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  • Measure 397: Melanoma Reporting


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry manual data entry: groups and individuals
    • Claims-based reporting: individuals only

    Measure Type: Outcome

    Description: This measure is to be calculated each time patients, aged 18 years and older, have a pathology report for primary malignant cutaneous melanoma that include the pT category and a statement on thickness and ulceration and for pT1, mitotic rate. The measure requires only one quality-data code 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

    To Which Patients Does the Measure Apply?

    Denominator: All melanoma pathology reports for primary malignant cutaneous melanoma.

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

    1. Patient characteristics: Description located in “Denominator” (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 Code."

    The quality measure also has exclusions for the denominator.

    Diagnosis Codes

    CMS has stated that providers should code ICD-10 to the greatest specificity; unspecified codes may be denied. You should not include the strikethrough codes listed below on your claim or submit them with this quality measure

    C43.0, 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

    CPT Codes

    88305

    Exclusion (patient ineligible): G9430 Specimen site other than anatomic cutaneous location

    How to Report the Measure

    IRIS Registry Manual Reporting

    Numerator: Pathology reports for primary malignant cutaneous melanoma that include the pT category and a statement on thickness and ulceration and for pT1, mitotic rate

    HCPCS Codes

    • Performance met (patient included in numerator and denominator): G9428 Pathology report includes the pT Category and a statement on thickness and ulceration and for pT1, mitotic rate
    • Denominator exclusion (patient not included in numerator or denominator): G9429 Documentation of medical reason(s) for not including pT Category and a statement on thickness and ulceration and for pT1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons)
    • Performance not met (patient not included in numerator, but included in denominator): G9431 Pathology report does not include the pT Category and a statement on thickness and ulceration and for pT1, mitotic rate

    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 performance 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) Claims
    3 97.14 – 99.99 95.00 – 97.05
    4 -- 97.06 – 99.99
    5 -- --
    6 -- --
    7 -- --
    8 -- --
    9 -- --
    10 100 100