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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
320 0658 Process Yes Communication and Care Coordination Registry

Measure Description

Percentage of patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. Performance for this measure is not limited to the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on services provided and the measure- specific denominator coding. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or74 will not qualify for inclusion into the measure.

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

Patients who had recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

Definition

No data available

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exception: 0528F with 1P:
At Least 10 Year Follow-Up Interval for Colonoscopy not Recommended for Medical Reasons

Append a submission modifier (1P) to CPT Category II code 0528F to submit documented circumstances that appropriately exclude patients from the denominator

Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is ≥ 66 years old, or life expectancy < 10 years old, other medical reasons)

NUMERATOR 

Performance Met: CPT II 0528F:
At Least 10 Year Follow-Up Interval for Colonoscopy Recommended

Recommended follow-up interval for repeat colonoscopy of at least 10 years documented in colonoscopy report

NUMERATOR:

Performance Not Met: 0528F with 8P:
At Least 10 Year Follow-Up Interval for Colonoscopy not Recommended, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 0528F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified

At least 10 year follow-up interval for colonoscopy not recommended, reason not otherwise specified

Numerator Note: No data

Denominator

All patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy

Denominator Instructions: Clinicians who indicate that the colonoscopy procedure is incomplete or was discontinued should use the procedure number and the addition (as appropriate) of modifier 52, 53, 73, or 74. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73, or 74 will not qualify for inclusion into this measure.

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged 50 to 75 on date of encounter

AND

Patient undergoing screening for malignant neoplasm of colon (ICD-10-CM): Z12.11

AND

Patient procedure during the performance period (CPT or HCPCS): 44388, 45378, G0121

WITHOUT

Modifiers: 52, 53, 73, or 74

 

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