Registry
| 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
