CMS646v2 – Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder Cancer

– DENOMINATOR EXCLUSIONS

• Immunosuppressed patients, includes HIV and immunocompromised state.
• Immunosuppressive drug therapy.
• Active Tuberculosis.
• Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease.
• Patients who undergo cystectomy, chemotherapy or radiation within 6 months of Bladder Cancer Staging.

– DENOMINATOR EXCEPTIONS

Unavailability of BCG

– NUMERATOR

Intravesical Bacillus-Calmette Guerin (BCG) instillation for initial dose or series.

BCG is initiated within 6 months of the bladder cancer staging and during the measurement period

For Denominator:

Patients fulfilling the following criteria are included in the denominator of this measure:

• Patients with a qualifying encounter during the measurement period. To record a qualifying encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

• Patients with ‘Bladder Cancer for Urology Care’ diagnosis where the bladder cancer prevalence period starts before the end of the measurement period. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis, add the diagnosis details and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

• Patients with one of the below results for most recent bladder cancer tumor staging:
  • Urinary tract tumor invades subepithelial connective tissue (finding)
  • Noninvasive papillary carcinoma (urinary tract) (finding)
  • Carcinoma in situ (flat tumor of urinary bladder) (finding)
  • Carcinoma in situ of bladder

To record the cancer tumor staging result, navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an assessment. Select ‘Performed’ from the ‘Status’ dropdown and select a reason from the ‘Result’ dropdown.

For Numerator:

• Patients with ‘BCG Bacillus Calmette Guerin for Urology Care’ medication administered 6 months or less after the cancer staging procedure and during the measurement period. The medication is not null.

  The tumor staging procedure should be performed with or before the start of bladder cancer diagnoses and overlaps with the bladder cancer prevalence period. The bladder cancer prevalence period starts before the end of the measurement period.

  • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
  • To record the medication, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

For Denominator Exclusions:

Patients satisfying any of the following conditions are excluded from the denominator:

• Patients with one of the below diagnoses:
  • Diagnosis of ‘HIV’ where the HIV prevalence period starts with or before the start of cancer staging procedure.
  • ‘Acute tuberculosis for urology care’ diagnosis where the prevalence period overlaps after the cancer staging procedure.
  • ‘Immunocompromised conditions’ diagnosis where the diagnosis prevalence period starts with or before the start of cancer staging procedure.
  • ‘Mixed histology urothelial cell carcinoma for Urology Care’ diagnosis where the mixed histology prevalence period starts with or before the start of cancer staging procedure.

The tumor staging procedure should be performed with or before the start of bladder cancer diagnoses and overlaps with its bladder cancer prevalence period. The bladder cancer prevalence period starts before the end of the measurement period.

• • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
• Patients with ‘Cystectomy for Urology Care’ procedure performed 6 months or less before the start of cancer staging procedure.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
  • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To document Cystectomy procedure, navigate to Patient > Provider Note > Orders > Procedures.

• Patients with ‘Combined radiotherapy (procedure)’ performed 6 months or less before the cancer staging procedure.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
  • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To document combined radiotherapy procedure, navigate to Patient > Provider Note > Orders > Procedures.

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button. 

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button. 

• Patients with active ‘Immunosuppressive Drugs for Urology Care’ medication during or before the cancer staging procedure.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
  • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To record an active medication for Immunosuppressive drugs for urology care, navigate to Patient > Provider Note > Medications. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’.

• Patients with active ‘Chemotherapy for Advanced Cancer’ medication starting 6 months or less before the cancer staging procedure.
  • To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
  • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
  • To record an active medication for Chemotherapy for advanced cancer, navigate to Patient > Provider Note > Medications.

For Denominator Exceptions:

Patients with “BCG Bacillus Calmette Guerin for Urology Care” medication not administered for 6 months or less after the start of cancer staging procedure and in the measurement period. The reason for medication not administered is the ‘’Unavailability of Bacillus Calmette Guerin for urology care”.

• To document the tumor staging result, use the workflow Patient > Clinical > Evaluations.
• To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
• To document the reason for the medication not administered, use the workflow Patient > Clinical > Medications. Select the medication that is not administered and click on ‘Discontinue’. Then select a reason from the ‘Reason’ dropdown and click ‘Save’.