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

Last updated: March 22, 2017

CMS Measure ID: CMS129v6
Version: 6
NQF Number: 0389
Measure Description:

Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low (or very 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 (or very 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: PCPI(R) Foundation (PCPI[R])
Domain: Efficiency and Cost Reduction
Previous Version: Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
Improvement Notation:

Higher score indicates better quality

Guidance:

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

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

Specifications

Release Notes

Header

  • ‚ÄčUpdated Copyright.

    Section: Copyright

    Source: Annual Update

  • Updated Definitions.

    Section: Definition

    Source: Measure Lead

  • Updated Denominator to align with current guidelines. Added reference to very low risk stratum.

    Section: Denominator

    Source: Measure Lead

  • Updated Description to align with current guidelines. Added reference to very low risk stratum.

    Section: Description

    Source: Measure Lead

  • Updated Disclaimer.

    Section: Disclaimer

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Guidance to align with current guidelines. Added reference to very low risk stratum.

    Section: Guidance

    Source: Measure Lead

  • Updated Measure Developer.

    Section: Measure Developer

    Source: Measure Lead

  • Updated Measure Steward.

    Section: Measure Steward

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Added attributes, 'Result: Prostate Cancer Primary Tumor Size T1a' and 'Result: Prostate Cancer Primary Tumor Size T1b', to $MostRecentPrCaCancerStaging logic to align with current guidelines.

    Section: Denominator

    Source: Measure Lead

  • Replaced 'Clinical Staging Procedure' value set with 'Cancer Staging' value set to address clinical experts' recommendation.

    Section: Denominator

    Source: Measure Lead

  • Replaced $MostRecentPrCaClinicalStaging variable with $MostRecentPrCaCancerStaging.

    Section: Denominator

    Source: Measure Lead

  • Updated PSA threshold result value from <= 10 ng/mL to < 10 ng/mL in the denominator logic to align with current guidelines.

    Section: Denominator

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exceptions

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Numerator

    Source: QDM Standards

  • Added attributes, 'Result: Prostate Cancer Primary Tumor Size T1a' and 'Result: Prostate Cancer Primary Tumor Size T1b', to align with current guidelines.

    Section: QDM Data Elements

    Source: Measure Lead

  • Replaced 'Clinical Staging Procedure' (2.16.840.1.113883.3.526.3.1098) value set with 'Cancer Staging' (2.16.840.1.113883.3.526.3.1536) value set to address clinical experts' recommendation.

    Section: QDM Data Elements

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Value set Male (2.16.840.1.113883.3.560.100.1): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: QDM Data Elements

    Source: Code System Update

  • Added attributes, 'Result: Prostate Cancer Primary Tumor Size T1a' and 'Result: Prostate Cancer Primary Tumor Size T1b', to $MostRecentPrCaCancerStaging logic to align with current guidelines.

    Section: QDM Variables

    Source: Measure Lead

  • Replaced 'Clinical Staging Procedure' value set with 'Cancer Staging' value set to address clinical experts' recommendation.

    Section: QDM Variables

    Source: Measure Lead

  • Replaced $MostRecentPrCaClinicalStaging variable with $MostRecentPrCaCancerStaging.

    Section: QDM Variables

    Source: Measure Lead

Value Set

  • Replaced 'Clinical Staging Procedure' (2.16.840.1.113883.3.526.3.1098) value set with 'Cancer Staging' (2.16.840.1.113883.3.526.3.1536) value set to address clinical experts' recommendation.

    Section: None

    Source: Measure Lead

  • Value set Male (2.16.840.1.113883.3.560.100.1): Changed code system from 'AdministrativeSex' to 'AdministrativeGender'.

    Section: None

    Source: Code System Update

  • Value set Prostate Cancer Primary Tumor Size T1a (2.16.840.1.113883.3.526.3.1534): Added to measure including 1 SNOMEDCT code (369833007).

    Section: None

    Source: None

  • Value set Prostate Cancer Primary Tumor Size T1b (2.16.840.1.113883.3.526.3.1535): Added to measure including 1 SNOMEDCT code (369834001).

    Section: None

    Source: None

  • Value set Prostate Cancer Treatment (2.16.840.1.113883.3.526.3.398): Added 2 CPT codes (77772, 77799) and deleted 3 CPT codes (77776, 77777, 77787).

    Section: None

    Source: None

External Resources