Measure datamay be submitted by individual MIPS eligibleclinicians, groups, orthird party intermediaries. The listed denominatorcriteriaareusedtoidentifytheintendedpatientpopulation.Thenumeratoroptionsincludedinthis specification are used to submit the quality actions as allowed by themeasure. The quality data codes listed do not needtobesubmitted by MIPS eligibleclinicians,groups,orthirdpartyintermediariesthatutilizethismodalityfor submissions; however, these codes may be submitted forthose third party intermediaries that utilizeMedicare 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 esophageal 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
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSION:
Specimen site other than anatomic location of esophagus: G8797
Numerator
Esophageal biopsyreport documents the presence of Barrett’s mucosa and includes a statementaboutdysplasia
Numerator Options:
Performance Met: Esophageal biopsy reportswith the histological findingof Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading)(3126F)
OR
Denominator Exception: Documentation ofmedicalreason(s)for not submitting the histological finding of Barrett’s mucosa (e.g.,malignant neoplasmorabsenceofintestinalmetaplasia)(3126Fwith 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,orindefinite,and if present,contains appropriate grading), reason not otherwise specified (3126F with 8P)
Rationale
Endoscopy is thetechnique of choice used to identify suspectedBarrett’s esophagus and to diagnosecomplications of GERD. Biopsy must beadded to confirm the presence of Barrett’sepithelium 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 peoplewithoutBarrett’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, partlybecausethediseaseisfrequentlydiscoveredat a latestageandbecause treatmentsarenot effective. A diagnosis of Barrett’s esophaguscould allow for appropriate screening of at risk patients as recommended by the American College ofGastroenterology.
Standard endoscopywith biopsy currently is themostreliablemeans of establishing a diagnosis ofBarrett’s esophagus. The definitive diagnosis of Barrett’s esophagus requires a pathologist’s reviewof 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 reviewof 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
ThediagnosisofBarrett’sesophagus requires systematicbiopsyoftheabnormal-appearingesophagealmucosato document intestinal metaplasia and to detect dysplasia (ACG, 2016).