Measure : Prostate Cancer: Cancer Surveillance Owner: NQF (625) Measure Code: PRS Rule : Applicable Provider Specialty: General Criteria Summary Steward: Active Health Management Lab Data: Y Percentage of males with prostate cancer that have had their PSA monitored in the past 12 months Urology, Oncology, Internal Medicine, Family Practice, Geriatric Medicine, Multispecialty Group 1. Measurement period: 1 year prior to measurement period end date 2. Continuous enrollment: 3. Anchor date: measurement period end date (ie. December 31 of calendar year) 4. Gaps in enrollment: One 45-day gap allowed in the 5. Medical coverage: Yes 6. Drug coverage: No 7. Attribution time frame: 1 year on all prostate cancer denominator events 8. Exclusions apply: Yes 9. Age range: 18 years or older as of the beginning of the Summary of changes for 2015 No changes ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- Denominator : All male patients, 18 years or older as of the beginning of the with a diagnosis of prostate cancer anytime prior to or during the Inclusion Criteria: All male patients, 18 years or older as of the beginning of the with a diagnosis of prostate cancer anytime prior to or during the Eligibility Criteria Age is 18 years or older Age in Years >= 18 age_years demog eligibility As of the beginning of Page 1
Claim Criteria Diagnosis of prostate cancer 1 Any Diagnosis Code = Prostate Cancer Value Set dx_cd dx any_dx Anytime prior to or during the Exclusion Criteria: Patients with prostate cancer treatment at anytime during the OR Patients with diagnosis of metastatic disease during the OR Patients who have been in a skilled nursing facility during the Prostate Cancer treatment OR Diagnosis of metastasis OR Patients in Skilled Nursing Facility 1 (CPT Procedure Code = Prostate Cancer Treatment Value Set ICD 9 Procedure Codes = Prostate Cancer Value Set) proc_cd Proc fac_dtl proc_cd any_fac proc proc 1 Any Diagnosis Code = Metastasis Value Set dx_cd dx any_dx 1 (CPT Procedure Code = Skilled Nursing Facility Value Set UB Rev Code = Skilled Nursing Facility Value Set fac_dtl proc_cd proc fac_dtl fac_reven ue_cd proc fac_dtl Page 2
Place of service code = Skilled Nursing Facility Value Set) mdst_plac e_cd clm_gen eral Continuous Enrollment Criteria: Continuous enrollment AND Has medical coverage Continuous Enrollment is 12 out of 12 months Coverage Indicator Medical = Y medical_c ovg_ind plan eligibility ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- Numerator : Males in the denominator who had PSA monitoring anytime during the. Inclusion Criteria: Males in the denominator who had PSA monitoring anytime during the. PSA monitoring 1 CPT Procedure Code = HCPCS code = ICD-9 Diagnosis = or proc_cd proc fac_dtl proc_cd proc fac_dtl dx_cd dx any_dx Page 3
LOINC codes = loinc_cd lab_other lab_results Notes: Appendix Prostate Cancer Value Set Code Code Type 185 ICD-9-CM Diagnosis Malignant neoplasm of prostate Prostate Cancer Value Set Code Code Type 55801 CPT Prostatectomy, perineal, subtotal 55810 CPT Extensive Prostate Surgery 55812 CPT Extensive Prostate Surgery 55815 CPT Extensive Prostate Surgery 55821 CPT Removal of Prostate 55831 CPT Removal of Prostate 55840 CPT Extensive Prostate Surgery 55842 CPT Extensive Prostate Surgery 55845 CPT Extensive Prostate Surgery 55859 CPT Percut/Needle Insert - Pros 55860 CPT Surgical Exposure - Prostate 55862 CPT Extensive Prostate Surgery 55865 CPT Extensive Prostate Surgery 55866 CPT Laparo Radical Prostatectomy 77750 CPT Infuse Radioactive Materials 77761 CPT Apply Intrcav Radiat Simple Page 4
77762 CPT Apply Intrcav Radiat Interm 77776 CPT Apply Interstit Radiat Simpl 77777 CPT Apply Interstit Radiat Inter 77778 CPT Apply Interstit Radiat Compl 77781 CPT High Intensity Brachytherapy 77782 CPT High Intensity Brachytherapy 77783 CPT High Intensity Brachytherapy 77784 CPT High Intensity Brachytherapy 77799 CPT Radium/Radioisotope Therapy G0256 CPT Prostate brachytherapy implanting Palladium seeds G0261 CPT Prostate brachytherapy implanting iodine seeds 4164F CPT Adjuvant hormonal therapy 4200F CPT Prostate external beam radiotherapy as primary therapy 4201F CPT Prostate external beam radiotherapy to non-prostate only 60.3 ICD-9-PCS Procedure Suprapubic prostatectomy 60.4 ICD-9-PCS Procedure Retropubic prostatectomy 60.5 ICD-9-PCS Procedure Radical prostatectomy 60.6 ICD-9-PCS Procedure Other prostatectomy 60.61 ICD-9-PCS Procedure Local excision of lesion of prostate 60.62 ICD-9-PCS Procedure Perineal prostatectomy 60.69 ICD-9-PCS Procedure Other prostatectomy Metastasis Value Set Code Code Type 197.00-197.09 ICD-9-CM Diagnosis Secondary Malig Neo Lung 197.10-197.19 ICD-9-CM Diagnosis Sec Mal Neo Mediastinum 197.20-197.29 ICD-9-CM Diagnosis Second Malig Neo Pleura 197.30-197.39 ICD-9-CM Diagnosis Sec Malig Neo Resp NEC 197.40-197.49 ICD-9-CM Diagnosis Sec Malig Neo Sm Bowel 197.50-197.59 ICD-9-CM Diagnosis Sec Malig Neo Lg Bowel Page 5
197.60-197.69 ICD-9-CM Diagnosis Sec Mal Neo Peritoneum 197.70-197.79 ICD-9-CM Diagnosis Second Malig Neo Liver 197.80-197.89 ICD-9-CM Diagnosis Sec Mal Neo GI NEC 198.00-198.09 ICD-9-CM Diagnosis Second Malig Neo Kidney 198.10-198.19 ICD-9-CM Diagnosis Sec Malig Neo Urin NEC 198.20-198.29 ICD-9-CM Diagnosis Secondary Malig Neo Skin 198.30-198.39 ICD-9-CM Diagnosis Sec Mal Neo Brain/Spine 198.40-198.49 ICD-9-CM Diagnosis Sec Malig Neo Nerve NEC 198.50-198.59 ICD-9-CM Diagnosis Secondary Malig Neo Bone 198.60-198.69 ICD-9-CM Diagnosis Second Malig Neo Ovary 198.70-198.79 ICD-9-CM Diagnosis Second Malig Neo Adrenal 198.80-198.89 ICD-9-CM Diagnosis Second Malig Other Specified Sites Skilled Nursing Facility Value Set Code Code Type 99304-99306 CPT Nursing Facility Care - Init 99307-99310 CPT Nursing Fac Care - Subseq 99315-99316 CPT Nursing Fac Discharge Day 99318 CPT Annual Nursing Fac Assessmnt 0550-0559 UB Revenue Skilled Nursing 31 Place of Service Skilled Nursing Facility Code Code Type 84152 CPT Assay of Psa - Complexed 84153 CPT Assay of Psa - Total 84154 CPT Assay of Psa - Free G0103 HCPCS Psa - Total Screening 790.93 ICD-9-CM Diagnosis Elvtd Prstate Spcf Antgn Page 6
2857-1 LOINC Prostate specific Ag 10886-0 LOINC Prostate specific Ag.free 12841-3 LOINC Prostate specific Ag.free/Prostate specific Ag.total 19195-7, 19197-3 LOINC Prostate specific Ag 19201-3, 19203-9 LOINC Prostate specific Ag.free 33667-7 LOINC Prostate specific Ag.protein bound 35741-8 LOINC Prostate specific Ag Page 7