Wiki MIPS Quality Measure #364--Incidental pulmonary nodule

mcrossley

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Can someone "dumb" down the criteria for reporting MIPS measure #364? I believe I understand, but would love confirmation: Report G9754 if report has incidental pulmonary nodule on a patient 35 and older, does not have cancer or history of, not a heavy smoker or a lung cancer screening patient. Report G9345 if report states a follow up recommendation, report G9755 if a documented reason of not recommending follow up, report G9347 if recommendation not documented at all. Am I right? I attached the literature on it and hope you can give your opinion. Thanks!!
 

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  • Quality ID #364_ Optimizing Patient Exposure to Ionizing Radiation_ Appropriateness_ Follow-up...pdf
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Can someone "dumb" down the criteria for reporting MIPS measure #364? I believe I understand, but would love confirmation: Report G9754 if report has incidental pulmonary nodule on a patient 35 and older, does not have cancer or history of, not a heavy smoker or a lung cancer screening patient. Report G9345 if report states a follow up recommendation, report G9755 if a documented reason of not recommending follow up, report G9347 if recommendation not documented at all. Am I right? I attached the literature on it and hope you can give your opinion. Thanks!!
There are 3 components of this measure that should be documented to code “measure met”. Also, coding requires two codes for “measure met”, or "exception", or "measure NOT met".

Incidental nodule/ follow recommendations/ and source of recommendations are documented report G9345 and G9754 (Measure Met)

Incidental nodule, follow-up recommended due to the patient’s unexplained fever report G9755 and G9754 (Measure Exception)

Incidental nodule, no follow-up recommendations given &/or no reason stated report G9347 & G9754 (Measure NOT Met)

Incidental nodule, the patient has known breast cancer report M1018 (Measure Exclusion)

Incidental nodule, the patient is a known heavy smoker report M1018 (Measure Exclusion)

Incidental nodule, the patient is a lung cancer screening patient report M1018 (Measure Exclusion)
 
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I have an additional question about this measure if you would be so kind. As for the term "incidental nodule", does that mean ANY new nodule found or only on the first incidental finding? For example, if a patient has nodules previously seen on other exams, but there are new nodules on the current exam, is that included in this measure or null because of the prior nodules?
 
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