Percentage of final reports for carotid imaging studies (neck magnetic resonance angiography [MRA], neck computed tomography angiography [CTA], neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement
This measure is to be submitted each time a carotid imaging study is performed during the performance period for all
patients, regardless of age. There is no diagnosis associated with this measure. Eligible clinicians who provide the
professional component of diagnostic imaging studies of the carotids will submit this measure.
NOTE: No notes for this Quality ID
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.
Final reports for carotid imaging studies that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement
This measure requires that the estimate of stenosis included in the report of the imaging study employ a method such as the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method for calculating the degree of stenosis. The NASCET method calculates the degree of stenosis with reference to the lumen of the carotid artery distal to the stenosis.
For duplex imaging studies the reference is indirect, since the degree of stenosis is inferred from velocity parameters and cross referenced to published or self-generated correlations among velocity parameters and results of angiography or other imaging studies which serve as the gold standard. In Doppler ultrasound, the degree of stenosis can be estimated using Doppler parameter of the peak systolic velocity (PSV) of the internal carotid artery (ICA), with concordance of the degree of narrowing of the ICA lumen. Additional Doppler parameters of ICA-to-common carotid artery (CCA) PSV ratio and ICA end-diastolic velocity (EDV) can be used when degree of stenosis is uncertain from ICA PSV. (Grant et al, 2003)
A short note can be made in the final report, such as:
- Severe left ICA stenosis of 70-80% by NASCET criteria” or
- “Severe left ICA stenosis of 70-80% by criteria similar to NASCET” or
- “70% stenosis derived by comparing the narrowest segment with the distal luminal diameter as related to the reported measure of arterial narrowing” or
- “Severe stenosis of 70-80% – validated velocity measurements with angiographic measurements, velocity criteria are extrapolated from diameter data as defined by the Society of Radiologists in Ultrasound Consensus Conference Radiology 2003; 229;340-346”.
NOTE: In cases where the carotid imaging exam findings result in no stenosis and that determination is
included in the final report, the measure can be submitted as “performance met” since “no stenosis” is
considered a NASCET category.
In a small number of denominator cases the distal ICA may not be viewed e.g. an innominate artery or common carotid injection. It can be reported that “stenosis measurements are made with reference to the distal lumen”, as a matter of process and consistent practice method
Numerator Quality-Data Coding Options
Reference to Measurements of Distal Internal Carotid Diameter as the Denominator for Stenosis Measurement Referenced
Performance Met: CPT II 3100F:
Carotid imaging study report (includes direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement)
Measurements of Distal Internal Carotid Diameter not Referenced, Reason not Otherwise Specified Append a reporting modifier (8P) to CPT Category II code 3100F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.
Performance Not Met: 3100F with 8P:
Carotid imaging study report did not include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement, reason not otherwise specified
Data not available
All final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the PFS
(Physician Fee Schedule). These non-covered services will not be counted in the denominator population for
Eligible cases are determined and must be reported, if either of the following conditions
Option 1 – Denominator Criteria (Eligible Cases):
Patient procedure during the performance period (CPT): 36221, 36222, 36223, 36224, 37215, 37216*, 37217, 37218, 70498, 70547, 70548, 70549, 93880, 93882