• Measure 137: Melanoma: Continuity of Care – Recall System


    Updated January 2018.

    Reporting Option: 

    • IRIS Registry for manual data entry: groups and individuals

    Measure Type: Structure-High Priority

    Instructions: This measure is to be submitted a minimum of once per performance period, for patients regardless of age, with a current diagnosis of melanoma or a history of melanoma whose information was entered, at least once within a 12-month period, into a recall system that includes both of the following:

    • A target date for the next complete physical skin exam; and
    • A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment.

    It is anticipated that eligible clinicians providing care for patients with melanoma or a history of melanoma will submit this measure.

    To Which Patients Does the Measure Apply?

    Denominator: All patients, regardless of age, with a current diagnosis of melanoma or a history of melanoma.

    There are three criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
    3. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

    Diagnosis Codes

    C43.0, C43.10, C43.11, C43.12, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.4, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, C43.8, C43.9, D03.0, D03.10, D03.11, D03.12, D03.20, D03.21, D03.22, D03.30, D03.39, D03.4, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72, D03.8, D03.9, Z85.82

    CPT Codes

    2018 additions in red.

    99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

    Without Telehealth modifier: GQ, GT, 95, POS 2.

    Denominator note: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule. These non-covered services will not be counted in the denominator population for claims-based measures.

    How to Report the Measure

    IRIS Registry Manual Reporting

    2018 additions in red.

    Numerator: Patients whose information is entered, at least once within a 12-month period, into a recall system that includes:

    • A target date for the next complete physical exam; and
    • A process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment.

    The recall system must be linked to a process to notify patients when their next physical exam is due, and to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment and must include the following elements at a minimum:

    • Patient identifier;
    • Patient contact information;
    • Cancer diagnosis(es);
    • Date(s) of initial cancer diagnosis (if known); and
    • The target date for the next complete physical exam.

    Numerator note: For denominator exception(s), patients are ineligible for this measure if at the time of encounter there are system reason(s) for not entering the patient’s information into a recall system (e.g. melanoma is being monitored by another physician provider).

    Category II Codes

    • Performance met (patient included in numerator and denominator): 7010F Patient information entered into a recall system that includes: target date for the next exam specified AND a process to follow up with patients regarding missed or unscheduled appointments
    • Denominator exclusion (patient not included in numerator or denominator): 7010F 3P Documentation of system reason(s) for not entering patient’s information into a recall system (e.g., melanoma being monitored by another physician provider);
    • Performance not met (patient not included in numerator, but included in denominator):7010F 8P Recall system not utilized, reason not otherwise specified

    Clinical Recommendation Statements: Skin examination and surveillance at least once a year for life is recommended for all melanoma patients, including those with stage 0, in situ melanoma. Clinicians should educate all patients about post-treatment monthly self-exam of their skin and of their lymph nodes if they had stage 1A to IV melanoma. Specific signs or symptoms are indications for additional radiologic imaging. (NCCN, 2011) No clear data regarding follow-up interval exists, but at least annual history and physical examination with attention to the skin and lymph nodes is recommended. (AAD, 2011) Regular clinical follow-up and interval patient self-exam of skin and regional lymph nodes are the most important means of detecting recurrent disease or new primary melanoma; findings from history and physical exam should direct the need for further studies to detect local, regional, and distant metastasis. (AAD, 2011)

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:
      • Small practices (≤ 15 clinicians) will receive 3 points,
      • Larger practices (> 15 clinicians) will receive 1 point.
    • If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 60 percent of applicable patients and on at least 20 patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.
    Decile/Points Registry (No EHR)
    3 87.50 – 93.64
    4 93.65 – 96.96
    5 96.97 – 99.99
    6 --
    7 --
    8 --
    9 --
    10 100