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PQRS Update: New 2016 Measure for Radiology Services

The Centers for Medicare and Medicaid Services (CMS) adopted new quality measure #436 for the 2016 reporting period.  It is anticipated that clinicians who provide the professional component of diagnostic imaging studies for computed tomography (CT) will submit this measure.  This measure applies to patients age 18 and older undergoing CT and reflects the percentage of final reports that contain documentation indicating that one or more of the following dose reduction techniques were used in the study:

• Automated exposure control
• Adjustment of the mA and/or kV according to patient size
• Use of iterative reconstruction technique

Rationale for the measure cites current advances in technology that have resulted in multiple methods to reduce rations dose for patients undergoing CT. 

The following CT/CTA studies and their corresponding CPT codes apply to this PQRS measure.  There are no associated diagnosis requirements.

70450, 70460 and 70470:  CT head or brain
70480, 70481 and 70482:  CT orbit, sella, or posterior fossa or outer, middle or inner ear
70486, 70487 and 70488:  CT maxillofacial area
70490, 70491 and 70492:  CT soft tissue neck
70496:  CTA head
70498:  CTA neck
71250, 71260 and 71270:  CT thorax
71275:  CTA chest
72125, 72126, 72127:  CT cervical spine
72128, 72129, 72130:  CT thoracic spine
72131, 72132, 72133:  CT lumbar spine
72191:  CTA pelvis
72192, 72193, 72194:  CT pelvis
73200, 73201, 73202:  CT upper extremity
73206:  CTA upper extremity
 73700, 73701, 73702:  CT lower extremity
73706:  CTA lower extremity
74150, 74160, 74170:  CT abdomen
74174:  CTA abdomen and pelvis
74175:  CTA abdomen
74176, 74177, 74178:  CT abdomen and pelvis
74261 and 74262:  CT colonography, diagnostic
75571, 75572 and 75573:  CT heart
75574:  CTA heart
75635:  CTA abdominal aorta and bilateral iliofemoral lower extremity runoff
76380:  CT limited or localized follow-up study
76497:  Unlisted CT procedure
77011:  CT guidance for stereotactic localization
77012:  CT guidance for needle placement
77013:  CT guidance for, and monitoring, of parenchymal tissue ablation
77014:  CT guidance for placement of radiation therapy fields
77078:  CT bone mineral density study
0042T:  Cerebral perfusion analysis using CT with contrast administration
 
In summary, as long as the interpretive report contains documentation indicating which dose reduction technique(s) was/were used, APS will apply the appropriate PQRS code (G9637) to claims for those CT and CTA studies in order to meet performance and reporting requirements for this measure.  In keeping with the specifications of this measure, final interpretive reports that do not contain this documentation will be assigned the PQRS code indicating that the measure wasn’t met as dose reduction was not performed (G9638). 

The full details of Measure #436 can be downloaded at:
https://pqrs.cms.gov/download/cxzd-j85i/application/pdf

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