2016 PQRS – FOCUS ON MEASURES 405 AND 406

The purpose of this newsletter is to alert you that clarifications for measures 405 and 406 have been made to the 2016 PQRS Reminder List which was posted in the January 2016 Radiology Views™. Below you will find detailed information regarding both of these measures along with a revised 2016 PQRS Reminder List.

MEASURE 405

The intent of this measure is to ensure patients with incidental findings that are highly likely to be benign do not receive follow up imaging routinely.

This measure is titled “APPROPRIATE FOLLOW-UP IMAGING FOR INCIDENTAL ABDOMINAL LESIONS.”  The “key” word is “appropriate.” To further explain, when CT abdomen, CT abdomen/pelvis, MRI abdomen, Ultrasound abdomen or a retroperitoneal study is performed and the patient has one or more incidental findings of either a liver lesion < 0.5 cm or a cystic kidney lesion < 1.0 cm or an adrenal lesion < 1.0 cm, do not recommend follow-up imaging unless you determine it is appropriate to do so due to a medical reason such as a known malignancy that can metastasize or other medical reason(s).

In the event you determine it is appropriate to recommend follow-up imaging, and the patient has an incidental finding of either a liver lesion < 0.5 cm or a cystic kidney lesion < 1.0 cm or an adrenal lesion < 1.0 cm, document the reason as to why the additional imaging was medically necessary.  Simply stated, do not recommend follow-up imaging for these incidental findings alone but if the patient has another medical condition that warrants additional imaging, include the reason for the recommendation.

The revised documentation reminder for Measure 405 is “Do not recommend follow-up imaging for asymptomatic patients with incidental findings of liver lesion < 0.5cm, cystic kidney lesion <1.0 cm, or adrenal lesion < 1.0 cm alone”

MEASURE 406

This measure is titled “APPROPRIATE FOLLOW-UP IMAGING FOR INCIDENTAL THYROID NODULES IN PATIENTS.”  The “key” word is “appropriate.”  To further explain, when CT or CTA neck, CT thorax, CT cervical spine, MRI orbit, face or neck, MRI chest, or Ultrasound of the head and neck is performed and the patient has an incidental thyroid nodule < 1.0 cm, do not recommend follow-up imaging unless you determine it is appropriate to do so due to a medical reason such as, the patient has multiple endocrine neoplasia or the patient has cervical lymphadenopathy, or other medical reason(s).

In the event you determine it is appropriate to recommend follow-up imaging, and the patient has an incidental finding of a thyroid nodule < 1.0 cm, document the reason as to why the additional imaging was medically necessary.  Simply stated, do not recommend follow-up imaging for an incidental finding of a thyroid nodule < 1.0 cm but if the patient has another medical condition that warrants additional imaging, clearly state the reason for the recommendation.

The revised documentation reminder for Measure 406 is “Do not recommend follow-up imaging for an incidental finding of a thyroid nodule < 1.0 alone”

SUMMARY:

The intent of both of these measures is to ensure patients, with these specified incidental findings that are highly likely to be benign, do not receive follow-up imaging routinely.  But in the event you determine appropriate follow-up imaging is necessary due to other medical reasons, include this information in your documentation. These PQRS Reminder Lists are created to be used as a tool to help you remember what to report but are not intended to take the place of the full CMS reporting instructions.  For complete instructions regarding PQRS reporting, see CMS Physician Quality Reporting  System