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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
251 1855 Process Yes Effective Clinical Care Claims

Measure Description

This is a measure based on whether quantitative evaluation of Human Epidermal Growth Factor Receptor 2 Testing (HER2) by immunohistochemistry (IHC) uses the system recommended in the current ASCO/CAP Guidelines for Human Epidermal Growth Factor Receptor 2 Testing in breast cancer

Instructions

This measure should be submitted each time a quantitative HER2 IHC pathology examination is performed during the
performance period for patients with breast cancer; 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

Breast cancer patients receiving quantitative breast tumor HER2 IHC evaluation using the ASCO/CAP recommended
manual system or a computer-assisted system consistent with the optimal algorithm for HER2 testing as described in
the current ASCO/CAP guideline

Definition

No data available

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exclusion: CPT II 3395F:
If patient is not eligible for this measure because quantitative non-HER2 IHC evaluation was performed (eg, testing for estrogen or progesterone, receptors, [ER/PR]) report:

Quantitative non-HER2 IHC evaluation (eg, testing forestrogen or progesterone receptors, [ER/PR]) performed

NUMERATOR 

Performance Met: CPT II 3394F:
Quantitative Evaluation of HER2 by IHC Performed

 

Quantitative HER2 by IHC evaluation consistent with scoring system defined in the ASCO/CAP guidelines

NUMERATOR:

Performance Not Met: 3394F with 8P:
Quantitative Evaluation of HER2 by IHC Performed but did not use the System Recommended in the ASCO/CAP Guidelines for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer:

Append a submission modifier (8P) to CPT Category II code 3394F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

Quantitative evaluation of HER2 did not use the system recommended in the ASCO/CAP Guidelines for Human Epidermal Growth Factor Receptor 2 Testing in breast cancer, reason not otherwise specified

Numerator Note: Submit CPT II quality data codes once per patient for each date-of-service.

Denominator

All breast cancer patients with quantitative breast tumor evaluation by HER2 IHC

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

Option 1 – Denominator Criteria (Eligible Cases):

AND

Diagnosis for breast cancer (ICD-10-CM): C50.011, C50.012, C50.019, C50.021, C50.022, C50.029,
C50.111, C50.112, C50.119, C50.121, C50.122, C50.129, C50.211, C50.212, C50.219, C50.221, C50.222,
C50.229, C50.311, C50.312, C50.319, C50.321, C50.322, C50.329, C50.411, C50.412, C50.419, C50.421,
C50.422, C50.429, C50.511, C50.512, C50.519, C50.521, C50.522, C50.529, C50.611, C50.612, C50.619,
C50.621, C50.622, C50.629, C50.811, C50.812, C50.819, C50.821, C50.822, C50.829, C50.911, C50.912,
C50.919, C50.921, C50.922, C50.929

 

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