Brief description of measure CMS646: Intravesical Bacillus-Calmette-Guerin for non-muscle invasive bladder cancer: 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. Description of issue ​The denominator exclusion language in the header does not clearly describe the logic and timing. The measure developer would like to reduce confusion by implementers and provide additional language. Goal of review Obtain clinical feedback

Proposed solution Current language: Denominator Exclusions: Immunosuppressed patients, includes HIV and immunocompromised state. Immunosuppressive drug therapy. Active Tuberculosis. Mixed histology urothelial cell carcinoma including micropapillary, plasmacytoid, sarcomatoid, adenocarcinoma and squamous disease. Patients who undergo cystectomy, chemotherapy or radiation within 6 months of Bladder Cancer Staging.  Proposed language: 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 that overlaps 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.  Rationale for change ​​This change will align the denominator exclusion language with the existing logic and timing.