CMS129v13 – 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.

– NUMERATOR

Patients who did not have a bone scan performed at any time since 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.

In essence, the criteria for denominator include the following:

• First prostate cancer treatment during the measurement period is not null
• Most Recent Prostate Cancer Staging Tumor Size T1a to T2a is not null
• Most recent PSA (Prostate Specific Antigen) Test Result is < 10 ng/mL
• Most Recent Gleason Score is 6 or less.

-DENOMINATOR EXCEPTION

Documentation of reason(s) for performing a bone scan. These reasons can include any of the following:

• Pain related to prostate cancer
• Salvage therapy
• Other medical reasons
• Bone scan ordered by someone other than reporting physician.

For Denominator:

• To record prostate cancer diagnosis, use the workflow Patient > Provider Notes > Diagnoses, and click ‘Add’. Search for the relevant diagnosis, fill out the details and click ‘Save’.

• Record the PSA test via Patient > Provider Note > Orders > Lab or Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the relevant test. Fill out the details and click ‘Save & Accept’ or ‘Sign & Accept’.

• The Gleason Score test can be documented Patient > Provider Note > Orders > Lab or through Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the relevant test and fill out the details. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• To document cancer treatment, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’ or ‘Sign & Accept’.

• To document the Cancer Staging procedure, use the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for the relevant evaluation. From the ‘Status’ dropdown, select ‘Performed’ and from the ‘Result’ dropdown, select the relevant result. Then click ‘Sign’ or ‘Save’.

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:

• To record diagnosis of pain related to prostate cancer, navigate to Patient > Provider Note > Diagnoses. Click ‘Add’. Search for a prostate cancer related pain diagnosis, add the diagnosis details, and click ‘Save’.

• To document Salvage Therapy, navigate to Patient > Provider Note > Orders > Procedures. Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’ or ‘Sign & Accept’.

• Documentation of bone scan study can be done via Patient > Provider Note > Radiology. Click ‘Add’ and search for relevant radiology order. Fill out the details and then click ‘Save & Accept’ or ‘Sign & Accept’.