Can anyone expand on how you would correctly report on this measure?
Would we bill 71250 to the insurance and add the G9754 plus one of the 3 numerator codes for reporting to the registry OR do we bill the 71250 AND G9754 to the insurance because the G9754 is a denominator code.
I am confused as we haven't used another measure like this one before.
Denominator
All final CT reports that indicate an incidental pulmonary nodule
Denominator Criteria (Eligible Cases):
All patients age 18 years and older
AND
Patient procedure during the performance period (CPT): 71250, 71260, 71270, 71275
AND
A finding of an incidental pulmonary nodule: G9754
Numerator
Final reports with documented follow-up recommendations for incidentally detected pulmonary nodules (e.g., followup CT imaging studies needed or that no follow-up is needed) based at a minimum on nodule size AND patient risk factors
Definition:
Follow-up Recommendations – No follow-up recommended in the final CT report OR follow-up is recommended within a designated time frame in the final CT report. Recommendations noted in the final CT report should be in accordance with recommended guidelines.
Numerator Options:
Performance Met:
Follow-up recommendations documented according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up CT imaging studies needed or that no follow-up is needed) based at a minimum on nodule size AND patient risk factors (G9345)
OR
Denominator Exception:
Documentation of medical reason(s) that follow-up imaging is indicated (e.g., patient has a known malignancy that can metastasize, other medical reason(s) (G9755)
OR
Performance Not Met:
Follow-up recommendations not documented according to recommended guidelines for incidentally detected pulmonary nodules, reason not given (G9347)
RESPECTFULLY,
Rick D Gladish, RCC, CPC
MD Revenue Management, LLC
111 Troy St STE F
Tupelo, MS 38804
ph 662-620-7102 fax 662-620-7106
email: rick@mdrm.us
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