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PQRS Update: Measure 406 for Radiology Services

Measure #406:   Appropriate Follow-up Imaging for Incidental Thyroid Nodules

The Centers for Medicare and Medicaid Services (CMS) adopted new quality measure #406 for the 2016 reporting period.  It is anticipated that clinicians who provide the professional component of diagnostic imaging studies will submit this measure.

The intent of this measure is to ensure patients with incidental findings that are highly likely to be benign do not receive follow up imaging routinely.  It applies to patients 18 years and older with no known thyroid disease that have an incidental thyroid nodule less than 1.0 cm that has been noted in the imaging study and documented in the final interpretive report.  In this case, the final report must state one of the following:
• No follow-up imaging is recommended
• Follow-up imaging is recommended and the medical reason is stated (e.g., multiple endocrine neoplasia or cervical lymphadenopathy)
• Follow-up imaging is recommended without giving a medical reason

As long as documentation reflects the presence of incidental thyroid nodules noted during the study, two PQRS codes are reported to CMS.  If no nodules are noted, the study will be assigned a single PQRS exclusion code for the measure.  The designated PQRS codes and their respective applications are summarized below.

Final reports with follow-up imaging recommended

G9554   Performance Met/Final reports for CT or MRI of the chest or neck, or Ultrasound of the neck with follow-up imaging recommended     AND

G9552   Incidental thyroid nodule less than 1.0 cm noted in report

Documenting medical reason(s) for recommended follow-up

G9555   Medical Performance Exclusion/Final report reflects the medical reason(s) that follow-up imaging is indicated     AND

G9552   Incidental thyroid nodule less than 1.0 cm noted in report

Final report without incidental finding G9557   Other Performance Exclusion/final reports for CT or MRI studies of the chest or neck, or Ultrasound of the neck without a thyroid nodule less than 1.0 cm noted
Final reports with follow-up imaging not recommended

G9556   Performance not met/final reports for CT or MRI of the chest or neck, or Ultrasound of the neck with follow-up imaging not recommended     AND

G9552   Incidental thyroid nodule less than 1.0 cm noted in report

The following imaging studies apply to this PQRS measure. There are no associated diagnosis requirements.

70490   CT soft tissue neck without contrast
70491   CT soft tissue neck with contrast
70492   CT soft tissue neck without contrast followed by contrast and further sections 
70540   MRI orbit, face and/or neck without contrast 
70542   MRI orbit, face and/or neck with contrast 
70543   MRI orbit, face and/or neck without contrast followed by contrast and further sequences     
71250   CT chest without contrast  
71260   CT chest with contrast  
71270   CT chest without contrast followed by contrast and further sections         
70498   CTA neck with contrast including non-contrast images, if performed, and image post-processing    
72125   CT cervical spine without contrast    
72126   CT cervical spine with contrast   
72127   CT cervical spine without contrast followed by contrast and further sections                                                                                                                                                              71550   MRI chest (ie, for evaluation of hilar and mediastinal lymphadenopathy) without contrast
71551   MRI chest (ie, for evaluation of hilar and mediastinal lymphadenopathy) with contrast
71552   MRI chest (ie, for evaluation of hilar and mediastinal lymphadenopathy) without contrast, followed by contrast and further sequences
76536   Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation

In keeping with the specifications of this measure, APS coding personnel will assign the applicable PQRS code(s) at the time of coding processing, based on the documentation within the final interpretive reports. 

The full details of Measure # 406 can be downloaded at:
https://pqrs.cms.gov/dataset/2016-PQRS-Measure-406-11-17-2015/js7u-5xew

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