Documentation of iron stores in patients with myelodysplastic syndrome (MDS) (Measure 68)

If patient has Myelodysplastic syndrome (ICD-9 diagnosis codes: 238.72, 238.73, 238.74, 238.75 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244 and 99245), recommend to calculate body’s iron stores before starting treatment with erythropoietin. To be effective erythropoietin requires that adequate iron stores be present due to iron’s importance in red-blood-cell synthesis. Iron deficiency presents a major limitation to the efficacy of erythropoietin therapy.

DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of MDS (myelodysplastic syndrome) who are receiving erythropoietin therapy with documentation of iron stores prior to initiating erythropoietin therapy GUIDELINE: If patient has Myelodysplastic syndrome, recommend to calculate body’s iron stores before starting treatment with erythropoietin. To be effective erythropoietin requires that adequate iron stores be present due to iron’s importance in red-blood-cell synthesis. Iron deficiency presents a major limitation to the efficacy of erythropoietin therapy.

Reference:

• NCCN Clinical practice guidelines in oncology. Myelodysplastic syndromes. V-2-2008 http://www.nccn.org/professionals/physician_gls/PDF/mds.pdf

• Goldberg H, Lusk E, Moore J, et al: Survey of exposure to genotoxic agents in primary myelodysplastic syndrome: correlation with chromosome patterns and data on patients without hematological disease. Cancer Res 1990 Nov 1; 50(21): 6876-81

• Westbrook, CA, Hsu, WT, Chyna, B, et al. Cytogenetic and molecular diagnosis of chromosome 5 deletions in myelodysplasia. Br J Haematol 2000; 110:847.
• Jacobs, RH, Cornbleet, MA, Vardiman, JW, et al. Prognostic implications of morphology and karyotype in primary myelodysplastic syndromes. Blood 1986; 67:1765.
• Rose, EH, Abels, RI, Nelson, RA, et al. The use of r-HuEpo in the treatment of anaemia related to myelodysplasia (MDS). Br J Haematol 1995; 89:831.

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Treatment of multiple myeloma with bisphosphonates (Measure 69)

If patient has multiple myeloma (ICD-9 diagnosis code: 203.00

AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244 and 99245) and has bone disease, including osteopenia recommend intravenous bisphosphonates monthly. Bisphosphonates can inhibit bone resorption by reducing the number and activity of osteoclasts and therefore could reduce pain and bone fractures in people with multiple myeloma.

DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of multiple myeloma, not in remission, who were prescribed or received intravenous bisphosphonate therapy within 12 months GUIDELINE If patient has multiple myeloma and has bone disease, including osteopenia recommend intravenous bisphosphonates monthly. Multiple myeloma is a disease characterized by bone destruction, in the form of diffuse osteopenia and/or osteolytic lesions, which develop in 85% of patients. Bisphosphonates can inhibit bone resorption by reducing the number and activity of osteoclasts and therefore could reduce pain and bone fractures in people with multiple myeloma

Reference:

• Kyle RA, Yee GC, Somerfield MR, Flynn PJ, Halabi S, Jagannath S, Orlowski RZ, Roodman DG, Twilde P, Anderson K. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol 2007 Jun 10;25(17):2464-72.
• Smith A, Wisloff F, Samson D, UK Myeloma Forum, Nordic Myeloma Study Group, British Committee for Standards in Haematology. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol 2006 Feb; 132(4):410-51.
• NCCN Clinical practice guidelines in oncology. Multiple myeloma. V.1.2008

http://www.nccn.org/professionals/physician_gls/PDF/myeloma.pdf

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217. Baseline Flow Cytometry in patients with CLL (Measure 70)

If patient has chronic Lymphocytic leukemia (ICD-9 diagnosis code: 204.10 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244 and 99245) recommend flow cytometric analysis. Due to the distinct pattern of protein antigens expressed in CLL, flow cytometry should be performed in order to confirm the diagnosis, correctly characterize the pathological cells, and determine prognosis. In some instances, flow cytometry may also offer additional therapeutically relevant information. Flow cytometric studies performed on patients with leukemic cell burden include kappa/lambda to assess clonality. Distinguishing CLL/SLL from mantle cell lymphoma is essential

DESCRIPTION: Percentage of patients aged 18 years and older with a diagnosis of Chronic Lymphocytic Leukemia (CLL) who had baseline flow cytometry studies performed GUIDELINE: If patient has chronic Lymphocytic leukemia, recommend flow cytometric analysis. Due to the distinct pattern of protein antigens expressed in CLL, flow cytometry should be performed in order to confirm the diagnosis, correctly characterize the pathological cells, and determine prognosis. In some instances, flow cytometry may also offer additional therapeutically relevant information. Flow cytometric studies performed on patients with leukemic cell burden include kappa/lambda to assess clonality. Distinguishing CLL/SLL from mantle cell lymphoma is essential.

Reference

· Chronic lymphocytic leukemia: Recommendations for diagnosis, staging, and response criteria. International Workshop on Chronic Lymphocytic Leukemia. Ann Intern Med 1989; 110:236.

· Rai KR, Sawitsky A, Cronkite EP: Clinical staging of chronic lymphocytic leukemia. Blood 1975 Aug; 46(2): 219-34

· Zwiebel JA, Cheson BD: Chronic lymphocytic leukemia: staging and prognostic factors. Semin Oncol 1998 Feb; 25(1): 42-59

· National Cancer Institute. Chronic Lymphocytic Leukemia (PDQ®) Treatment: General Information. Retrieved on 2007-09-04.

· Chiorazzi N, Rai KR, Ferrarini M (2005). "Chronic lymphocytic leukemia". N. Engl. J. Med. 352 (8): 804-15.

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Treatment of stage IC-III, ER/PR positive breast cancer with hormonal therapy (Measure 71)

If a female has stage 1c – III breast cancer (ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255) and tumor is positive for estrogen /progesterone receptors, recommend hormonal therapy. Based on results from multiple large randomized trials, adjuvant therapy for women with hormone receptor-positive breast cancer should include hormonal therapy in order to lower the risk of tumor recurrence.

DESCRIPTION: Percentage of Stage IC-III, estrogen receptor (ER) or progesterone receptor (PR) positive, female breast cancer patients aged 18 years and older who are receiving tamoxifen or aromatase inhibitor (AI) at the time of the visit GUIDELINE: If a female has stage 1c – III breast cancer and tumor is positive for estrogen /progesterone receptors (ER/PR), recommend hormonal therapy. Based on results from multiple large randomized trials, adjuvant therapy for women with hormone receptor-positive breast cancer should include hormonal therapy in order to lower the risk of tumor recurrence.

References:

• American Society of Clinical Oncology, Use of Aromatase Inhibitors As Adjuvant Therapy for Postmenopausal Women With Hormone Receptor-Positive Breast Cancer

http://www.asco.org/portal/site/ASCO/menuitem.c543a013502b2a89de912310320041a0/?vgnextoid=e64ef314170d8010VgnVCM100000ed730ad1RCRD&vgnextfmt=default

• National Comprehensive Cancer Network Breast Cancer guideline recommendations for stage ICIII, ER/PR positive cancer: BINV-G, BINV-5, BINV-6, BINV-9.

http://www.nccn.org/professionals/physician_gls/default.asp

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Treatment of stage III ca colon with chemotherapy (Measure 72)

If patient has stage III ca colon (ICD-9 diagnosis codes: 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255), recommend adjuvant chemotherapy. Direct evidence from randomized controlled trials supports the use of adjuvant chemotherapy for patients with stage III colon cancer.

DESCRIPTION: Percentage of stage III colon cancer patients aged 18 through 80 years who were prescribed chemotherapy GUIDELINE If patient has stage III ca colon, recommend adjuvant chemotherapy. Direct evidence from randomized controlled trials supports the use of adjuvant chemotherapy for patients with stage III colon cancer.

References

• National Comprehensive Cancer Network Colon Cancer guideline recommendations for stage III cancer: COL-4.

http://www.nccn.org/professionals/physician_gls/default.asp

• Otchy D, Hyman NH, Simmang C, Anthony T, Buie WD, Cataldo P, Church J, Cohen J, Dentsman F, Ellis CN, Kilkenny JW 3rd, Ko C, Moore R, Orsay C, Place R, Rafferty J, Rakinic J, Savoca P, Tjandra J, Whiteford M. Practice parameters for colon cancer. Dis Colon Rectum 2004 Aug; 47(8):1269-84.

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220. Plan for chemotherapy in cancer treatment (Measure 73)

If patient has cancer (ICD-9 diagnosis codes: 140.0, 140.1, 140.3, 140.4, 140.5, 140.6, 140.8, 140.9, 141.0, 141.1, 141.2, 141.3, 141.4, 141.5, 141.6, 141.8, 141.9, 142.0, 142.1, 142.2, 142.8, 142.9, 143.0, 143.1, 143.8, 143.9, 144.0, 144.1, 144.8, 144.9, 145.0, 145.1, 145.2, 145.3, 145.4, 145.5, 145.6, 145.8, 145.9, 146.0, 146.1, 146.2, 146.3, 146.4, 146.5, 146.6, 146.7, 146.8, 146.9, 147.0, 147.1, 147.2, 147.3, 147.8, 147.9, 148.0, 148.1, 148.2, 148.3, 148.8, 148.9, 149.0, 149.1, 149.8, 149.9, 150.0, 150.1, 150.2, 150.3, 150.4, 150.5, 150.8, 150.9, 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9, 152.0, 152.1, 152.2, 152.3, 152.8, 152.9, 153.0, 153.1, 153.2, 153.3, 153.4, 153.5, 153.6, 153.7, 153.8, 153.9, 154.0, 154.1, 154.2, 154.3, 154.8, 155.0, 155.1, 155.2, 156.0, 156.1, 156.2, 156.8, 156.9, 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9, 158.0, 158.8, 158.9, 159.0, 159.1, 159.8, 159.9, 160.0, 160.1, 160.2, 160.3, 160.4, 160.5, 160.8, 160.9, 161.0, 161.1, 161.2, 161.3, 161.8, 161.9, 162.0, 162.2, 162.3, 162.4, 162.5, 162.8, 162.9, 163.0, 163.1, 163.8, 163.9, 164.0, 164.1, 164.2, 164.3, 164.8, 164.9, 165.0, 165.8, 165.9, 170.0, 170.1, 170.2, 170.3, 170.4, 170.5, 170.6, 170.7, 170.8, 170.9, 171.0, 171.2, 171.3, 171.4, 171.5, 171.6, 171.7, 171.8, 171.9, 172.0, 172.1, 172.2, 172.3, 172.4, 172.5, 172.6, 172.7, 172.8, 172.9, 173.0, 173.1, 173.2, 173.3, 173.4, 173.5, 173.6, 173.7, 173.8, 173.9, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 175.0, 175.9, 176.0, 176.1, 176.2, 176.3, 176.4, 176.5, 176.8, 176.9, 179, 180.0, 180.1, 180.8, 180.9, 181, 182.0, 182.1, 182.8, 183.0, 183.2, 183.3, 183.4, 183.5, 183.8, 183.9, 184.0, 184.1, 184.2, 184.3, 184.4, 184.8, 184.9, 185, 186.0, 186.9, 187.1, 187.2, 187.3, 187.4, 187.5, 187.6, 187.7, 187.8, 187.9, 188.0, 188.1, 188.2, 188.3, 188.4, 188.5, 188.6, 188.7, 188.8, 188.9, 189.0, 189.1, 189.2, 189.3, 189.4, 189.8, 189.9, 190.0, 190.1, 190.2, 190.3, 190.4, 190.5, 190.6, 190.7, 190.8, 190.9, 191.0, 191.1, 191.2, 191.3, 191.4, 191.5, 191.6, 191.7, 191.8, 191.9, 192.0, 192.1, 192.2, 192.3, 192.8, 192.9, 193, 194.0, 194.1, 194.3, 194.4, 194.5, 194.6, 194.8, 194.9, 195.0, 195.1, 195.2, 195.3, 195.4, 195.5, 195.8, 196.0, 196.1, 196.2, 196.3, 196.5, 196.6, 196.8, 196.9, 197.0, 197.1, 197.2, 197.3, 197.4, 197.5, 197.6, 197.7, 197.8, 198.0, 198.1, 198.2, 198.3, 198.4, 198.5, 198.6, 198.7, 198.81, 198.82, 198.89, 199.0, 199.1, 200.00, 200.01, 200.02, 200.03, 200.04, 200.05, 200.06, 200.07, 200.08, 200.10, 200.11, 200.12, 200.13, 200.14, 200.15, 200.16, 200.17, 200.18, 200.20, 200.21, 200.22, 200.23, 200.24, 200.25, 200.26, 200.27, 200.28, 200.80, 200.81, 200.82, 200.83, 200.84, 200.85, 200.86, 200.87, 200.88, 201.00, 201.01, 201.02, 201.03, 201.04, 201.05, 201.06, 201.07, 201.08, 201.10, 201.11, 201.12, 201.13, 201.14, 201.15, 201.16, 201.17, 201.18, 201.20, 201.21, 201.22, 201.23, 201.24, 201.25, 201.26, 201.27, 201.28, 201.40, 201.41, 201.42, 201.43, 201.44, 201.45, 201.46,201.47, 201.48, 201.50, 201.51, 201.52, 201.53, 201.54, 201.55, 201.56, 201.57, 201.58, 201.60, 201.61, 201.62, 201.63, 201.64, 201.65, 201.66, 201.67, 201.68, 201.70, 201.71, 201.72, 201.73, 201.74, 201.75, 201.76, 201.77, 201.78, 201.90, 201.91, 201.92, 201.93, 201.94, 201.95, 201.96, 201.97, 201.98, 202.00, 202.01, 202.02, 202.03, 202.04, 202.05, 202.06, 202.07, 202.08, 202.10, 202.11, 202.12, 202.13, 202.14, 202.15, 202.16, 202.17, 202.18, 202.20, 202.21, 202.22, 202.23, 202.24, 202.25, 202.26, 202.27, 202.28, 202.30, 202.31, 202.32, 202.33, 202.34, 202.35, 202.36, 202.37, 202.38, 202.40, 202.41, 202.42, 202.43, 202.44, 202.45, 202.46, 202.47, 202.48, 202.50, 202.51, 202.52, 202.53, 202.54, 202.55, 202.56, 202.57, 202.58, 202.60, 202.61, 202.62, 202.63, 202.64, 202.65, 202.66, 202.67, 202.68, 202.80, 202.81, 202.82, 202.83, 202.84, 202.85, 202.86, 202.87, 202.88, 202.90, 202.91, 202.92, 202.93, 202.94, 202.95, 202.96, 202.97, 202.98, 203.00, 203.01, 203.10, 203.11, 203.80, 203.81, 204.00, 204.01, 204.10, 204.11, 204.20, 204.21, 204.80, 204.81, 204.90, 204.91, 205.00, 205.01, 205.10, 205.11, 205.20, 205.21, 205.30, 205.31, 205.80, 205.81, 205.90, 205.91, 206.00, 206.01, 206.10, 206.11, 206.20, 206.21, 206.80, 206.81, 206.90, 206.91, 207.00, 207.01, 207.10, 207.11, 207.20, 207.21, 207.80, 207.81, 208.00, 208.01, 208.10, 208.11, 208.20, 208.21, 208.80, 208.81, 208.90, 208.91, 210.0, 210.1, 210.2, 210.3, 210.4, 210.5, 210.6, 210.7, 210.8, 210.9, 211.0, 211.1, 211.2, 211.3, 211.4, 211.5, 211.6, 211.7, 211.8, 211.9, 212.0, 212.1, 212.2, 212.3, 212.4, 212.5, 212.6, 212.7, 212.8, 212.9, 213.0, 213.1, 213.2, 213.3, 213.4, 213.5, 213.6, 213.7, 213.8, 213.9, 214.0, 214.1, 214.2, 214.3, 214.4, 214.8, 214.9, 215.0, 215.2, 215.3, 215.4, 215.5, 215.6, 215.7, 215.8, 215.9, 216.0, 216.1, 216.2, 216.3, 216.4, 216.5, 216.6, 216.7, 216.8, 216.9, 217, 218.0, 218.1, 218.2, 218.9, 219.0, 219.1, 219.8, 219.9, 220, 221.0, 221.1, 221.2, 221.8, 221.9, 222.0, 222.1, 222.2, 222.3, 222.4, 222.8, 222.9, 223.0, 223.1, 223.2, 223.3, 223.81, 223.89, 223.9, 224.0, 224.1, 224.2, 224.3, 224.4, 224.5, 224.6, 224.7, 224.8, 224.9, 225.0, 225.1, 225.2, 225.3, 225.4, 225.8, 225.9, 226, 227.0, 227.1, 227.3, 227.4, 227.5, 227.6, 227.8, 227.9, 228.00, 228.01, 228.02, 228.03, 228.04, 228.09, 228.1, 229.0, 229.8, 229.9, 230.0, 230.1, 230.2, 230.3, 230.4, 230.5, 230.6, 230.7, 230.8, 230.9, 231.0, 231.1, 231.2, 231.8, 231.9, 232.0, 232.1, 232.2, 232.3, 232.4, 232.5, 232.6, 232.7, 232.8, 232.9, 233.0, 233.1, 233.2, 233.3, 233.4, 233.5, 233.6, 233.7, 233.9, 234.0, 234.8, 234.9, 235.0, 235.1, 235.2, 235.3, 235.4, 235.5, 235.6, 235.7, 235.8, 235.9, 236.0, 236.1, 236.2, 236.3, 236.4, 236.5, 236.6, 236.7, 236.90, 236.91, 236.99, 237.0, 237.1, 237.2, 237.3, 237.4, 237.5, 237.6, 237.70, 237.71, 237.72, 237.9, 238.0, 238.1, 238.2, 238.3, 238.4, 238.5, 238.6, 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, 238.79, 238.8, 238.9, 239.0, 239.1, 239.2, 239.3, 239.4, 239.5, 239.6, 239.7, 239.8, 239.9 AND CPT procedure codes: 96401, 96402, 96405, 96406, 96409, 96411, 96413, 96415, 96416, 96417, 96420, 96422, 96423, 96425, 96440, 96445, 96450, 96521, 96522, 96523, 96542, 96549 AND CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255) for which chemotherapy is required, recommend making and documenting a plan for the amount of chemotherapy to be given including doses and time intervals. A documented plan for chemotherapy treatment is important for promoting adherence to evidence based care, improving safety, and enhancing coordination among providers.

DESCRIPTION: Percentage of cancer patients for whom a plan for the amount of chemotherapy to be given was documented before the chemotherapy was administered GUIDELINE If patient has cancer for which chemotherapy is required, recommend making and documenting a plan for the amount of chemotherapy to be given including doses and time intervals. A documented plan for chemotherapy treatment is important for promoting adherence to evidence based care, improving safety, and enhancing coordination among providers.

References:

• NICCQ: Malin JL SE, Epstein AM, Adams J, Emanuel EJ, Kahn, K: Results of the National Initiative for Cancer Care Quality: How can we improve the quality of cancer care in the United States. J Clin Oncol 24:626-634, 2006

http://www.jco.org/cgi/content/abstract/24/4/626

• Breast cancer: chemotherapy treatment plan documented 63% overall, range 44-78% across 5 MSAs

• Colon cancer: chemotherapy treatment plan documented 53% overall, range 50-71% across 5 MSAs

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221. Treatment Post operative radiotherapy after breast conserving surgery for ca breast (Measure 74)

If patient had ca breast and has undergone breast conserving surgery (ICD-9 diagnosis codes: 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9 AND CPT E/M service codes: 99241, 99242, 99243, 99244 and 99245), recommend post operative radiation therapy. Data from multiple large randomized trials have demonstrated that the addition of radiation after breast conserving surgery in patients with invasive breast cancer lowers the risk of local recurrence. The Oxford meta-analysis of these studies has also detected an improvement in overall survival with the use of radiation therapy in this setting.

DESCRIPTION: Percentage of invasive female breast cancer patients aged 18 through 70 years old who have undergone breast conserving surgery and who have received recommendation for radiation therapy within 12 months of the first office visit GUIDELINE If patient had ca breast and has undergone breast conserving surgery, recommend post operative radiation therapy. Data from multiple large randomized trials have demonstrated that the addition of radiation after breast conserving surgery in patients with invasive breast cancer lowers the risk of local recurrence. The Oxford meta-analysis of these studies has also detected an improvement in overall survival with the use of radiation therapy in this setting.

References:

• National Comprehensive Cancer Network Breast Cancer guideline recommendations v2.2007, BINV-2. http://www.nccn.org/patients/patient_gls/_english/_breast/1_introduction.asp

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