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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
099 0391 Process Yes Effective Clinical Care Claims

Measure Description

Percentage of breast cancer resection pathology reports that include the pT category (primary tumor), thepN category (regional lymph nodes), and the histologic grade

Instructions

This measure is to be submitted each time a breast cancer resection surgical pathology examination is performed during the performance period for breast cancer patients. Each unique CPT Category I code submitted on the claim will be counted for denominator inclusion. It is anticipated that eligible clinicians who examine breast tissue specimens following resection in a laboratory or institution will submit this measure. If the specimen is not primary breast tissue (e.g., liver, lung), report only CPT II code 3250F

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Reports that include the pT category, the pN category and the histologic grade

Definition

No data related

Numerator Quality-Data Coding Options

Denominator Exclusion: CPT II 3250F:
If Patient is not Eligible for this Measure because the Specimen is not Primary Breast Tissue (e.g., Liver, Lung) Report :

Specimen site other than anatomic location of primary tumor

OR

Denominator Exclusion: 3260F with 1P:
pT Category, pN Category and Histologic Grade not Documented for Medical Reasons:

Append a modifier (1P) to CPT Category II code 3260F to report documented circumstances that appropriately exclude patients from the denominator.

Documentation of medical reason(s) for not including the pT category, the pN category, or the histologic grade in the pathology report (eg, re-excision without residual tumor, non-carcinomas)

Performance Met: CPT II 3260F:
pT Category, pN Category and Histologic Grade Documented

pT category (primary tumor), pN category (regionallymph nodes), and histologic grade documented in pathology report

Performance Not Met: 3260F with 8P:
pT Category, pN Category and Histologic Grade not Documented, Reason not Otherwise Specified:

Append a reporting modifier (8P) to CPT Category II code 3260F to report circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

pT category, pN category, and histologic grade were not documented in pathology report, reason not otherwise specified

NUMERATOR NOTE: No notes related

Denominator

All breast cancer resection pathology reports (excluding biopsies)

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Diagnosis for breast cancer (ICD-10-CM): C50.011, C50.012, C50.019, C50.021, C50.022, C50.029, C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222, C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421, C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619, C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.821, C50.822, C50.829, C50.911, C50.912, C50.919, C50.921, C50.922, C50.929

 

 

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