Practice Management

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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Thank you.

That is the way I was leaning but this is the 1^st measure I have used where there was a G code listed in the numerator section and it looked different from the other measure where 2 codes are required.