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Synopsis of MIPS Measure 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-Up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines
Matthew B. Morgan, MD, MS
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KEY FACTS

  • Terminology

    TERMINOLOGY

    • Description

      • Percentage of final reports for CT studies with finding of incidental pulmonary nodule for patients aged 35+ years that contain impression or conclusion that includes recommended interval and modality for follow-up (e.g., type of imaging or biopsy) or for no follow-up and source of recommendations (e.g., guidelines, such as Fleischner Society, American Lung Association, American College of Chest Physicians)
    • Rationale

      • With increasing use of chest CT comes increase in frequency of incidental pulmonary nodule findings. Recent study found that, between 2006 and 2012, annual rate of pulmonary nodule identification in large, integrated health systems increased from 3.9 to 6.6 per 1,000 person-years. Authors estimated that > 1.5 million adult Americans will have pulmonary nodule identified each year (MacMahon et al., 2017). These incidental findings require appropriate management to avoid subjecting patients to unnecessary follow-up scans or conversely missing early malignancies. A number of factors contribute to appropriate management decisions for pulmonary nodules, based on estimations of individual risk of malignancy, including nodule size and morphology, as well as clinical risk factors. Despite evidence-based recommendations from groups such as Fleischner Society regarding management and follow-up of small pulmonary nodules detected incidentally, various studies have documented low rates of adherence. For example, MacMahon et al. found that 44.7% of patients received care inconsistent with Fleischner Society recommendations (17.8% overevaluation, 26.9% underevaluation). This measure aims to encourage use of evidence-based approach in recommending follow-up imaging for incidental pulmonary nodules.
    • Instructions

      • This measure is to be submitted each time procedure for CT with incidental pulmonary nodule is performed during performance period. There is no diagnosis associated with this measure. 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

      • Final reports that contain impression or conclusion that includes recommended interval and modality for follow-up (e.g., type of imaging or biopsy) or for no follow-up and source of recommendations (e.g., guidelines, such as Fleischner Society, American Lung Association, American College of Chest Physicians)
    • Denominator

      • All final reports for CT studies with finding of incidental pulmonary nodule for patients aged 35+ years

    Selected References

    1. MIPS Measure 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines. Centers for Medicare and Medicaid Services (CMS). 2021.
    2. MacMahon H et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Feb 23:161659.
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    Tables

    Tables

    KEY FACTS

    • Terminology

      TERMINOLOGY

      • Description

        • Percentage of final reports for CT studies with finding of incidental pulmonary nodule for patients aged 35+ years that contain impression or conclusion that includes recommended interval and modality for follow-up (e.g., type of imaging or biopsy) or for no follow-up and source of recommendations (e.g., guidelines, such as Fleischner Society, American Lung Association, American College of Chest Physicians)
      • Rationale

        • With increasing use of chest CT comes increase in frequency of incidental pulmonary nodule findings. Recent study found that, between 2006 and 2012, annual rate of pulmonary nodule identification in large, integrated health systems increased from 3.9 to 6.6 per 1,000 person-years. Authors estimated that > 1.5 million adult Americans will have pulmonary nodule identified each year (MacMahon et al., 2017). These incidental findings require appropriate management to avoid subjecting patients to unnecessary follow-up scans or conversely missing early malignancies. A number of factors contribute to appropriate management decisions for pulmonary nodules, based on estimations of individual risk of malignancy, including nodule size and morphology, as well as clinical risk factors. Despite evidence-based recommendations from groups such as Fleischner Society regarding management and follow-up of small pulmonary nodules detected incidentally, various studies have documented low rates of adherence. For example, MacMahon et al. found that 44.7% of patients received care inconsistent with Fleischner Society recommendations (17.8% overevaluation, 26.9% underevaluation). This measure aims to encourage use of evidence-based approach in recommending follow-up imaging for incidental pulmonary nodules.
      • Instructions

        • This measure is to be submitted each time procedure for CT with incidental pulmonary nodule is performed during performance period. There is no diagnosis associated with this measure. 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

        • Final reports that contain impression or conclusion that includes recommended interval and modality for follow-up (e.g., type of imaging or biopsy) or for no follow-up and source of recommendations (e.g., guidelines, such as Fleischner Society, American Lung Association, American College of Chest Physicians)
      • Denominator

        • All final reports for CT studies with finding of incidental pulmonary nodule for patients aged 35+ years

      Selected References

      1. MIPS Measure 364: Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines. Centers for Medicare and Medicaid Services (CMS). 2021.
      2. MacMahon H et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Feb 23:161659.