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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
249 1854 Process No Effective Clinical Care Registry

Measure Description

Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia

Instructions

This measure is to be submitted each time a patient’s surgical pathology report demonstrates Barrett’s Esophagus; however, only one quality-data code (QDC) per date of service for a patient is required. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

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

Esophageal biopsy report documents the presence of Barrett’s mucosa and includes a statement about dysplasia

Definition

NUMERATOR NOTE: Submit quality data codes once per patient for each date-of-service.

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exclusion: G8797:
If Patient is not Eligible for this Measure because the Specimen is not of Esophageal Origin Report:

Specimen site other than anatomic location of esophagus

OR

Denominator Exception: 3126F with 1P:
Esophageal Biopsy Reports with the Histological Finding of Barrett’s Mucosa that Contains a Statement about Dysplasia (present, absent, or indefinite) not Performed for Medical Reasons:

Append a modifier (1P) to Category II code 3126F to submit documented circumstances that appropriately
exclude patients from the denominator

Documentation of medical reason(s) for not submitting the histological finding of Barrett’s mucosa (e.g., malignant neoplasm or absence of intestinal metaplasia)

NUMERATOR 

Performance Met: CPT II 3126F:
Esophageal Biopsy Reports with the Histological Finding of Barrett’s Mucosa that Contains a Statement about Dysplasia (present, absent, or indefinite and if present, contains appropriate grading)

Esophageal biopsy reports with the histological finding of Barrett’s mucosa that contains a statement about dysplasia (present, absent, or indefinite and if present, contains appropriate grading)

NUMERATOR:

Performance Not Met: 3126F with 8P:
Esophageal Biopsy Reports with the Histological Finding of Barrett’s Mucosa that does not Contain a Statement about Dysplasia (present, absent, or indefinite), Reason not Otherwise Specified

Append a submit modifier (8P) to CPT Category II code 3126F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Pathology report with the histological finding of Barrett’s mucosa that does not contain a statement about dysplasia (present, absent, or indefinite, and if present, contains appropriate grading), reason not otherwise specified

Numerator Note: See description

Denominator

All surgical pathology biopsy reports for Barrett’s Esophagus

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

Option 1 – Denominator Criteria (Eligible Cases):

AND

Diagnosis for Barrett’s esophagus (ICD-10-CM): K22.70, K22.710, K22.711, K22.719

 

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