Brief Description of Measure:

​CMS157: Oncology: Medical and Radiation - Pain Intensity Quantified:
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified

Description of Issue:

​​Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face or telehealth encounter date. The measure steward has provided guidance within the header that a lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face or telehealth encounter, which is required to assess the numerator. However, this lookback period is not reflected in the logic, as it is only applicable to CPT code 77427.

Proposed Solution:

​​Based on the feedback and requests we received from measure implementers to add the lookback period in the measure logic, the measure steward proposes to add a 'union' clause to the CQL definition 'Numerator 2'. The data element  for the 'union' clause will using a direct reference code for CPT 77427. This proposed change will incorporate the lookback period noted in the measure guidance.

CURRENT:
Numerator 2
"Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationTherapy
  with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed
    such that Global."NormalizeInterval" ( PainAssessed.relevantDatetime, PainAssessed.relevantPeriod ) during Global."NormalizeInterval" ( RadiationTherapy.relevantDatetime, RadiationTherapy.relevantPeriod )
      and PainAssessed.result is not null
 
PROPOSED:
Numerator 2
("Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationTherapy
  with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed
    such that Global."NormalizeInterval" ( PainAssessed.relevantDatetime, PainAssessed.relevantPeriod ) during Global."NormalizeInterval" ( RadiationTherapy.relevantDatetime, RadiationTherapy.relevantPeriod )
      and PainAssessed.result is not null)
union ( ["Procedure, Performed": "Radiation treatment management, 5 treatments"] RadiationTreatment
      with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed
        such that Global."NormalizeInterval" ( PainAssessed.relevantDatetime, PainAssessed.relevantPeriod ) 6 days or less on or before day of start of Global."NormalizeInterval" ( RadiationTreatment.relevantDatetime, RadiationTreatment.relevantPeriod )
          and PainAssessed.result is not null
      where Global."NormalizeInterval" ( RadiationTreatment.relevantDatetime, RadiationTreatment.relevantPeriod ) during "Measurement Period" )

Rationale for Change:

​​The proposed change incorporating the lookback period in the measure logic will assist measure implementers in measure calculation in instances when CPT code 77427 is used or reported.