CMS129v11 – Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

All patients, regardless of age, with a diagnosis of prostate cancer.

– DENOMINATOR

All patients, regardless of age, with a diagnosis of prostate cancer at low (or very low) risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy.

-DENOMINATOR EXCEPTION

Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician).

– NUMERATOR

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer.

For Denominator:

Patients with prostate cancer diagnosis and satisfying all the following conditions are included in the denominator for this measure:

To record prostate cancer diagnosis, use the workflow Patient > Provider Notes > Diagnoses, and click ‘Add’. Search for prostate cancer diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

• Patient is undergoing first prostate cancer treatment during the measurement period. To document cancer treatment, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’.

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. 

• Patient has cancer staging procedure performed before the start of the first prostate cancer treatment. To document the cancer staging procedure performed, use the workflow Patient > Clinical > Evaluations. Click ‘+ Evaluation’ and search for an intervention. From the ‘Status’ dropdown, select ‘Performed’ and from the ‘Result’ dropdown, select a result. Then click ‘Sign’ or ‘Save.

• Patient has a Gleason score less than 6. The Gleason score test should have been performed before the start of the first prostate cancer treatment. To perform a laboratory test, navigate to Patient > Clinical > Orders & Result > Labs to click on the ‘+ Add Order’ button.

Select a Laboratory and search for a Gleason score test. Once done, click on the ‘Save’ or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’.

Next, click on the ‘Mark as received’ button.

On the Lab result screen, add the observations and click on the ‘Save’ button.

Note:

Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

When a CPT code is added to a lab order, please ensure that the CPT code is present in the ‘Procedures’. 

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

• Patient has prostate specific antigen test performed before the cancer staging procedure. Also, the PSA test result should be less than 10 ng/mL. To perform a PSA test, navigate to Patient > Clinical > Orders & Result > Labs to click on the ‘+ Add Order’ button. Select a Laboratory and search for a Gleason score test. Once done, click on the ‘Save’ or hover over the ‘Sign’ button. If the user hovers over the ‘Sign’ button, then click ‘Queue’. Next, click on the ‘Mark as received’ button. On the Lab result screen, add the observations and click on the ‘Save’ button.

For Numerator:

Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer are included in the numerator.

For Denominator Exceptions:

Patients satisfying any of the following conditions are included in the denominator exception:

• Patient is experiencing pain related to prostate cancer after the diagnosis of a prostate cancer. To record diagnosis of pain related to prostate cancer, navigate to Patient > Provider Notes > Diagnosis and click ‘Add’. Search for a prostate cancer diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ and diagnosis is added to the provider note.

• Patient has a salvage therapy performed after the diagnosis of prostate cancer. To document cancer treatment, navigate to Patient > Provider Notes > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hovers over ‘Sign & Accept’, then click ‘Complete’.

• Patient has a bone scan study performed with a documented reason after the diagnosis of prostate cancer. To document the bone scan study performed, use the workflow Patient > Clinical > Evaluations. Click ‘+ Evaluation’ and search for an intervention. From the ‘Status’ dropdown, select ‘Performed’ and from the ‘Reason’ dropdown, select a reason. Then click ‘Sign’ or ‘Save.