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A: Measure #76 reports the “percentage of patients, regardless of age, who undergo central venous catheter (CVC) insertion for whom CVC was inserted with all elements of maximal sterile barrier technique [cap AND mask AND sterile gloves AND a large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis (or acceptable alternative antiseptics per current guideline)] followed.” The instructions of the measure state that it is to be reported each time a CVC insertion is performed during the reporting period, using CPT Category II code 6030F. Consistent documentation is advised in order to receive credit for the maximum number of patients, though guidelines are not given. 

 

Please note that the measure does not require the compliance statement to be documented in the final report or patient chart. The physician reporting CPTII 6030F is attesting that the maximal sterile barrier technique was used. Having a written policy or procedure indicating that the technique is to be used, describing each specific element will support attestation in the event of an audit. 

A: Cerebral angiogram and other angiographic modalities such as magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) all provide direct angiographic stenosis calculations. A direct method (using North American Symptomatic Carotid Endarterectomy Trial) OR an equivalent validated method needs to be documented when performing the measurement, but not both. 

 

Measure #195, Stenosis Measurement in Carotid Imaging Studies, requires the radiologist to use a standardized method for stenosis quantification based on measurements of distal internal carotid diameter as the denominator. Direct measurements may be done with cerebral angiogram or other angiographic modalities such as MRA or CTA; indirect methods will likely be used for duplex ultrasound studies. Having velocity parameters correlate to the residual internal carotid lumen, with methods based on the distal internal carotid lumen, is an equivalent validating method and can be stated as such in the report. The comparative measurements are not made as part of the carotid ultrasound. The diameter stenosis range reported based on the velocity measurements should correlate with angiographic measurements using a method such as NASCET (as opposed, for example, to representing an area stenosis or a diameter stenosis related to the carotid bulb). 

 

A short note can be made in the final report, such as: “Severe left ICA stenosis of 70-80% by NASCET criteria” or “Severe left ICA stenosis of 70-80% by criteria similar to NASCET” or “70% stenosis derived by comparing the narrowest segment with the distal luminal diameter as related to the reported measure of arterial narrowing” or “Severe stenosis of 70-80% — validated velocity measurements with angiographic measurements, velocity criteria are extrapolated from diameter data as defined by the Society of Radiologists in Ultrasound Consensus Conference Radiology 2003; 229;340-346.” 

A: Yes, reminder letters that inform patients of the date of their last mammogram and state it is time for them to schedule an appointment meet the requirements of Measure #225. Measure #225 requires that the reminder system determine the target due date for the next exam in order to create a letter in the appropriate time frame according to the patient’s needs. The measure numerator states: “Patients whose information is entered into a reminder system with a target due date for the next mammogram” and [the reminder system] includes the following element requirements (at a minimum):

 

Patient identifier

Patient contact information

Date(s) of prior screening mammogram(s) (if known)

Target due date for the next mammogram

The numerator quality-data coding options for satisfactory reporting include CPT II 7025F or 7025F with 8P (the patient information has NOT been entered into a reminder system and the reason is not otherwise specified).

 

Additionally, note that the measure does not require that information to be included in a final report. It would be practical to have a written policy or procedure that states all patients receiving screening mammograms have the specific information entered into a system to allow followup and reminder letters, in case of an audit.

A: It is appropriate for physicians to report on measure #225 even if they use a hospital-based reminder system. Please ensure that the reminder system includes the criteria as listed in the 2011 Physician Quality Reporting System Measure Specification as follows:

 

Numerator Instructions: The reminder system should be linked to a process for notifying patients when their next mammogram is due and should include the following elements at a minimum: patient identifier, patient contact information, dates(s) of prior screening mammogram(s) (if known), and the target due date for the next mammogram.

 

In order to report this measure correctly, please report on patients that meet the denominator criteria as listed in the measure specification. 

A: Radionuclide bone imaging plays an integral part in tumor staging and management. The majority of bone scans are performed in patients with a diagnosis of malignancy, especially carcinoma of the breast, prostate gland and lung. This modality is extremely sensitive for detecting skeletal abnormalities. Numerous studies have confirmed that it is considerably more sensitive than conventional radiography for this purpose.

 

However, the specificity of bone scan abnormalities can be low since many other conditions may mimic tumor; therefore, it is important that radionuclide bone scans are correlated with available, relevant imaging studies. Existing imaging studies that are available can help inform the diagnosis and treatment for the patient. Furthermore, correlation with existing radiographs is considered essential to insure that benign conditions are not interpreted as tumor.

 

While there are no formal studies on variations in care and how often correlation with existing studies is performed, there is significant anecdotal information from physicians practicing in the field that there is a gap in care and that correlation is not occurring frequently when images are available. 

 

Literature suggests that as many as 30 percent of radiology reports contain errors, regardless of the imaging modality, radiologist’s experience or time spent in interpretation. Evidence also suggests that radiology reports are largely nonstandardized and commonly incomplete, vague, untimely and error-prone and may not serve the needs of referring physicians. Therefore, it is imperative that existing imaging reports be correlated with the nuclear medicine bone scintigraphy procedure to ensure proper diagnosis and appropriate patient treatment.