Robyn Watson, PhD Dave Adler ASCO Staff Kristen McNiff, MPH Pamela Kadlubek, MPH Julia Tompkins ACRO Staff Jennifer Dreyfus American College of Surgeons Staff Julie Lewis American Medical Association Staff Karen Kmetik, PhD Erin O. Kaleba, MPH Joseph Gave, MPH Kendra Hanley, MS Centers for Medicare and Medicaid Service Tiffany Sanders, MD College of American Pathologists Staff Fay Shamanski, PhD Consumer Representative Catherine D. Harvey, Dr.PH Health Plan Representative Ranae Dahlberg Consortium Consultants Timothy Kresowik, MD Rebecca Kresowik National Committee for Quality Assurance Donna Pillittere National Comprehensive Cancer Network Joan McClure, MS Physician Performance Measures (Measures) and related data specifications, developed by the Physician Consortium for Performanc e Improvement TM (the Consortium), are intended to facilitate quality improvement activities by physicians.<br><br> These Measures are intended to assist physicians in enhancing quality of care. Measures are designed for use by any physician who manages the care of a patient for a specific condition or for prevention. These performance Measures are not clinical guidelines and do not establis h a standard of medical care.<br><br> The Consortium has not tested its Measures for all potential applications. The Consortium encourages the testing and evaluation of its Measures. Measures are subject to review and may be revised or rescinded at any time by the Consortium.<br><br> The Measures may not be altered without the prior written approval of the Consortium. Measures developed by the Consortium, while copyrighted, can be reproduced and distributed, withou t modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as th e sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distribu ted for commercial gain .<br><br> Commercial uses of the Measures require a license agreement between the user and American Medical Association, on behalf of the Consortium . Neither the Consortium nor its members shall be responsible for any use of these Measures. THE MEASURES ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND © 2007 American Medical Association.<br><br> All Rights Reserved Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets shou ld obtain all necessary licenses from the owners of these code sets. The AMA, the Consortium and its members disclaim all liability for use or accurac y of any Current Procedural Terminology (CPT ® ) or other coding contained in the specifications.<br><br> THE SPECIFICATIONS ARE PROVIDED cAS IS d WITHOUT WARRANTY OF ANY KIND. 2 © 2007 American Medical Association. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 3 Purpose of Measures: These clinical performance measures, developed by the American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, and the Physician Consortium for Performance Improvement ® (Consortium), are designed for individual quality improvement. Unless otherwise indicated, the measures are also appropriate for accountability if appropriat e methodological, statistical, and implementation rules are achieved. Accountability Measures: Measure #1: Cancer stage documented National Quality Forum (NQF) Endorsed " (Time-Limited) Measure #2: Hormonal therapy for stage IC through IIIC, ER/PR positive breast cancer NQF Endorsed " Measure #3: Chemotherapy for Stage IIIA through IIIC colon cancer patients NQF Endorsed " (Time-Limited) Measure #4: Plan for chemotherapy documented Measure #6: Treatment summary communication 3 Radiation oncology NQF Endorsed " (Time-Limited) Measure #7: Radiation dose limits to normal tissues NQF Endorsed " (Time-Limited) Measure #8: Pain intensity quantified 3 Medical oncology and radiation oncology NQF Endorsed " (Time-Limited) Measure #9: Plan of care for pain 3 Medical oncology and radiation oncology NQF Endorsed " (Time-Limited) Quality Improvement only: Measure #5: Treatment summary documented and communicated 3 Medical oncology Measure #10: Pathology report Intended Audience and Patient Population: These measures are designed for use by physicians and for calculating reporting or performance measurement at the individual physician level.<br><br> When existing hospital-level or plan-level measures are available for the same measurement topics, the Consortium attempts to harmonize the measures to the extent feasible. These measures are designed for oncologists and other physicians managing the care of patients with cancer. The Consortium also encourages the use of these measures by non-physician health professionals, where appropriate.<br><br> Measure Specifications The Consortium seeks to specify measures for implementation using multiple data sources, including paper medical record, administrative (claims) data, and particular emphasis on Electronic Health Record Systems (EHRS). Specifications to report on these measures for Oncology using administrative (claims) data are included in this document. We have identified codes for thes e measures, including ICD-9 and CPT (Evaluation & Management Codes, Category I and where Category II codes would apply).<br><br> Specifications for additional data sources, including EHRS, will be fully developed at a later date. Measure Exclusions: For process measures , the Consortium provides three categories of reasons for which a patient may be excluded from the denominator of an individual measure: " Medical reasons Includes: - not indicated (absence of organ/limb, already received/performed, other) - contraindicated (patient allergic history, potential adverse drug interaction, other) © 2007 American Medical Association. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 4 " Patient reasons Includes: - patient declined - economic, social, or religious reasons - other patient reasons " System reasons Includes: - resources to perform the services not available - insurance coverage/payor-related limitations - other reasons attributable to health care delivery system These measure exclusion categories are not available uniformly across all measures; for each measure, there must be a clear rationale to permit an exclusion for a medical, patient, or system reason. The exclusion of a patient may be reported by appen ding the appropriate modifier to the CPT Category II code designated for the measure: " Medical reasons : modifier 1P " Patient reasons : modifier 2P " System reasons : modifier 3P Although this methodology does not require the external reporting of more detailed exclusion data, the Consortium recommends that physicians document the specific reasons for exclusion in patients 9 medical records for purposes of optimal patient management and audit-readiness. The Consortium also advocates the systematic review and analysis of each physician 9s exclusions data to identify practice patterns and opportunities for quality improvement.<br><br> For example, it is possible for imple menters to calculate the percentage of patients that physicians have identified as meeting the criteria for exclusion. Please refer to documentation for each individual measure for information on the acceptable exclusion categories and the codes and modifiers to be used for reporting. Measures #1-10 in the Oncology measurement set are process measures.<br><br> For outcome measures , the Consortium specifically identifies all acceptable reasons for which a patient may be excluded from the denominator. Each specified reason is reportable with a CPT Category II code designated for that purpose. There are no outcome measures in the Oncology measurement set.<br><br> The Consortium continues to evaluate and likely will evolve its methodology for handling exclusions as it gains experience in t he use of the measures. Data Capture and Measure Calculation The Consortium intends for physicians to collect data on each patient eligible for a measure. Feedback on measures should be available to physicians by patient to facilitate patient management and in aggregate to identify opportunities for improvement across a physician's patient population.<br><br> Measure calculations will differ depending on whether a rate is being calculated for performance or reporting purposes. The method of calculation for performance follows these steps: first, identify the patients who meet the eligibility criteria for the denominator (PD); second, identify which of those patients meet the numerator criteria (A); and third, for those patients who d o not meet the numerator criteria, determine whether an appropriate exclusion applies and subtract those patients from the denominato r (C). (see examples below) The methodology also enables implementers to calculate the rates of patient exclusions and to further analyze both low and high rates, as appropriate (see examples below).<br><br> The method of calculation for reporting differs. One program which currently focuses on reporting rates is the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting Initiative (PQRI). Currently, under that program design, there will be a reporting denominator determined solely from claims data (CPT and ICD-9), which in some cases result in a reporting denominator that is much larger than the eligible population for the performance denominator.<br><br> Additional components of the reporting denominator are explained below. The components that make up the numerator for reporting include all patients from the eligible population for which the physici an has reported, including: the number of patients who meet the numerator criteria (A), the number of patients for whom valid exclusions apply (C) and also the number of patients who do not meet the numerator criteria (D). These components, where applicable, are summed together to make up the inclusive reporting numerator.<br><br> The calculation for reporting will be the reporti ng numerator divided by the reporting denominator. (see examples below). Examples of calculations for reporting and performance are provided for each measure.<br><br> Calculation for Performance For performance purposes, this measure is calculated by creating a fraction with the following components: Numerator, Denominator, and Denominator Exclusions. Numerator (A) Includes: Number of patients meeting numerator criteria Performance Denominator (PD) Includes: Number of patients meeting criteria for denominator inclusion Denominator Exclusions (C) Include: Number of patients with valid medical, patient or system exclusions (where applicable; will differ by measure) Performance Calculation A (# of patients meeting numerator criteria) PD (# patients in denominator) 3 C (# patients with valid denominator exclusions) It is also possible to calculate the percentage of patients excluded overall, or excluded by medical, patient, or system reason where applicable: Overall Exclusion Calculation C (# of patients with any valid exclusion) PD (# patients in denominator) OR Exclusion Calculation by Type C 1 (# patients with medical reason) PD (# patients in denominator) C 2 (# patients with patient reason) PD (# patients in denominator) C 3 (# patients with system reason) PD (# patients in denominator) Calculation for Reporting For reporting purposes, this measure is calculated by creating a fraction with the following components: Reporting Numerator and Reporting Denominator © 2007 American Medical Association. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 5 Reporting Numerator includes each of the following components, where applicable. (There may be instances where there are no patients to include in A, C, D, or E). A.<br><br> Number of patients meeting additional denominator criteria (for measures where true denominator cannot be determined through ICD-9 and CPT Category I coding alone) AND numerator criteria C. Number of patients with valid medical, patient or system exclusions (where applicable; will differ by measure) D. Number of patients not meeting numerator criteria and without a valid exclusion E.<br><br> All other patients not meeting additional denominator criteria (for measures where true denominator cannot be determined through ICD-9 and CPT Category I coding alone) Reporting Denominator (RD) Includes : RD. Denominator criteria (identifiable through ICD-9 and CPT Category I coding) Reporting Calculation A (# of patients meeting additional denominator criteria AND numerator criteria) + C (# of patients with valid exclusions) + D (# of patients NOT meeting numerator criteria) + E (# of patients not meeting additional denominator criteria) RD (# of patients in denominator) © 2007 American Medical Association. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 6 © 2007 American Medical Association, American Society of Clinical Oncology. All Rights Reserved. CPT ® Copyright 2006 American Medical Association 7 Oncology Measure #1: Cancer Stage Documented This measure may be used as an Accountability measure Clinical Performance Measure Numerator : Patients who have a baseline AJCC cancer stage* or documentation that the cancer is metastatic in the medical record at least once during the 12 month reporting period *Cancer stage refers to stage at diagnosis Denominato r: All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting Denominator Exclusion: None Measure: Percentage of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record at least once during the 12 month reporting period The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: A simple classification scheme, which can be incorporated into a form for staging and can be universally applied, is the goal o f the TNM system as proposed by the AJCC.<br><br> Thus, examination during the surgical procedure and histologic examination of the surgically removed tissues may identify significant additional indicators of the prognosis of the patient (T, N, and M) as diff erent from what could be discerned clinically before therapy. Because this is that pathologic (pTNM) classification and stage groupin g (based on examination of a surgically resected specimen with sufficient tissue to evaluate the highest T, N, or M classificatio n), it is recorded in addition to the clinical classification. It does not replace the clinical classification.<br><br> Both should be maintai ned in the patient 9s permanent medical record&It is intended to provide a means by which this information can readily be communicated to others, to assist in therapeutic decisions, and to help estimate prognosis. (Joint Committee on Cancer 2002) 1 A central component of the treatment of breast cancer is full knowledge of extent of disease and biological features. The need for and selection of various local or systemic therapies are based on a number of prognostic and predictive factors.<br><br> These factors include tumor histology, clinical and pathologic characteristics of the primary tumor, axillary node status, tumor horm one receptor content, tumor HER2 status, presence or absence of detectable metastatic disease, patient comorbid conditions, patient age, and menopausal status. (NCCN, 2007) 2 Rationale for the measure: Cancer stage is a critical component in determining treatment options for patients with cancer. Though critically important, cancer stage is not always documented in the medical record.<br><br> This measure is intended to be reported at least once per 12 month reporting period. Data capture and calculations: Calculation for Performance For performance purposes, this measure is calculated by creating a fraction with the following components: Numerator and Denominator. Performance Numerator (A) Includes: " Patients who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record Performance Denominator (PD) Includes: " All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting Performance Calculation Components for this measure are defined as: A # of patients who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record PD # of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting Calculation for Reporting For reporting purposes, this measure is calculated by creating a fraction with the following components: Reporting Numerator and Reporting Denominator Reporting Numerator includes each of the following instances: A.<br><br> Patients who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record D. Patients who do not have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record Reporting Denominator (RD) Includes : " All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting Reporting Calculation © 2007 American Medical Association, American Society of Clinical Oncology. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 8 Components for this measure are defined as: A # of patients who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record D # of patients who do not have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record RD # of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting A (# of patients meeting numerator criteria) PD (# of patients in denominator) A (# of patients meeting numerator criteria) + D (# of patients NOT meeting numerator criteria) RD (# of patients in denominator) © 2007 American Medical Association, American Society of Clinical Oncology. All Rights Reserved. CPT ® Copyright 2006 American Medical Association 9 Measure Specifications 3 Measure #1: Cancer Stage Documented Measure specifications for data sources other than administrative claims will be developed at a later date.<br><br> A. Administrative claims data Administrative claims data collection requires users to identify the eligible population (denominator) and numerator using codes recorded on claims or billing forms (electronic or paper). Users report a rate based on all patients in a given practice for whom data are available and who meet the eligible population/denominator criteria.<br><br> (Note: The specifications listed below are those needed for performance calculation .) Denominator (Eligible Population) : All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are seen in the ambulatory setting " ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 (malignant neoplasm of female breast), 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9 (malignant neoplasm of colon), 154.0, 154.1, 154.2, 154.3, 154.8 (malignant neoplasm of rectum and anus) AND either option 1 or 2 1. Chemotherapy " CPT® E/M Service Code: " 99201, 99202, 99203, 99204, 99205 (office-new patient), " 99212, 99213, 99214, 99215 (office-established patient), " 99241, 99242, 99243, 99244, 99245 (outpatient consult), " 99024 (post-operative follow-up visit) OR 2. Radiation therapy " CPT® codes for radiation treatment planning: 77261, 77262, 77263 Denominator Exclusion: None Numerator : Patients who have a baseline AJCC cancer stage or documentation that the cancer is metastatic in the medical record at least once during the 12 month reporting period " Report one of the following CPT Category II codes: 3300F 3 American Joint Committee on Cancer (AJCC) stage documented and reviewed OR 3301F - Cancer stage documented in medical record as metastatic and reviewed B.<br><br> Electronic Health Record System (in development) C. Paper Medical Record (in development) © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 10 Oncology Measure #2: Hormonal Therapy for Stage IC through IIIC, ER/PR Positive Breast Cancer This measure may be used as an Accountability measure Clinical Performance Measure Numerator Patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period Denominator All female patients aged 18 years and older with Stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer Denominator Exclusions: Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient 9s disease has progressed t o metastatic, patient is receiving a gonadotropin-releasing hormone analogue, patient has received oophorectomy, patient is recei ving radiation or chemotherapy, patient 9s diagnosis date was e 5 years from reporting date) Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient refusal) Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient is currently enrolled in a clinical trial) Measure: Percentage of female patients aged 18 years and older with Stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: Adjuvant therapy for postmenopausal women with hormone receptor 3positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumor recurrence. Aromatase inhibitors are appropriate as initial treatment for women with contraind ications to tamoxifen. For all other postmenopausal women, treatment options include 5 years of aromatase inhibitors treatment or sequential therapy consisting of tamoxifen (for either 2 to 3 years or 5 years) followed by aromatase inhibitors for 2 to 3, or 5 years (ASCO guidelines include narrative rankings).<br><br> (ASCO 3 ) Patients intolerant of aromatase inhibitors should receive tamoxifen. Women with hormone receptor 3negative tumors should not receive adjuvant endocrine therapy (ASCO guidelines include narrative rankings). (ASCO 3 ) Patients with invasive breast cancers that are estrogen or progesterone receptor positive should be considered for adjuvant endocrine therapy regardless of patient age, lymph node status, or whether or not adjuvant chemotherapy is to be administered (Category 2A).<br><br> (NCCN 4 ) The most firmly established adjuvant endocrine therapy is tamoxifen for both premenopausal and postmenopausal women... Prospective, randomized trials demonstrate that the optimal duration of tamoxifen appears to be five years. In patients receivi ng both tamoxifen and chemotherapy, chemotherapy should be given first, followed by sequential tamoxifen.<br><br> Several studies have evaluated aromatase inhibitors in the treatment of postmenopausal women with early-stage breast cancer (Category 2A). (NCCN 4 ) Rationale for the measure: Despite evidence suggesting the role of adjuvant endocrine therapy in lowering the risk of tumor recurrence, many female patien ts who should be receiving this therapy are not. This measure assesses whether patients with a certain stage of breast cancer (IC -III) and ER/PR+ are currently receiving the therapy.<br><br> There are allowable medical, patient, and system reasons to document instances in which a woman with stage IC-III, ER/PR+ may not be a candidate for the therapy. Note: the reporting/managing physician does not need to have actually written the prescription; however the reporting/managing physician must verify that the patient alrea dy has been prescribed the hormonal therapy by another physician Data capture and calculations: Calculation for Performance For performance purposes, this measure is calculated by creating a fraction with the following components: Numerator, Denominator, and Denominator Exclusions. Performance Numerator (A) Includes: " Patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period Performance Denominator (PD) Includes: " Female patients aged 18 years and older AND " Stage IC through IIIC breast cancer AND " Estrogen receptor (ER) OR progesterone receptor (PR) positive Performance Denominator Exclusions (C) Include: " Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) (eg, patient 9s disease has progressed to metastatic, patient is receiving a gonadotropin-releasing hormone analogue, patient has received oophorectomy, patient is receiving radiation or chemotherapy, patient 9s diagnosis date was e 5 years from reporting date) " Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) (eg, patient refusal) " Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) (eg, patient is currently enrolled in a clinical trial) Performance Calculation Components for this measure are defined as: A # of patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period PD # of female patients aged 18 years and older with stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer C # of patients who were not prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period but for whom there is a documented medical, patient, or system reason for not doing so Calculation for Reporting For reporting purposes, this measure is calculated by creating a fraction with the following components: Reporting Numerator and Reporting Denominator A (# of patients meeting measure criteria) PD (# of patients in denominator) 3 C (# of patients with valid denominator exclusions © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 11 Reporting Numerator includes each of the following instances: A. Stage IC through IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period C.<br><br> Stage IC through IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients but for whom there is a documented medical, patient, or system reason for not doing so D. Stage IC through IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients who were not prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period and there is no documented reason for not doing so E. Patients with Stage 0, Stage I [-T1 mic, -T1a, or -T1b (tumor size d 1 cm)] OR Stage IV breast cancer or patients who are not estrogen receptor (ER) or progesterone receptor (PR) positive Reporting Denominator (RD) Includes : " Female patients aged 18 years and older with a diagnosis of breast cancer Reporting Calculation © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 12 Components for this measure are defined as: A # of stage IC through IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period C # of stage IC through stage IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients who were not prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period but for whom there is a documented medical, patient, or system reason for not doing so D # of stage IC through stage IIIC breast cancer AND estrogen receptor (ER) OR progesterone receptor (PR) positive patients who were not prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period and there is no documented reason for not doing so E # of patients with stage 0, Stage I [-T1 mic, -T1a, or -T1b (tumor size d 1 cm)] OR stage IV breast cancer or who are not estrogen receptor (ER) or progesterone receptor (PR) positive RD # of female patients aged 18 years and older with a diagnosis of breast cancer A (# of patients meeting additional denominator criteria AND meeting numerator criteria) + C (# of patients meeting additional denominator criteria with valid exclusions) + D (# of patients meeting additional denominator criteria NOT meeting numerator criteria) + E (# of patients not meeting additional denominator criteria) RD (# of patients in denominator) © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 13 Measure Specifications 3 Measure #2: Hormonal Therapy for Stage IC through IIIC, ER/PR Positive Breast Cancer Measure specifications for data sources other than administrative claims will be developed at a later date. A. Administrative claims data Administrative claims data collection requires users to identify the eligible population (denominator) and numerator using codes recorded on claims or billing forms (electronic or paper).<br><br> Users report a rate based on all patients in a given practice for whom data are available and who meet the eligible population/denominator criteria. (Note: The specifications listed below are those needed for performance calculation . Additional CPT Category II codes may be required based on measure implementation [ie, if measure is utilized in a reporting program]).<br><br> Denominator (Eligible Population) : All female patients aged 18 years or older with stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer " ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 (malignant neoplasm of female breast) AND CPT® E/M Service Code: " 99201, 99202, 99203, 99204, 99205 (office-new patient), " 99212, 99213, 99214, 99215 (office-established patient), AND " CPT Category II code for stage IC through IIIC cancer from the following table: 3374F-AJCC Breast Cancer Stage I: T1c (tumor size > 1cm to 2 cm), documented 3376F- AJCC Breast Cancer Stage II, documented 3378F- AJCC Breast Cancer Stage III, documented AND " CPT Category II code 3315F: Estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer: Additional CPT II Denominator Codes -For Reporting Purposes 3370F- AJCC Breast Cancer Stage 0, documented 3372F- AJCC Stage I: T1mic, T1a or T1b (tumor size d 1cm), documented 3380F- AJCC Breast Cancer Stage IV, documented OR 3316F: Estrogen Receptor (ER) and progesterone receptor (PR) negative breast cancer Numerator : Patients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period " Report the CPT Category II code: 4179F - Tamoxifen or aromatase inhibitor (AI) prescribed Denominator Exclusion : Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period (eg, patient 9s disease has progressed to metastatic, patient is receiving a gonadotropin- releasing hormone analogue, patient has received oophorectomy, patient is receiving radiation or chemotherapy, patient 9s diagnosis date was e 5 years from reporting date) " Append modifier to CPT Category II code: 4179F-1P Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period (eg, patient refusal) " Append modifier to CPT Category II code: 4179F-2P Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (AI) during the 12 month reporting period (eg, patient is currently enrolled in a clinical trial) " Append modifier to CPT Category II code: 4179F-3P B. Electronic Health Record System (in development) C. Paper Medical Record (in development) © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 14 Oncology Measure #3: Chemotherapy for Stage IIIA through IIIC Colon Cancer Patients This measure may be used as an Accountability measure Clinical Performance Measure Numerator : Patients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy* within the 12 month reporting period *According to current NCCN guidelines, the following therapies are recommended: 5-fluorouracil/leucovorin/oxaliplatin as the standard of care, or either single agent capecitabine, or 5- fluorouracil/leucovorin in patients felt to be inappropriate for oxaliplatin therapy. Denominato r: All patients aged 18 years and older with Stage IIIA through IIIC colon cancer Denominator Exclusion: Documentation of medical reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, medical comorbidities, diagnosis date more than 5 years prior to the current visit date, patient 9s cancer has metastasized, medical contraindication/allergy, poor performance status) Documentation of patient reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient refusal) Documentation of system reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy) Measure: Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy or have previously received adjuvant chemotherapy within the 12 month reporting period The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: Following primary surgical treatment, the panel recommends 6 months of adjuvant chemotherapy for patients with Stage III (T1- 4, N1-2, M0) resected colon cancer.<br><br> The treatment options are: 5-fluorouracil/leucovorin/oxaliplatin as the standard of care (Category I), or either single agent capecitabine (category 2A), or 5- fluorouracil/leucovorin (Category 2A) in patients felt to be inappropriate for oxaliplatin therapy. (NCCN 5 ) Rationale for the measure: Patients with Stage IIIA through Stage IIIC colon cancer do not always receive the recommended treatment of adjuvant chemotherapy. This measure is intended to determine whether and how often chemotherapy is administered.<br><br> The specific chemotherapy drugs specified in this measure reflect the most current guidelines of the National Comprehensive Cancer Network. © 2007 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 15 Measure Specifications 3 Measure #3: Chemotherapy for Stage IIIA through IIIC Colon Cancer Patients Measure specifications for data sources other than administrative claims will be developed at a later date. A. Administrative claims data Administrative claims data collection requires users to identify the eligible population (denominator) and numerator using codes recorded on claims or billing forms (electronic or paper).<br><br> Users report a rate based on all patients in a given practice for whom data are available and who meet the eligible population/denominator criteria. (Note: The specifications listed below are those needed for performance calculation . Additional CPT Category II codes may be required based on measure implementation [ie, if measure is utilized in a reporting program]).<br><br> Denominator (Eligible Population) : All patients aged 18 years and older with Stage IIIA through IIIC colon cancer CPT® E/M Service Code: " 99201, 99202, 99203, 99204, 99205 (office-new patient), " 99212, 99213, 99214, 99215 (office-established patient), AND " ICD-9 diagnosis codes: 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9 (malignant neoplasm of colon) AND " CPT Category II code for stage IIIA through IIIC cancer : 3388F-AJCC Colon cancer, Stage III, documented Additional CPT II Denominator Codes -For Reporting Purposes 3382F- AJCC Colon cancer, Stage 0, documented 3384F- AJCC Colon cancer, Stage I, documented 3386F- AJCC Colon cancer, Stage II, documented 3390F- AJCC Colon cancer, Stage IV, documented Denominator Exclusion : Documentation of medical reason(s) for not referring for or prescribing adjuvant chemotherapy within the 12 month reporting period (eg, medical comorbidities, diagnosis date more than 5 years prior to the current visit date, patient 9s cancer has metastasized; medical contraindication/allergy, poor performance status) " Append modifier to CPT Category II code: 4180F-1P Documentation of patient reason(s) for not referring for or prescribing adjuvant chemotherapy within the 12 month reporting period (eg, patient refusal) " Append modifier to CPT Category II code: 4180F-2P Documentation of system reason(s) for not referring for or prescribing adjuvant chemotherapy within the 12 month reporting period (eg, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy) " Append modifier to CPT Category II code: 4180F-3P Numerator : Patients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or who have previously received adjuvant chemotherapy within the 12 month reporting period (according to current NCCN guidelines, the following therapies are recommended: 5-fluorouracil/leucovorin or capecitabine, or 5-fluorouracil/leucovorin/oxaliplatin ) " Report the CPT Category II code: 4180F - Adjuvant chemotherapy referred, prescribed, or previously received for Stage IIIA through IIIC colon cancer B. Electronic Health Record System (in development) C. Paper Medical Record (in development) Oncology Measure #4: Plan for Chemotherapy Documented This measure may be used as an Accountability measure Clinical Performance Measure Numerator : Patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen Note: Abbreviated documentation is acceptable only if: a) there is a standard, written definition for the abbreviation that inc ludes details of the medications, dose and duration, that is physically available at the practice or in the practice EHR/Electronic System or b) the abbreviated documentation includes a reference to a published regimen.<br><br> Denominato r: All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy Denominator Exclusion: None Measure: Percentage of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: American Society of Clinical Oncology, cChemotherapy Treatment Summary, d ( www.asco.org/treatmentsummary ) specifies that a treatment plan should include the following information about the planned chemotherapy regimen: " Chemotherapy regimen and starting dosages " Duration of treatment and number of planned cycles ASCO 6 Rationale for the measure: A detailed plan for the chemotherapy regimen is a critical component of ensuring safety and high quality care for patients. Th ere are no exclusions for this measure. Data capture and calculations: Calculation for Performance For performance purposes, this measure is calculated by creating a fraction with the following components: Numerator and Denominator.<br><br> Performance Numerator (A) Includes: Patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen Performance Denominator (PD) Includes: " Patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy Performance Calculation © 2007 American Medical Association and American Society of Clinical Oncology. All Rights Reserved. CPT ® Copyright 2006 American Medical Association 16 A (# of patients meeting numerator criteria) PD (# of patients in denominator) Components for this measure are defined as: A # of patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen PD # of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy Calculation for Reporting For reporting purposes, this measure is calculated by creating a fraction with the following components: Reporting Numerator and Reporting Denominator.<br><br> Reporting Numerator includes each of the following instances: A. Patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen D. Patients for whom the planned chemotherapy regimen is not documented prior to the initiation of a new treatment regimen Reporting Denominator (RD) Includes : " Patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy Reporting Calculation © 2007 American Medical Association and American Society of Clinical Oncology.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 17 Components for this measure are defined as: A # of patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen D # of patients for whom the planned chemotherapy regimen is not documented prior to the initiation of a new treatment regimen RD # of patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy A (# of patients meeting numerator criteria) + D (# of patients NOT meeting numerator criteria) RD (# of patients in denominator) © 2007 American Medical Association and American Society of Clinical Oncology. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 18 Measure Specifications 3 Measure #4: Plan for Chemotherapy Documented Measure specifications for data sources other than administrative claims will be developed at a later date. A. Administrative claims data Administrative claims data collection requires users to identify the eligible population (denominator) and numerator using codes recorded on claims or billing forms (electronic or paper).<br><br> Users report a rate based on all patients in a given practice for whom data are available and who meet the eligible population/denominator criteria. (Note: The specifications listed below are those needed for performance calculation . Additional CPT Category II codes may be required based on measure implementation [ie, if measure is utilized in a reporting program]).<br><br> Denominator (Eligible Population) : All patients, regardless of age, with a diagnosis of breast, colon, or rectal cancer who are receiving intravenous chemotherapy " ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 (malignant neoplasm of female breast), 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9 (malignant neoplasm of colon), 154.0, 154.1, 154.2, 154.3, 154.8 (malignant neoplasm of rectum, rectosigmoid junction, and anus) AND " CPT® E/M Service Code: " 99201, 99202, 99203, 99204, 99205 (office-new patient), " 99212, 99213, 99214, 99215 (office-established patient), AND " CPT procedure codes: 96401, 96402, 96405, 96406, 96409, 96411, 96413, 96415, 96416,96417, 96420, 96422, 96423, 96425, 96440, 96445, 96450, 96521, 96522, 96523, 96542, 96549 (chemotherapy administration) Denominator Exclusion: None Numerator : Patients for whom the planned chemotherapy regimen (which includes, at a minimum: drug(s) prescribed, dose, and duration) is documented prior to the initiation of a new treatment regimen " Report the CPT Category II code: 0519F - Planned chemotherapy regimen, including at a minimum: drug(s) prescribed, dose, and duration, documented prior to initiation of a new treatment regimen B. Electronic Health Record System (in development) C. Paper Medical Record (in development) © 2007 American Medical Association.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 19 Oncology Measure #5: Treatment Summary Documented and Communicated 3 Medical Oncology This measure may be used as a Quality Improvement measure only Clinical Performance Measure Numerator: (this numerator has 3 components that must be calculated individually ): A. Patients who have a chemotherapy treatment summary* documented in the chart B.<br><br> Patients who have a documentation that a written chemotherapy treatment summary* was provided to the patient C. Patients who have documentation that the chemotherapy treatment summary* was communicated to the physician(s) providing continuing care *Treatment Summary definition - a report that includes mention of all of the following components: 1) chemotherapy treatment delivered (including number of cycles administered, duration, and extent of dose reduction); 2) reason treatment was stopped; 3 ) major toxicities and/or hospitalizations; 4) treatment response; 5) follow up care and relevant providers. This measure requires that ALL components listed within the numerator statement should be provided in order to meet the measure.<br><br> Denominator : All patients, regardless of age, with a diagnosis of cancer who have completed adjuvant chemotherapy treatment within the 12 month reporting period Denominator Exclusion: Documentation of a patient reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the chemotherapy treatment summary was communicated to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient requests that report not be sent) Documentation of system reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the written chemotherapy treatment summary was provided to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient does not have any physician responsible for providing continuing care) This measure requires that ALL components listed within the numerator statement should be provided in order to meet the measure. Measure: Percentage of patients, regardless of age, with a diagnosis of cancer who have completed chemotherapy within the 12 month reporting period who: A) have a chemotherapy treatment summary* documented in the chart; AND B) have a documentation that the written chemotherapy treatment summary* was provided to the patient; AND C) have documentation that the chemotherapy treatment summary* was communicated to the physician(s) providing continuing care The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure: The chemotherapy treatment summary should be prepared at the completion of a course of treatment. The core elements of a chemotherapy treatment summary are: Chemotherapy treatment delivered, including number of cycles administered, duration, and extent of dose reduction Reason treatment was stopped Major toxicities and/or hospitalizations Treatment response Follow up care and relevant providers This may occur at the end of a course of adjuvant therapy, before a planned surgical resection, or after disease progression.<br><br> Treatment breaks, holidays, and minor modifications are not envisioned as triggering preparation of such a summary. The treatment plan and summary are not intended to replace detailed chart documentation, including complete patient histories or chemotherapy flow sheets. (ASCO) Rationale for the measure: Timely, accurate, and effective communications are critical to quality and value in contemporary medical practices.<br><br> This measure is broken into 3 distinct components to encourage sharing of communication about the patient 9s course of treatment with the patient him/herself, the physician proving continuing care for the patient, and documented in the medical record. Sin ce each component of the numerator will be scored separately, physicians will know exactly which aspect of care may need improvement. Data capture and calculations: Calculation for Performance For performance purposes, this measure is calculated by creating a fraction with the following components: Numerator, Denominator, and Denominator Exclusions.<br><br> Performance Numerator (A) Includes: " Patients who have a chemotherapy treatment summary documented in the chart AND who have a documentation that the written chemotherapy treatment summary was provided to the patient AND who have documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care Performance Denominator (PD) Includes: " All patients, regardless of age, with a diagnosis of cancer AND " Patients who have completed adjuvant chemotherapy treatment within the 12 month reporting period Performance Denominator Exclusions (C) Include: " Documentation of patient reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the chemotherapy treatment summary was communicated to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient requests that report not be sent) " Documentation of system reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the written chemotherapy treatment summary was provided to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient does not have any physician responsible for providing continuing care) Performance Calculation Components for this measure are defined as: A # of patients who have a chemotherapy treatment summary documented in the chart AND who have a documentation that the written chemotherapy treatment summary was provided to the patient AND who have documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care PD # of patients with a diagnosis of cancer who have completed adjuvant chemotherapy treatment within the 12 month reporting period C # of patients with documented patient or system reason(s) for not having either a chemotherapy A (# of patients meeting measure criteria) PD (# of patients in denominator) 3 C (# of patients with valid denominator exclusions © 2007 American Medical Association. All Rights Reserved. CPT ® Copyright 2006 American Medical Association 20 © 2007 American Medical Association.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 21 treatment summary documented in the chart OR not having documentation that the written chemotherapy treatment summary was provided to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care © 2007 American Medical Association. All Rights Reserved.<br><br> CPT ® Copyright 2006 American Medical Association 22 Measure Specifications 3 Measure #5: Treatment Summary Documented and Communicated 3 Medical Oncology Measure specifications for data sources other than administrative claims will be developed at a later date. A. Administrative claims data Administrative claims data collection requires users to identify the eligible population (denominator) and numerator using codes recorded on claims or billing forms (electronic or paper).<br><br> (Note: The specifications listed below are those needed for performance calculation . Additional CPT Category II codes may be required based on measure implementation [ie, if measure is utilized in a reporting program]). Denominator (Eligible Population) : All patients with a diagnosis of cancer who have completed adjuvant chemotherapy treatment within the 12 month reporting period CPT® E/M Service Code: " 99201, 99202, 99203, 99204, 99205 (office-new patient), " 99212, 99213, 99214, 99215 (office-established patient), AND " ICD-9 diagnosis codes: 140.0, 140.1, 140.3, 140.4, 140.5, 140.6, 140.8, 140.9, 141.0, 141.1, 141.2, 141.3, 141.4, 141.5, 141.6, 141.8, 141.9, 142.0, 142.1, 142.2, 142.8, 142.9, 143.0, 143.1, 143.8, 143.9, 144.0, 144.1, 144.8, 144.9, 145.0, 145.1, 145.2, 145.3, 145.4, 145.5, 145.6, 145.8, 145.9, 146.0, 146.1, 146.2, 146.3, 146.4, 146.5, 146.6, 146.7, 146.8, 146.9, 147.0, 147.1, 147.2, 147.3, 147.8, 147.9, 148.0, 148.1, 148.2, 148.3, 148.8, 148.9, 149.0, 149.1, 149.8, 149.9 (malignant neoplasm of lip, oral cavity and pharynx), 150.0, 150.1, 150.2, 150.3, 150.4, 150.5, 150.8, 150.9, 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9, 152.0, 152.1, 152.2, 152.3, 152.8, 152.9, 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 154.2, 154.3, 154.8, 155.0, 155.1, 155.2, 156.0, 156.1, 156.2, 156.8, 156.9, 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9, 158.0, 158.8, 158.9, 159.0, 159.1, 159.8, 159.9 (malignant neoplasm of digestive organs and peritoneum),160.0, 160.1, 160.2, 160.3, 160.4, 160.5, 160.8, 160.9, 161.0, 161.1, 161.2, 161.3, 161.8, 161.9, 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 163.0, 163.1, 163.8, 163.9, 164.0, 164.1, 164.2, 164.3, 164.8, 164.9, 165.0, 165.8, 165.9 (malignant neoplasm of respiratory and intrathoracic organs),170.0, 170.1, 170.2, 170.3, 170.4, 170.5, 170.6, 170.7, 170.8, 170.9, 171.0, 171.2, 171.3, 171.4, 171.5, 171.6, 171.7, 171.8, 171.9, 172.0, 172.1, 172.2, 172.3, 172.4, 172.5, 172.6, 172.7, 172.8, 172.9, 173.0, 173.1, 173.2, 173.3, 173.4, 173.5, 173.6, 173.7, 173.8, 173.9, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 175.0, 175.9, 176.0, 176.1, 176.2, 176.3, 176.4, 176.5, 176.8, 176.9 (malignant neoplasm of bone, connective tissue, skin and breast),179, 180.0, 180.1, 180.8, 180.9, 181, 182.0, 182.1, 182.8, 183.0, 183.2, 183.3, 183.4, 183.5, 183.8, 183.9, 184.0, 184.1, 184.2, 184.3, 184.4, 184.8, 184.9, 185, 186.0, 186.9, 187.1, 187.2, 187.3, 187.4, 187.5, 187.6, 187.7, 187.8, 187.9, 188.0, 188.1, 188.2, 188.3, 188.4, 188.5, 188.6, 188.7, 188.8, 188.9, 189.0, 189.1, 189.2, 189.3, 189.4, 189.8, 189.9 (malignant neoplasm of genitourinary organs), 190.0, 190.1, 190.2, 190.3, 190.4, 190.5, 190.6, 190.7, 190.8, 190.9, 191.0, 191.1, 191.2, 191.3, 191.4, 191.5, 191.6, 191.7, 191.8, 191.9, 192.0, 192.1, 192.2, 192.3, 192.8, 192.9, 193, 194.0, 194.1, 194.3, 194.4, 194.5, 194.6, 194.8, 194.9, 195.0, 195.1, 195.2, 195.3, 195.4, 195.5, 195.8, 196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9, 197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2, 198.3, 198.4, 198.5, 198.6, 198.7, 198.81, 198.82, 198.89, 199.0, 199.1, 199.2 (malignant neoplasm of other and unspecified sites), 200.00, 200.01, 200.02, 200.03, 200.04, 200.05, 200.06, 200.07, 200.08, 200.10, 200.11, 200.12, 200.13, 200.14, 200.15, 200.16, 200.17, 200.18, 200.20, 200.21, 200.22, 200.23, 200.24, 200.25, 200.26, 200.27, 200.28, 200.30, 200.31, 200.32, 200.33, 200.34, 200.35, 200.36, 200.37, 200.38, 200.40, 200.41, 200.42, 200.43, 200.44, 200.45, 200.46, 200.47, 200.48, 200.50, 200.51, 200.52, 200.53, 200.54, 200.55, 200.56, 200.57, 200.58, 200.60, 200.61, 200.62, 200.63, 200.64, 200.65, 200.66, 200.67, 200.68, 200.70, 200.71, 200.72, 200.73, 200.74, 200.75, 200.76, 200.77, 200.78, 200.80, 200.81, 200.82, 200.83, 200.84, 200.85, 200.86, 200.87, 200.88, 201.00, 201.01, 201.02, 201.03, 201.04, 201.05, 201.06, 201.07, 201.08, 201.10, 201.11, 201.12, 201.13, 201.14, 201.15, 201.16, 201.17, 201.18, 201.20, 201.21, 201.22, 201.23, 201.24, 201.25, 201.26, 201.27, 201.28, 201.40, 201.41, 201.42, 201.43, 201.44, 201.45, 201.46, 201.47, 201.48, 201.50, 201.51, 201.52, 201.53, 201.54, 201.55, 201.56, 201.57, 201.58, 201.60, 201.61, 201.62, 201.63, 201.64, 201.65, 201.66, 201.67, 201.68, 201.70, 201.71, 201.72, 201.73, 201.74, 201.75, 201.76, 201.77, 201.78, 201.90, 201.91, 201.92, 201.93, 201.94, 201.95, 201.96, 201.97, 201.98, 202.00, 202.01, 202.02, 202.03, 202.04, 202.05, 202.06, 202.07, 202.08, 202.10, 202.11, 202.12, 202.13, 202.14, 202.15, 202.16, 202.17, 202.18, 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 202.30, 202.31, 202.32, 202.33, 202.34, 202.35, 202.36, 202.37, 202.38, 202.40, 202.41, 202.42, 202.43, 202.44, 202.45, 202.46, 202.47, 202.48, 202.50, 202.51, 202.52, 202.53, 202.54, 202.55, 202.56, 202.57, 202.58, 202.60, 202.61, 202.62, 202.63, 202.64, 202.65, 202.66, 202.67, 202.68, 202.70, 202.71, 202.72, 202.73, © 2007 American Medical Association.<br><br> All Rights Reserved. CPT ® Copyright 2006 American Medical Association 23 202.74, 202.75, 202.76, 202.77, 202.78, 202.80, 202.81, 202.82, 202.83, 202.84, 202.85, 202.86, 202.87, 202.88, 202.90, 202.91, 202.92, 202.93, 202.94, 202.95, 202.96, 202.97, 202.98, 203.00, 203.01, 203.02, 203.10, 203.11, 203.12 203.80, 203.81, 203.82, 204.00, 204.01, 204.02, 204.10, 204.11, 204.12, 204.20, 204.22, 204.21, 204.80, 204.81, 204.82 204.90, 204.91, 204.92, 205.00, 205.01,205.02, 205.10, 205.11, 205.12, 205.20, 205.21, 205.22, 205.30, 205.31, 205.32, 205.80, 205.81, 205.90, 205.91, 205.92 206.00, 206.01, 206.02, 206.10, 206.11, 206.12, 206.20, 206.21, 206.22, 206.80, 206.81, 206.82, 206.90, 206.91, 206.92, 207.00, 207.01, 207.02, 207.10, 207.11, 207.12 207.20, 207.21, 207.22, 207.80, 207.81, 207.82, 208.00, 208.01, 208.02, 208.10, 208.11, 208.12, 208.20, 208.21, 208.22, 208.80, 208.81,208.82, 208.90, 208.91, 208.92(malignant neoplasm of lymphatic and hematopoietic tissue), 209.00, 209.01, 209.02, 209.03, 209.10, 209.11, 209.12, 209.13, 209.14, 209.15, 209.16, 209.17, 209.20, 209.21, 209.22, 209.23, 209.24, 209.24, 209.25, 209.26, 209.27, 209.29, 209.30 (neuroendrocrine tumors), 235.0, 235.1, 235.2, 235.3, 235.4, 235.5, 235.6, 235.7, 235.8, 235.9, 236.0, 236.1, 236.2, 236.3, 236.4, 236.5, 236.6, 236.7, 236.90, 236.91, 236.99, 237.0, 237.1, 237.2, 237.3, 237.4, 237.5, 237.6, 237.70, 237.71, 237.72, 237.9, 238.0, 238.1, 238.2, 238.3, 238.4, 238.5, 238.6, 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, 238.77, 238.8, 238.9 (neoplasms of uncertain behavior), 239.0, 239.1, 239.2, 239.3, 239.4, 239.5, 239.6, 239.7, 239.8, 239.9 (neoplasms of unspecified nature)AND " CPT Category II code adjuvant chemotherapy treatment completed within the 12 month reporting period (in development): XXXXF This measure requires that ALL components listed within the numerator statement be reported to meet the measure . If denominator exclusion CPT-II code(s) is (are) reported for any of the components, it is required that CPT-II codes be reported for the other elements of care.<br><br> Denominator Exclusion : Documentation of patient reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the written chemotherapy treatment summary was provided to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient requests that report not be sent) Append to the CPT-II code for each component as appropriate. " Append modifier to CPT Category II code (in development): XXXXF-2P " Append modifier to CPT Category II code (in development): XXXXF-2P " Append modifier to CPT Category II code (in development): XXXXF-2P Documentation of system reason(s) for not having either a chemotherapy treatment summary documented in the chart OR not having documentation that the written chemotherapy treatment summary was provided to the patient OR not having documentation that the chemotherapy treatment summary was communicated to the physician(s) providing continuing care (eg, patient does not have any physician respo

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