Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Last updated: March 22, 2017

CMS Measure ID: CMS129v5
Version: 5
NQF Number: 0389
Measure Description:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer

Initial Patient Population:

All patients, regardless of age, with a diagnosis of prostate cancer

Denominator Statement:

Equals Initial Population at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy

Denominator Exclusions:

None

Numerator Statement:

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician)

Measure Steward: American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Domain: Efficiency and Cost Reduction
Next Version: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Previous Version: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality

Guidance:

A higher score indicates appropriate treatment of patients with prostate cancer at low risk of recurrence.

Only patients with prostate cancer with low risk of recurrence will be counted in the performance denominator of this measure.

Specifications

Release Notes

Header

  • Clinical Recommendation Statement updated.
  • Copyright updated.
  • Definition updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • References updated.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variables $FirstProstateCancerTreatment and $MostRecentPrCaClinicalStaging to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Value set Prostate Cancer Treatment (OID 2.16.840.1.113883.3.526.3.398): Deleted 1 CPT code (55876), added one CPT code (77435).
  • Value set Prostate Cancer Treatment (OID 2.16.840.1.113883.3.526.3.398): Deleted 2 SNOMED codes (236209003, 236211007).
  • Value set Salvage Therapy (OID 2.16.840.1.113883.3.526.3.399): Deleted 2 CPT codes (55875, 55876).

External Resources