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2019 Pathology Quality Measures

Claims-based Reporting 2019 Update

Starting in 2019, Medicare Part B claims measures can only be submitted via claims by pathologists in a small practice (15 or fewer eligible clinicians), and can be submitted with individual or group participation. Pathologists in a group of 16 or more cannot submit quality measures using claims, regardless of whether participating as an individual or group, and must submit using a qualified registry (QR) or qualified clinical data registry (QCDR). The Pathologists Quality Registry provides both options.

The Pathologists Quality Registry offers 28 quality measures. Seven are Merit-based Incentive Payment System (MIPS) Clinical Quality Measures (CQMs). The remaining 21 are specific pathology measures, all developed by the CAP and approved by the CMS as qualified clinical data registry (QCDR) measures—exclusively available in the Pathologists Quality Registry.

Important 2019 Updates

Beginning January 1, 2019 these measures can no longer be reported on for MIPS.The CMS removed the following measures from the program:

  • 99: Breast Cancer Resection Pathology Reporting
  • 100: Colorectal Cancer Resection Pathology Reporting
  • 251: Evaluation of HER2 for Breast Cancer

For quality measure 397, Melanoma Reporting, specifications updates were:

  • Melanoma in situ added as a denominator exclusion
  • Mitotic rate included for all pT categories

Pathology Specific QPP Measures

These measures can be reported to the CMS using the Pathologists Quality Registry, through billing/claims, and other registries.

QPP 249: Barrett Esophagus Pathology Reporting Registry and Claims Specifications
QPP 250: Radical Prostatectomy Pathology Reporting Registry and Claims Specifications
QPP 395: Lung Cancer Reporting (biopsy/cytology specimens) * Registry and Claims Specifications
QPP 396: Lung Cancer Reporting* (resection specimens) * Registry and Claims Specifications
QPP 397: Melanoma Reporting* Registry and Claims Specifications

These measures can be reported to the CMS using the Pathologists Quality Registry and other registries.

QPP 265: Biopsy Follow-Up* Registry Specifications (American Academy of Dermatology measure)
QPP 440: Basal Cell Carcinoma (BCC)/Squamous Cell Carcinoma (SCC): Biopsy Reporting Time* Registry Specifications (American Academy of Dermatology measure)

Pathologists Quality Registry QCDR Measures

These measures can be reported to the CMS only with the Pathologists Quality Registry.

CAP8: Turnaround Time (TAT) – Lactate*
CAP9: Turnaround Time (TAT) – Troponin*
CAP10: Blood Laboratory Samples for Potassium Determination with Hemolysis Drawn in the Emergency Department **
CAP11: Accurate Human Epidermal Growth Factor Receptor 2 (HER2) Tumor Evaluation and Repeat Evaluation in Patients with Breast Carcinoma *
CAP12: Accurate Human Epidermal Growth Factor Receptor 2 (HER2) Tumor Evaluation and Repeat Evaluation in Patients with Gastroesophageal Adenocarcinoma *
CAP13: Anaplastic Lymphoma Kinase (ALK) Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Non-small Cell Lung Cancer *
CAP14: Appropriate Formalin Fixation Time (6 – 72 hours) of Breast Cancer Specimens to Ensure Accurate Ancillary Testing Results
CAP15: BRAF Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Metastatic Colorectal Adenocarcinoma *
CAP16: Epidermal Growth Factor Receptor (EGFR) Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Non-small Cell Lung Cancer *
CAP17: FMS-like Tyrosine 3-Internal Tandem Duplication (FLT3-ITD) Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Acute Myeloid Leukemia *
CAP18: Mismatch Repair (MMR) or Microsatellite Instability (MSI) Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Primary or Metastatic Colorectal Carcinoma *
CAP19: ROS 1 Biomarker Testing to Inform Clinical Management and Treatment Decisions in Patients with Non-small Cell Lung Cancer *
CAP20: High Risk HPV Testing and p16 Scoring in Surgical Specimens for Patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC) *
CAP21: High Risk HPV Testing in Cytopathology Specimens for Patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC) *
CAP22:Turnaround Time (TAT) – Biopsies *
CAP23: Cancer Protocol Elements and Turnaround Time for Carcinoma and Carcinosarcoma of the Endometrium *
CAP24: Cancer Protocol Elements and Turnaround Time for Carcinoma of the Intrahepatic Bile Ducts *
CAP25: Cancer Protocol Elements and Turnaround Time for Carcinoma of the Pancreas *
CAP26: Cancer Protocol Elements and Turnaround Time for Hepatocellular Carcinoma *
CAP27: Cancer Protocol Elements and Turnaround Time for Invasive Carcinoma of Renal Tubular Origin *
CAP28: Helicobacter pylori Status and Turnaround Time *

* = high-priority measure

** = outcome measure

The CMS recommends that eligible professionals check with the QPP HelpDesk for more information on measures and the QPP.
Professionals may contact the QPP Help Desk.
7:00 AM–7:00 PM CT Monday - Friday
email: QPP@cms.hhs.gov
Phone: 866-288-8292

Resources

Claims-based Reporting Information

The CAP developed an instruction sheet on claims-based reporting to assist with submitting data on quality measures for MIPS through claims. The corresponding document provides the CPT II and quality data codes (QDC) and descriptors of the for 2019 QPP measures.

For the 2019 Reporting Period

Beginning January 1, 2019 pathologists in a group of 16 or more clinicians cannot submit quality measures using claims (or, billing company), regardless of whether participating as an individual or a group.

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