| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Claims, Registry | Process | Yes | Communication and Care Coordination | Gastroenterology |
Measure Description
Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior adenomatous polyp(s) in previous colonoscopy findings, which had an interval of 3 or more years since their last colonoscopy
Instruction
This measure is to be reported each time a surveillance colonoscopy is performed during the performance period. It is anticipated the eligible clinician who performs the listed procedures, as specified in the denominator coding, will report on this measure. Patients who have a coded colonoscopy procedure that has a modifier 52, 53, 73 or 74 will not qualify for inclusion into this measure.
Denominator
All patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior adenomatous polyp(s) in previous colonoscopy findings
Denominator Instructions: Eligible 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.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter
AND
Diagnosis for history of adenomatous (colonic) polyp(s) (ICD-10-CM): Z86.010
AND
Patient procedure during the performance period (CPT or HCPCS): 44388, 44389, 44392, 44394, 45378, 45380, 45381, 45384, 45385, G0105
WITHOUT
Modifiers: 52, 53, 73 or 74
Numerator
Patients who had an interval of 3 or more years since their last colonoscopy
Numerator Options:
Performance Met: Interval of 3 or more years since patient’s last colonoscopy, documented (0529F)
OR
Denominator Exception: Documentation of medical reason(s) for an intervalof less than 3 years since the last colonoscopy (eg, last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, last colonoscopy found greater than 10 adenomas, or patient at high risk for colon cancer [Crohn’s disease, ulcerative colitis, lower gastrointestinal bleeding, personal or family history of colon cancer]) (0529F with 1P)
OR
Denominator Exception: Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (eg, unable to locate previous colonoscopy report, previous colonoscopy report was incomplete) (0529F with 3P)
OR
Performance Not Met: Interval of less than 3 years since patient’s last colonoscopy, reason not otherwise specified (0529F with 8P)