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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
250 1853 Process No Effective Clinical Care Registry

Measure Description

Percentage of radical prostatectomy pathology reports that include the pT category, the pN category, the Gleason score and a statement about margin status

Instructions

This measure is to be submitted each time a radical prostatectomy surgical pathology examination is performed during the performance period for prostate patients. Each unique CPT Category I code or quality-data code submitted on the claim will be counted for denominator inclusion. It is anticipated that eligible clinicians who examine prostate tissue specimens following resection in a laboratory or institution will submit this measure. If the specimen is not primary prostate tissue (e.g., breast, lung), submit only G8798.

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

Radical Prostatectomy reports that include the pT category, the pN category, Gleason score and a statement about margin status

Definition

No data available

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exclusion: G8798:
If Patient is not Eligible for this Measure because the Specimen is not Primary Prostate Tissue from a Radical Resection Report:

Specimen site other than anatomic location of prostate

OR

Denominator Exception: 3267F with 1P:
pT category, pN category, Gleason Score and Statement about Margin Status not Documented for Medical Reasons:

Append a modifier (1P) to Category II code 3267F to submit documented circumstances that appropriately
exclude patients from the denominator.

Documentation of medical reason(s) for not including pT category, pN category, Gleason score and statement about margin status in the pathology report (e.g., specimen originated from other malignant neoplasms, transurethral resections of the prostate (TURP), or secondary site prostatic carcinomas)

NUMERATOR 

Performance Met: CPT II 3267F:
Radical Prostatectomy Report includes pT category, pN category, Gleason Score and Statement about Margin Status

Pathology report includes pT category, pN category, Gleason score and statement about margin status

NUMERATOR:

Performance Not Met: 3267F with 8P:
pT category, pN category, Gleason Score and Statement about Margin Status not Documented, Reason not Otherwise Specified

Append a submitting modifier (8P) to CPT Category II code 3267F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

pT category, pN category, Gleason score and statement about margin status were not documented in pathology report, reason not otherwise specified

Numerator Note: No notes related

Denominator

All radical prostatectomy surgical pathology examinations performed during the measurement period for prostate cancer
patients

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

Option 1 – Denominator Criteria (Eligible Cases):

AND

Diagnosis for malignant neoplasm of prostate (ICD-10-CM): C61

 

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