Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status.
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.
All radical prostatectomysurgicalpathologyexaminations performed duringthemeasurementperiodfor primary prostate cancer
Denominator Criteria (Eligible Cases):
Diagnosis for malignant neoplasm of prostate (ICD-10-CM): C61
Patient procedure during the performance period (CPT): 88309
Telehealth Modifier: GQ, GT, 95, POS 02
Specimen site other than anatomic location of prostate: G8798
RadicalProstatectomy reports that include the pT category, the pNcategory,Gleason score and a statement about margin status
Performance Met: Pathology report includes pT category, pN category, Gleasonscoreandstatement about margin status (3267F)
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)
Performance Not Met: pTcategory, pNcategory,Gleasonscoreand statement aboutmargin statuswere not documented in pathology report, reason not otherwise specified (3267Fwith 8P)
Therapeutic decisions for prostate cancermanagement are stage driven and cannot bemadewithout a complete set of pathology descriptors. Incomplete pathology reports for prostate cancer may result in misclassification of patients, rework anddelays,andsuboptimalmanagement.TheCollegeofAmericanPathologistsCancerCommitteehas produced an evidencebased protocol/checklist of essential pathologic parameters that are recommended to be included in prostate cancer resection pathology reports.Conformance of pathology reportswith theCAPchecklist is a requirement for Cancer Center certification by the ACS.
Theprotocolrecommendsthe use oftheTNMStaging System forcarcinomaoftheprostateof theAmericanJoint Committeeon Cancer(AJCC)andtheInternationalUnionAgainstCancer(UICC) (AJCC, 2017). Theradical prostatectomy checklist also includes extraprostatic extension.
In a studyof cancer recurrencefollowing radical prostatectomy,itwasnotedthat“Therelativelyhighproportionof patientswho have biopsy-provenlocalrecurrencewhohaveorgan-confineddiseaseis probably inaccurate and,inlarge part, reflects under sampling and under recognition of extraprostatic extension” (Ripple et al 2000 Mod Path).
TheCAP Q probesdata(2006)indicatethat11.6%ofprostatepathologyreportshadmissingelements.Extent of invasion (pTNM) wasmost frequently missing (52.1% of the reports missing elements), and extraprostatic extension was the second most frequentlymissing (41.7%of the reports missing elements).Margin statuswas missing in 8.3%of reports.
A sampling from prostate cancer cases in 2000 through 2001 fromtheCollege ofSurgeonsNationalCancerDataBase found only 48.2% of surgical pathology reports for prostate cancer documented pathologic stage similar to themore recent data fromthe CAP Q probes study. The NCDB data showed theGleason scorewas present 86.3% of the time, slightly less than the 100% compliance found in the CAP Q probes study and thatmargin status was present in 84.9% of reports.
Clinical Recommendation Statements
Patientmanagementandtreatment guidelinespromoteanorganizedapproachtoprovidingquality care.The(American College ofSurgeonsCommittee onCancer)CoCrequires that 90%of pathology reports that include a cancer diagnosis containthescientificallyvalidateddataelementsoutlinedinthesurgicalcase summary checklistoftheCollegeof American Pathologists (CAP) publicationReportingonCancer Specimens. TheCollegeregards thereportingelements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report.However,themannerinwhichtheseelementsarereportedisatthediscretionofeachspecific 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.