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Synopsis: Biopsy Follow-Up (MIPS Measure 265)
Matthew B. Morgan, MD, MS
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KEY FACTS

  • Terminology

    TERMINOLOGY

    • Description

      • Percentage of new patients whose biopsy results have been reviewed and communicated to primary care/referring physician and patient
    • Rationale

      • Purpose of this measure is to ensure that biopsy results with potentially serious consequences for patient care are not lost or ignored. Large health plan/delivery systems have identified prominent quality-of-care issue as involving missing or overlooked biopsy pathology reports. All biopsy results should be accounted for and results communicated to patient or patient's guardian/caregiver and to patient's primary care physician &/or other physician/professional responsible for follow-up care. Failure of medical team to take appropriate action based on biopsy result may lead to significant delays in obtaining appropriate treatment with subsequent poor outcomes, complications, and even death. This measure will facilitate physician quality assurance that all biopsies are read and recorded and results communicated.
    • Instructions

      • This measure is to be submitted once per performance period for patients who are seen for office visit and have biopsy performed during performance period. This measure may be submitted by Merit-Based Incentive Payment System (MIPS)-eligible clinicians who perform quality actions described in measure based on services provided and measure-specific denominator coding.
    • Numerator

      • Patients whose biopsy results have been reviewed and communicated to primary care/referring physician and patient by provider &/or office and medical team. There must also be acknowledgment &/or documentation of communication in biopsy tracking log and document in patient's medical record.
    • Denominator

      • All patients undergoing biopsy

    Selected References

    1. MIPS Measure 265: Biopsy Follow-Up. Centers for Medicare and Medicaid Services (CMS). 2021.
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    References
    Tables

    Tables

    KEY FACTS

    • Terminology

      TERMINOLOGY

      • Description

        • Percentage of new patients whose biopsy results have been reviewed and communicated to primary care/referring physician and patient
      • Rationale

        • Purpose of this measure is to ensure that biopsy results with potentially serious consequences for patient care are not lost or ignored. Large health plan/delivery systems have identified prominent quality-of-care issue as involving missing or overlooked biopsy pathology reports. All biopsy results should be accounted for and results communicated to patient or patient's guardian/caregiver and to patient's primary care physician &/or other physician/professional responsible for follow-up care. Failure of medical team to take appropriate action based on biopsy result may lead to significant delays in obtaining appropriate treatment with subsequent poor outcomes, complications, and even death. This measure will facilitate physician quality assurance that all biopsies are read and recorded and results communicated.
      • Instructions

        • This measure is to be submitted once per performance period for patients who are seen for office visit and have biopsy performed during performance period. This measure may be submitted by Merit-Based Incentive Payment System (MIPS)-eligible clinicians who perform quality actions described in measure based on services provided and measure-specific denominator coding.
      • Numerator

        • Patients whose biopsy results have been reviewed and communicated to primary care/referring physician and patient by provider &/or office and medical team. There must also be acknowledgment &/or documentation of communication in biopsy tracking log and document in patient's medical record.
      • Denominator

        • All patients undergoing biopsy

      Selected References

      1. MIPS Measure 265: Biopsy Follow-Up. Centers for Medicare and Medicaid Services (CMS). 2021.