CMS646v4 – Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder Cancer
Intravesical Bacillus-Calmette-Guerin for Non-Muscle Invasive Bladder Cancer
CMS646v4
Percentage of patients initially diagnosed with non-muscle invasive bladder cancer and who received intravesical Bacillus-Calmette-Guerin (BCG) within 6 months of bladder cancer staging
– DENOMINATOR
All patients initially diagnosed with T1, Tis or high-grade Ta non-muscle invasive bladder cancer with bladder cancer staging within 6 months before to 6 months after the start of the measurement period and a qualified encounter in the measurement period.
A qualifying encounter in this case is an Office Visit.
– 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.
– DENOMINATOR EXCLUSIONS
Immunosuppressed patients, includes HIV and immunocompromised state, with a diagnosis prior to Bladder Cancer Staging.
Immunosuppressive drug therapy starting on or before Bladder Cancer Staging.
Active Tuberculosis diagnosis during the Bladder Cancer Staging.
Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease prior to Bladder Cancer Staging.
Patients who undergo cystectomy, chemotherapy or radiation within 6 months of Bladder Cancer Staging.
– APPLICATION WORKFLOW
For Denominator:
To record an encounter, navigate to Patient > Provider Note > Create Superbill. Under the ‘Procedure-CPTs’, enter the relevant encounter code.
eSuperbill for Encounter
The diagnosis of bladder cancer can be recorded via Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.
Example of Bladder Cancer for Urology Care Diagnosis
For documenting the cancer staging procedure and its result, head over to Patient > Provider Note > 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.
Tumor Staging Evaluation
Note: In order to be counted in the denominator, the result of the cancer staging should be one of the following:
Tis: Carcinoma in situ (flat tumor of urinary bladder)
Carcinoma in situ of bladder
For Numerator:
To prescribe BCG medication, navigate to Patient > Provider Note > Prescription. Here, click ‘Add’ and search for the relevant BCG medication. Fill out the details and once done, click ‘Prescribe’.
Example of BCG Medication for Urology Care
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 Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out the details and once done, click ‘Save’.
Example of Active Tuberculosis Diagnosis
To record the Cystectomy and Combined Radiotherapy procedure, navigate to Patient > Provider Note > 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’.
Example of Cystectomy Procedure
The immunosuppressive drugs and chemotherapy medication can be documented via Patient > Provider Note > Medications. Here, click ‘Add’ and search for the relevant medications. Fill out the details and once done, click ‘Save’.
