If a report is submitted that qualifies as a primary resection or biopsy for colorectal, gastroesophageal, endometrial, or small bowel carcinoma, Measure 491 requires documentation of an impression or recommendation for testing of mismatch repair (MMR) by immunohistochemistry (biomarkers MLH1, MSH2, MSH6, and PMS2), or microsatellite instability (MSI) by DNA-based testing status, or both.
Per CMS: Diagnosis of primary colorectal, endometrial, gastroesophageal or small bowel carcinoma, biopsy or resection (ICD-10-CM®): C15.3, C15.4, C15.5, C15.8, C15.9, C16.0, C16.1, C16.2, C16.3, C16.4, C16.5, C16.6, C16.8, C16.9, C17.0, C17.1, C17.2, C17.3, C17.8, C17.9, C18.0, C18.2, C18.3, C18.4, C18.5, C18.6, C18.7, C18.8, C18.9, C19, C20, C26.0, C54.1, C54.3, C54.8, C54.9, C55
Excluded from this measure are patients with:
• an existing diagnosis of squamous cell carcinoma of the esophagus
• an existing diagnosis of Lynch Syndrome (ICD-10-CM Z15.04, Z15.09, Z80.0)
Appropriate documentation to support the requirements of this quality measure should be included on the original pathology report. Many cases do include the appropriate elements, but not until an amendment is sent to us. Because we submit data on a regular basis to our registries, it is imperative that the documentation on the original report contain a reference to the intended testing.
Verbiage:
Anywhere on the original report, if MMR/MSI testing is likely to be or has already been performed, include a statement to indicate this.
• “MMR/MSI testing will be performed as indicated for specimen A”
• “MMR/MSI testing to follow in an amendment.”
• “MMR/MSI testing not recommended due to ___”
• “MMR/MSI testing performed on previous specimen and not repeated”
• Or results from the MMR/MSI study
It is not necessary to include results if the testing has not yet been performed. Statements such as the above indicating the impression of or recommendation for testing qualify the case as “met” per CMS guidance.
Scoring:
In it’s 2nd year of the QPP program, this measure is worth 5 to 10 points toward the quality score, depending on performance.
Detailed measure specifics are available from CMS.
CPT copyright 2023 American Medical Association. All rights reserved.
