eCQM Title

Oncology: Medical and Radiation - Pain Intensity Quantified

eCQM Identifier (Measure Authoring Tool) 157 eCQM Version number 8.1.000
NQF Number 0384e GUID 9a0330d0-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward PCPI(R) Foundation (PCPI[R])
Measure Developer American Medical Association (AMA)
Measure Developer PCPI(R) Foundation (PCPI[R])
Endorsed By National Quality Forum
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
Copyright 2019 PCPI(R) Foundation and American Medical Association. All Rights Reserved.
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. 

The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. 

Commercial uses of the Measure require a license agreement between the user and the PCPI(R) Foundation (PCPI[R]) or the American Medical Association (AMA). Neither the AMA, nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor PCPI, nor their members shall be responsible for any use of the Measure.

AMA and PCPI encourage use of the Measure by other health care professionals, where appropriate.


Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members and former members of the AMA-PCPI disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2018 American Medical Association. LOINC(R) is copyright 2004-2018 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2018 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].
Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: 
- Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy 
- Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy

For the purposes of this measure, a single performance rate can be calculated as follows:
Performance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2)
Initial and ongoing pain assessments are essential to ensure proper pain management among patients with cancer. An inadequate assessment of pain is linked to poor pain control. Unrelieved pain has a significant impact on patients' quality of life, denying them comfort and greatly affecting their activities, motivation, and interactions with family and friends. Additionally, there is growing evidence that cancer survival is associated with effective pain management (National Comprehensive Cancer Network, 2018).
Clinical Recommendation Statement
-All patients must be screened for pain at each contact. 

-Pain intensity must be routinely quantified and documented, and quality must be characterized by the patient (whenever possible based on patient communication capacity). Also include patient reporting of breakthrough pain, treatments used and their impact on pain, patient reporting of adequate comfort, patient reporting of satisfaction with pain relief, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from family/caregiver regarding pain and impact on function. 

-Comprehensive pain assessment must be performed if new or worsening pain is present and regularly performed for persisting pain.

Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2018).
Improvement Notation
Higher score indicates better quality
National Comprehensive Cancer Network. (2018). Clinical practice guidelines in oncology: Adult cancer pain. Version 1. Retrieved from 

This measure 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.

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).
Transmission Format
Initial Population
All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy
Equals Initial Population
Denominator Exclusions
Patient visits in which pain intensity is quantified
Numerator Exclusions
Not Applicable
Denominator Exceptions
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set