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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
104 0390 Process No Effective Clinical Care
Registry

Measure Description

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at high or very high risk of recurrence receiving external beam radiotherapy to the prostate who were prescribed androgen deprivation therapy in combination with external beam radiotherapy to the prostate

Instructions

This measure is to be submitted once per episode of radiation therapy for all male patients with prostate cancer who receive external beam radiotherapy to the prostate during the performance period. Each episode of radiation therapy in an eligible patient receiving external beam radiotherapy to the prostate occurring during the performance period will be counted when calculating the data completeness and performance rates. The quality-data code or equivalent needs to be submitted only once during the episode of radiation therapy (e.g., 8 weeks of therapy). It is anticipated that eligible clinicians who perform external beam radiotherapy to the prostate will submit this measure.

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

Numerator

Patients who were prescribed androgen deprivation therapy in combination with external beam radiotherapy to the prostate

Definition

Prescribed – Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the performance period, even if the prescription for that medication was ordered prior to the encounter.

Numerator Quality-Data Coding Options

Performance Met:

Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate (G9894)

Denominator Exception:

Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (eg, salvage therapy) (G9895)

OR

Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (G9896)

Performance Not Met:

Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given (G9897)

NUMERATOR NOTE  Denominator Exception(s) are determined on the date of the denominator eligible encounter

Denominator

All patients, regardless of age, with a diagnosis of prostate cancer at high or very high risk of recurrence receiving external beam radiotherapy to the prostate

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

Definitions:
Risk Strata – Very Low, Low, Intermediate, High, or Very High–Very Low Risk – PSA < 10 ng/mL; AND Gleason score 6 or less/Gleason grade group 1; AND clinical stage T1c; AND presence of disease in fewer than 3 biopsy cores; AND ≤ 50% prostate cancer involvement in any core; AND PSA density < 0.15 ng/mL/cm3.

Low Risk – PSA < 10 ng/mL; AND Gleason score 6/Gleason grade group 1; AND clinical stage T1 to T2a.

Intermediate Risk – PSA 10 to 20 ng/mL; OR Gleason score 7/Gleason grade group 2-3; OR clinical stage T2b to T2c.
Note: Patients with multiple adverse factors may be shifted into the high risk category.

High RiskPSA > 20 ng/mL; OR Gleason score 8 to 10/Gleason grade group 4-5; OR clinically localized stage T3a.
Note: Patients with multiple adverse factors may be shifted into the very high risk category.

Very High Risk – Clinical stage T3b to T4; OR primary Gleason pattern 5; OR more than 4 cores with Gleason score 8 to 10/Gleason grade group 4-5. (NCCN, 2017)

External beam radiotherapyExternal beam radiotherapy refers to 3D conformal radiation therapy (3DCRT), intensity  modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), and proton beam therapy

Denominator Criteria (Eligible Cases):
Any male patient, regardless of age

AND

Diagnosis for prostate cancer (ICD-10-CM): C61

AND

Patient encounter during the performance period (CPT): 77427, 77435

AND

High or very high risk of recurrence of prostate cancer: G8465

AND NOT

DENOMINATOR EXCLUSION:
Diagnosis for metastatic cancer (ICD-10-CM):
C77.0, C77.1, C77.2, C77.3, C77.4, C77.5, C77.8,
C77.9, C78.00, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.6, C78.7, C78.80,
C78.89, C79.00, C79.01, C79.02, C79.10, C79.11, C79.19, C79.2, C79.31, C79.32, C79.40, C79.49,
C79.51, C79.52, C79.60, C79.61, C79.62, C79.70, C79.71, C79.72, C79.81, C79.82, C79.89, C79.9


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