CMS646v3 – Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder Cancer

All patients initially diagnosed with T1, Tis or high-grade Ta non-muscle invasive bladder cancer and a qualified encounter in the measurement period.

A qualifying encounter in this case is an Office Visit.

– 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.

– 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:

• To record an encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’, enter the relevant encounter code.

• The diagnosis of bladder cancer can be recorded via Patient > Provider Notes > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

• For documenting the cancer staging procedure and its result, head over to Patient > Provider Notes > Evaluations. Here, search for the relevant cancer staging evaluation and from the status drop-down select ‘Performed’. Then, from the ‘Result’ drop-down select the relevant result.

Note: In order to be counted in the denominator, the result of the cancer staging should be one of the following:

• T1: Urinary tract tumor invades subepithelial connective tissue
• Ta: Noninvasive papillary carcinoma (urinary tract)
• Tis: Carcinoma in situ (flat tumor of urinary bladder)
• Carcinoma in situ of bladder

For Numerator:

To record the administration of the medication, navigate to Patient > Provider Notes > Prescription. Here, click ‘Add’ and search for the relevant BCG medication. Fill out the details and once done, click ‘Prescribe’.

Note: To be counted for the numerator, the medication is to be administered once the cancer staging procedure and its results are documented as mentioned in the denominator workflow.

For Denominator Exclusions:

• The documentation of the following diagnoses:
• Acute tuberculosis
• HIV
• Immunocompromised conditions
• Mixed histology urothelial cell carcinoma for urology care

can be done through Patient > Provider Notes > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.

• To record the Cystectomy and Combined Radiotherapy procedure, navigate to Patient > Provider Notes > Orders > Procedures. Here, click ‘Add’ and search for the relevant procedure. Fill out the details as needed and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• The immunosuppressive drugs and chemotherapy medication can be documented via Patient > Provider Notes > Medications. Here, click ‘Add’ and search for the relevant medications. Fill out the details and once done, click ‘Save’.