2023 MIPS Measure #147: Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

Measure Description

Percentage of final reports for all patients, regardless of age, undergoing bone scintigraphy that include physician documentation of correlation with existing relevant imaging studies (e.g., x-ray, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), etc.) that were performed.

Instructions

This measure is to be submitted each time bone scintigraphy is performed during the performance period. There is no diagnosis associated with this measure. It is anticipated that Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the professional component of the bone scintigraphy study 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 final reports for patients, regardless of age, undergoing bone planar and whole body scintigraphy

Denominator Criteria (Eligible Cases):

Patient encounter during the performance period (CPT): 78300, 78305, 78306, 78315

WITHOUT

Telehealth Modifier (including but not limited to): GQ, GT, 95, POS 02

Numerator

Final reports that include physician documentation of correlation with existing relevant imaging studies (e.g., x-ray, MRI, CT, etc.)

Definition:

Relevant Imaging Studies – “Relevant imaging studies” are defined as studies that correspond to the same anatomical region in question.

Numerator Options:

Performance Met: Final report for bone scintigraphy study includes correlation with existing relevant imaging studies (e.g., x-ray, MRI, CT) corresponding to the same anatomical region in question (3570F)

OR

Denominator Exception: Documentation of system reason(s) for not documenting correlation with existing relevant imaging studies in final report (e.g., no existing relevant imaging study available, patient did not have a previous relevant imaging study) (3570F with 3P)

NOTE: Correlative studies are considered to be unavailable if relevant studies (reports and/or actual examination material) from other imaging modalities exist but could not be obtained after reasonable efforts to retrieve the studies are made by the interpreting physician prior to the finalization of the bone scintigraphy report.

OR

Performance Not Met: Bone scintigraphy report not correlated in the final report with existing relevant imaging studies, reason not otherwise specified (3570F with 8P)

Rationale

Radionuclide bone imaging plays an integral part in tumor staging and management; the majority of bone scans are performed in patients with a diagnosis of malignancy, especially carcinoma of the breast, prostate gland, and lung. This modality is extremely sensitive for detecting skeletal abnormalities, and numerous studies have confirmed that it is considerably more sensitive than conventional radiography for this purpose. However, the specificity of bone scan abnormalities can be low since many other conditions may mimic tumor; therefore, it is important that radionuclide bone scans are correlated with available, relevant imaging studies. Existing imaging studies that are available can help inform the diagnosis and treatment for the patient. Furthermore, correlation with existing radiographs is considered essential to insure that benign conditions are not interpreted as tumor. While there are no formal studies on variations in care in how often correlation with existing studies is not performed, there is significant anecdotal information from physicians practicing in the field that there is a gap in care and that correlation is not occurring frequently when images are available.

Literature suggests that as many as 30% of Radiology reports contain errors, regardless of the imaging modality, radiologists’ experience, or time spent in interpretation. Evidence has also suggested that Radiology reports are largely non-standardized and commonly incomplete, vague, untimely, and error-prone and may not serve the needs of referring physicians. Therefore, it is imperative that existing imaging reports be correlated with the Nuclear Medicine bone scintigraphy procedure to ensure proper diagnosis and appropriate patient treatment.

Clinical Recommendation Statements

Bone scintigraphy abnormalities should be correlated with appropriate physical examination and imaging studies to ascertain that osseous or soft-tissue abnormalities, which might cause cord or other nerve compression or pathologic fracture in an extremity, are not present. (SNM, 2003)

Interpretation criteria

Bone scans are very sensitive for disease, but specificity of findings is low and must be interpreted in light of other information

1. History
2. Physical Exam
3. Other test results
4. Comparison with previous studies

(SNM, 2003)

Reporting

1. Description of technique
2. Description of abnormal tracer uptake
3. Correlation with other studies
4. Comparison with previous studies
5. Interpretation

(SNM, 2003)

Comparisons with previous examinations and reports, when possible, should be a part of the imaging consultation and report. Integrated Positron Emission Tomography – Computed Tomography (PET/CT) studies are more valuable when correlated with previous diagnostic CT, previous PET, previous PET/CT, previous MRI, and all appropriate imaging studies and clinical data that are relevant. (SNM, 2010)

As bone tracer concentration reflects osteoblastic activity which is a common response to a wide range of pathologies, a focus of abnormal tracer concentration should not be confidently assigned to a particular pathology without a typical pattern of tracer distribution such as multiple randomly placed foci in metastatic bone disease or multiple aligned foci of rib uptake in trauma. In the absence of this, correlation of foci or uptake with alternative modality images such as plain radiographs, MR or CT images should be reviewed when available as this can significantly increase the accuracy of bone scintigraphy interpretation. (BNMS, 2014)