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Oncology: Medical and Radiation - Pain Intensity Quantified

Specifications
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General eCQM Information

CMS Measure ID CMS157v9
NQF Number 0384e
Measure Description

Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified

Initial Population All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy
Denominator Statement

Equals Initial Population

Denominator Exclusions

None

Numerator Statement

Patient visits in which pain intensity is quantified

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward PCPI(R) Foundation (PCPI[R])
Domain Person and Caregiver-Centered Experience and Outcomes
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

Higher score indicates better quality

Guidance

This eCQM is an episode-of-care measure; the level of analysis for this measure is every visit for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period.

For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face encounter occurring on the actual billing date or within the 6 days prior to the billing date.

For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy within 30 days prior to the encounter AND administered chemotherapy within 30 days after the date of the encounter.

Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI).

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Quality ID 143
Meaningful Measure Management of Chronic Conditions
Telehealth Eligible Yes
Previous Version
Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards Update

  • Updated rationale to align with most recent National Quality Forum (NQF) submission.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statements to align with updated guidelines and most recent NQF submission.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with updated guidelines and most recent NQF submission.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Added guidance related to the lookback period for the face-to-face encounter for CPT 77427 to clarify reporting expectations in instances where the encounter date is not the same as the billing date.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added text to identify the Quality Data Model (QDM) version used in the measure specification.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Added text to indicate whether the measure is patient-based or episode-based.

    Measure Section: Guidance

    Source of Change: Standards Update

Logic

  • Added a Clinical Quality Language (CQL) definition 'Chemotherapy Within 31 days Prior and After Measurement Period' to apply an initial filter for the chemotherapy procedures to reduce implementation system burden.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (Jira): CQM-3600

  • QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Revised CQL definition construction to reduce the overall complexity of the measure logic without changing the intent and/or application of data element. These revisions were intended to make the definition logic less complex, easier to understand, and more meaningful.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Cancer (2.16.840.1.113883.3.526.3.1010): Deleted 796 ICD-9-CM codes. Removed ICD-9 codes from all measures that do not have lookback periods or removed ICD-9 codes from all measures with lookback period for which the ICD-9 codes were no longer relevant. Added 3 SNOMED CT codes (709031009, 725049005, 773995001) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Removed ICD-9-CM extensional value sets from applicable Groupings due to ICD-9-CM no longer being maintained and the measure not requiring historical lookback period.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Chemotherapy Administration (2.16.840.1.113883.3.526.3.1027): Deleted 1 CPT code (96402) based upon feedback that this code is used for administration of other agents and is not limited to chemotherapy.​​

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jul 01, 2020