• Measure 224: Melanoma: Overutilization of Imaging Studies in Melanoma


    Updated January 2018.

    Reporting Option: 

    • IRIS Registry for manual data entry: groups and individuals

    Measure Type: Process – High Priority

    Instructions: This measure is to be submitted once per performance period, for patients regardless of age, with a current diagnosis of stage 0 through IIC melanoma or a history of melanoma of any stage, who are seen for an office visit during the one-year measurement period, for whom no diagnostic imaging studies were ordered.

    This measure is intended to reflect the quality of services provided for the primary management of patients with melanoma who have an office visit during the performance period.

    There are two reporting criteria for this measure:

    • Option 1: Patients with a diagnosis of Stage 0 through IIC melanoma without signs or symptoms suggesting systemic spread
    • Option 2: Patients with a history of any stage melanoma without signs or symptoms suggesting systemic spread

    Definition:

    Signs – For the purposes of this measure, signs include tenderness, jaundice, localized neurologic signs such as weakness, or any other sign.

    Symptoms – For the purposes of this measure, symptoms include cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread.

    Diagnostic imaging studies – CXR, CT, Ultrasound, MRI, PET, and nuclear medicine scans. Ordering any of these imaging studies during the one year measurement period is considered a failure of the measure, unless a justified reason is documented through use of a medical or system reason for exception.

    To Which Patients Does the Measure Apply?

    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.”

    Option 1:

    Denominator: All patients, regardless of age, with a current diagnosis of Stage 0 through IIC melanoma, without signs or symptoms suggesting systematic spread, seen for an office visit during the one-year measurement period

    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

    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 should be counted in the denominator population for registry-based measures.

    HCPCS Codes

    G8944 AJCC Melanoma Cancer Stage 0 through IIC Melanoma

    And

    G8749 Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)

    Option 2:

    Denominator: All patients, regardless of age, with a history of melanoma of any stage, without signs or symptoms suggesting systemic spread, seen for an office visit during the one-year measurement period.

    Diagnosis Codes

    Z85.820

    CPT Codes

    2018 additions in red.

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

    Note: Eye visit codes are not included in this measure.

    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 should be counted in the denominator population for registry-based measures.

    HCPCS Codes

    G8749 Absence of signs of melanoma (cough, dyspnea, tenderness, localized neurologic signs such as weakness, jaundice, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)

    How to Report the Measure

    IRIS Registry Manual Reporting

    Numerator: Patients for whom no diagnostic imaging studies were ordered

    2018 additions in red.

    A higher score indicates appropriate treatment of patients with melanoma without additional signs or symptoms.

    Numerator note: Denominator Exception(s), patients are ineligible for this measure if at the time of encounter there are patient or system reason(s) for ordering an imaging study (e.g. patient has co-morbid condition that warrant imaging or studies were ordered by another provider, etc.).

    Category II Codes

    • Performance met (patient included in numerator and denominator): 3320F None of the following diagnostic imaging studies ordered: chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans
    • Denominator exclusion (patient not included in numerator or denominator): 3319F 1P Documentation of medical reason(s) for ordering diagnostic imaging studies (e.g., patient has co-morbid condition that warrants imaging, other medical reasons)
      3319F 3P Documentation of system reason(s) for ordering diagnostic imaging studies (e.g., requirement for clinical trial enrollment, ordered by another provider, other system reasons)
    • Performance not met (patient not included in numerator, but included in denominator): 3319F One of the following diagnostic imaging studies ordered; chest x-ray, CT, Ultrasound, MRI, PET, or nuclear medicine scans

    How CMS Scores Your Performance

    • This measure is 1of 6 measures identified as "topped-out" in all submission mechanisms. CMS has limited the points available for this measure to 7 points.
    • 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 --
    4 --
    5 --
    6 --
    7 100
    8 --
    9 --
    10 --