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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
395 0000 Process Yes Communication and Care Coordination Claims

Measure Description

Pathology reports based on biopsy and/or cytology specimens with a diagnosis of primary non-small cell lung cancer classified into specific histologic type or classified as NSCLC-NOS with an explanation included in the pathology report.

Instructions

This measure is to be submitted each time a patient’s pathology report addresses specimens with a diagnosis of non-small cell lung 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

Biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer classified into specific histologic type (squamous cell carcinoma, adenocarcinoma) OR classified as NSCLC-NOS with an explanation included in the pathology report

Definition

No data

Numerator Quality-Data Coding Options

NUMERATOR 

If Patient is not Eligible for this Measure because the Specimen is not of Lung Origin or is not
Classified as Non-Small Cell Lung Cancer Report:

Denominator Exclusion: G9420:

Specimen site other than anatomic location of lung or is not classified as primary non-small cell lung cancer

OR

Non-small cell lung Cancer Biopsy and Cytology Specimen Reports not Classified for a Medical Reason

Denominator Exception: G9419:

Documentation of medical reason(s) for not including the histological type OR NSCLC-NOS classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of primary non-small cell lung cancer or other documented medical reasons)

NUMERATOR 

Non-Small Cell Lung Cancer Biopsy and Cytology Specimen Reports Classified

Performance Met: G9418:

Primary non-small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type OR classified as NSCLC-NOS with an explanation

NUMERATOR:

Performance Not Met: G9421:
Non-Small Cell Lung Cancer Biopsy and Cytology Specimen Reports not Classified, Reason not Given

Primary non-small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type OR classified as NSCLC-NOS with an explanation

Numerator Note: No data

Denominator

Biopsy and cytology specimen reports with a diagnosis of primary non-small cell lung cancer

 

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years on the date of encounter

AND
Diagnosis for lung cancer (ICD-10-CM): C34.00, C34.01, C34.02, C34.10, C34.11, C34.12, C34.2, C34.30,
C34.31, C34.32, C34.80, C34.81, C34.82, C34.90, C34.91, C34.92
AND
Patient encounter during performance period (CPT): 88104, 88108, 88112, 88173, 88305

 

 

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