2017 MIPS Measure #265: Biopsy Follow-Up

Measure Description

Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician

Instruction

This measure is to be reported once per performance period for patients who are seen for an office visit and have a biopsy performed during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Note: While this measure is only required to be reported once per eligible patient per performance period, it is recommended that the eligible clinician performing the biopsy communicates the results to the primary care/referring physician and patient each time a biopsy is done.

Denominator

All patients undergoing a biopsy

Denominator Criteria (Eligible Cases):
All patients regardless of age on date of encounter
AND
Patient procedure during the performance period (CPT): 11100, 11755, 19081, 19083, 19085, 19100,19101, 19125, 20200, 20205, 20206, 20220, 20225, 20240, 20245, 20250, 20251, 21550, 21920, 21925, 23065, 23066, 23100, 23101, 24065, 24066, 24100, 24101, 25065, 25066, 25100, 25101, 26100, 26105, 26110, 27040, 27041, 27050, 27052, 27323, 27324, 27330, 27331, 27613, 27614, 27620, 28050, 28052, 28054, 29800, 29805, 29830, 29840, 29860, 29870, 29900, 30100, 31050, 31051, 31237, 31510, 31576, 31625, 31628, 31629, 31632, 31633, 31717, 32096, 32097, 32098, 32400, 32405, 32604, 32606, 32607, 32608, 32609, 37200, 37609, 38221, 38500, 38505, 38510, 38520, 38525, 38530, 38570, 38572, 40490, 40808, 41100, 41105, 41108, 42100, 42400, 42405, 42800, 42804, 42806, 43193, 43197, 43198, 43202, 43239, 43261, 43605, 44010, 44020, 44025, 44100, 44322, 44361, 44377, 44382, 44386, 44389, 45100, 45305, 45331, 45380, 45392, 46606, 47000, 47001, 47100, 47553, 48100, 48102, 49000, 49010, 49180, 49321, 50200, 50205, 50555, 50557, 50574, 50576, 50955, 50957, 50974, 50976, 52007, 52204, 52224, 52250, 52354, 53200, 54100, 54105, 54500, 54505, 54800, 54865, 55700, 55705, 55706, 55812, 55842, 55862, 56605, 56821, 57100, 57105, 57421, 57454, 57455, 57460, 57500, 57520, 58100, 58558, 58900, 59015, 60100, 60540, 60545, 60650, 61140, 61575, 61576, 61750, 61751, 62269, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63615, 64795, 65410, 67346, 67400, 67450, 67810, 68100, 68510, 68525, 69100, 69105, 75970, 93505
AND
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205
WITHOUT
Telehealth Modifier: GQ, GT

Numerator

Patients whose biopsy results have been reviewed and communicated to the primary care/referring
physician and the patient by the physician performing the biopsy. The physician performing the
biopsy must also acknowledge and/or document the communication in a biopsy tracking log and
document in the patient’s medical record.

Numerator Instructions: To satisfy this measure, the biopsying physician must:

• Review the biopsy results with the patient
• Communicate those results to the primary care/referring physician
• Track communication in a log
• Document tracking process in the patient’s medical record

Definition:
The components of a tracking log incorporate the following-

• Initials of physician performing the biopsy
• Patient name
• Date of biopsy
• Type of biopsy
• Biopsy result
• Date of biopsy result

Numerator Options:
Performance Met: Biopsy results reviewed, communicated, tracked, and documented (G8883)
OR
Denominator Exception: Clinician documented reason that patient’s biopsy results were not reviewed, [e.g., patient asks that biopsy results not be communicated to the primary care/referring physician, patient does not have a primary care/referring physician or is a self-referred patient] (G8884)
OR
Performance Not Met: Biopsy results not reviewed, communicated, tracked, or documented (G8885)