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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