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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
185 0659 Process Yes Communication and Care Coordination Registry

Measure Description

Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of aprior adenomatous polyp(s) in previous colonoscopy findings, which had an interval of 3 or more years since their last colonoscopy

Instructions

This measure is to be submitted each time a surveillance colonoscopy is performed during the performance period. It is anticipated the eligible clinician who performs the listed procedures, as specified in the denominator coding, will submiton this measure. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73 or 74 will not qualify for inclusion into this measure.

NOTE: No notes for this Quality ID

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

Patients who had an interval of 3 or more years since their last colonoscopy

Numerator Instructions:

Data not available

Numerator Quality-Data Coding Options

Interval of Less Than Three Years Since Patient’s Last Colonoscopy for Medical or System Reasons

Denominator Exception: 0529F with 1P:

Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [Crohn’s disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer])

OR

Denominator Exception: 0529F with 3P:

Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g. unable to locate previous colonoscopy report, previous colonoscopy report was incomplete)

Interval of Three or More Years Since Patient’s Last Colonoscopy

Performance Met: CPT II 0529F:

Interval of 3 or more years since patient’s last colonoscopy, documented

Interval of Less Than Three Years Since Patient’s Last Colonoscopy, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 0529F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Performance Not Met: 0529F with 8P:

Interval of less than 3 years since patient’s last colonoscopy, reason not otherwise specified

NUMERATOR NOTE:

Data not available

Denominator

All patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior adenomatous polyp(s) in previous colonoscopy findings

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for history of adenomatous (colonic) polyp(s) (ICD-10-CM): Z86.010

AND

Patient procedure during the performance period (CPT or HCPCS): 44388, 44389, 44392, 44394, 45378, 45380, 45381, 45384, 45385, G0105

WITHOUT

Modifiers: 52, 53, 73 or 74

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