PQRS Information

Year: 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007

PQRS Measure

#264Sentinel Lymph Node Biopsy for Invasive Breast Cancer

This measure may be submitted via Registry only

The following codes apply for this PQRS measure:

Code	Modifier	POS	Description
CPT Codes
19301	N/A	N/A	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);
19302	N/A	N/A	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy
19307	N/A	N/A	Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle
38500	N/A	N/A	Biopsy or excision of lymph node(s); open, superficial
38510	N/A	N/A	Biopsy or excision of lymph node(s); open, deep cervical node(s)
38520	N/A	N/A	Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad
38525	N/A	N/A	Biopsy or excision of lymph node(s); open, deep axillary node(s)
38530	N/A	N/A	Biopsy or excision of lymph node(s); open, internal mammary node(s)
38542	N/A	N/A	Dissection, deep jugular node(s)
38740	N/A	N/A	Axillary lymphadenectomy; superficial
38745	N/A	N/A	Axillary lymphadenectomy; complete
38900	N/A	N/A	Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)
HCPCS Codes
Code	Modifier	POS	Description
G8879	N/A	N/A	Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
G8878	N/A	N/A	Sentinel lymph node biopsy procedure performed
G8880	N/A	N/A	Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)
G8882	N/A	N/A	Sentinel lymph node biopsy procedure not performed, reason not given
ICD9 Codes
Code	Modifier	POS	Description
174.0	N/A	N/A	Malignant neoplasm of nipple and areola of female breast
174.1	N/A	N/A	Malignant neoplasm of central portion of female breast
174.2	N/A	N/A	Malignant neoplasm of upper-inner quadrant of female breast
174.3	N/A	N/A	Malignant neoplasm of lower-inner quadrant of female breast
174.4	N/A	N/A	Malignant neoplasm of upper-outer quadrant of female breast
174.5	N/A	N/A	Malignant neoplasm of lower-outer quadrant of female breast
174.6	N/A	N/A	Malignant neoplasm of axillary tail of female breast
174.8	N/A	N/A	Malignant neoplasm of other specified sites of female breast
174.9	N/A	N/A	Malignant neoplasm of breast (female), unspecified
175.0	N/A	N/A	Malignant neoplasm of nipple and areola of male breast
175.9	N/A	N/A	Malignant neoplasm of other and unspecified sites of male breast
ICD10CM Codes
Code	Modifier	POS	Description
C50.011	N/A	N/A	Malignant neoplasm of nipple and areola, right female breast
C50.012	N/A	N/A	Malignant neoplasm of nipple and areola, left female breast
C50.019	N/A	N/A	Malignant neoplasm of nipple and areola, unspecified female breast
C50.021	N/A	N/A	Malignant neoplasm of nipple and areola, right male breast
C50.022	N/A	N/A	Malignant neoplasm of nipple and areola, left male breast
C50.029	N/A	N/A	Malignant neoplasm of nipple and areola, unspecified male breast
C50.111	N/A	N/A	Malignant neoplasm of central portion of right female breast
C50.112	N/A	N/A	Malignant neoplasm of central portion of left female breast
C50.119	N/A	N/A	Malignant neoplasm of central portion of unspecified female breast
C50.121	N/A	N/A	Malignant neoplasm of central portion of right male breast
C50.122	N/A	N/A	Malignant neoplasm of central portion of left male breast
C50.129	N/A	N/A	Malignant neoplasm of central portion of unspecified male breast
C50.211	N/A	N/A	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	N/A	N/A	Malignant neoplasm of upper-inner quadrant of left female breast
C50.219	N/A	N/A	Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.221	N/A	N/A	Malignant neoplasm of upper-inner quadrant of right male breast
C50.222	N/A	N/A	Malignant neoplasm of upper-inner quadrant of left male breast
C50.229	N/A	N/A	Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.311	N/A	N/A	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	N/A	N/A	Malignant neoplasm of lower-inner quadrant of left female breast
C50.319	N/A	N/A	Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.321	N/A	N/A	Malignant neoplasm of lower-inner quadrant of right male breast
C50.322	N/A	N/A	Malignant neoplasm of lower-inner quadrant of left male breast
C50.329	N/A	N/A	Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.411	N/A	N/A	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	N/A	N/A	Malignant neoplasm of upper-outer quadrant of left female breast
C50.419	N/A	N/A	Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.421	N/A	N/A	Malignant neoplasm of upper-outer quadrant of right male breast
C50.422	N/A	N/A	Malignant neoplasm of upper-outer quadrant of left male breast
C50.429	N/A	N/A	Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.511	N/A	N/A	Malignant neoplasm of lower-outer quadrant of right female breast
C50.512	N/A	N/A	Malignant neoplasm of lower-outer quadrant of left female breast
C50.519	N/A	N/A	Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.521	N/A	N/A	Malignant neoplasm of lower-outer quadrant of right male breast
C50.522	N/A	N/A	Malignant neoplasm of lower-outer quadrant of left male breast
C50.529	N/A	N/A	Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.611	N/A	N/A	Malignant neoplasm of axillary tail of right female breast
C50.612	N/A	N/A	Malignant neoplasm of axillary tail of left female breast
C50.619	N/A	N/A	Malignant neoplasm of axillary tail of unspecified female breast
C50.621	N/A	N/A	Malignant neoplasm of axillary tail of right male breast
C50.622	N/A	N/A	Malignant neoplasm of axillary tail of left male breast
C50.629	N/A	N/A	Malignant neoplasm of axillary tail of unspecified male breast
C50.811	N/A	N/A	Malignant neoplasm of overlapping sites of right female breast
C50.812	N/A	N/A	Malignant neoplasm of overlapping sites of left female breast
C50.819	N/A	N/A	Malignant neoplasm of overlapping sites of unspecified female breast
C50.821	N/A	N/A	Malignant neoplasm of overlapping sites of right male breast
C50.822	N/A	N/A	Malignant neoplasm of overlapping sites of left male breast
C50.829	N/A	N/A	Malignant neoplasm of overlapping sites of unspecified male breast
C50.911	N/A	N/A	Malignant neoplasm of unspecified site of right female breast
C50.912	N/A	N/A	Malignant neoplasm of unspecified site of left female breast
C50.919	N/A	N/A	Malignant neoplasm of unspecified site of unspecified female breast
C50.921	N/A	N/A	Malignant neoplasm of unspecified site of right male breast
C50.922	N/A	N/A	Malignant neoplasm of unspecified site of left male breast
C50.929	N/A	N/A	Malignant neoplasm of unspecified site of unspecified male breast

Legend:
ClaimThis measure can be submitted via claim. Use the 'Data Collection' pdf associated with the measure.
GroupThis measure can be submitted through one or more groups. Click on the group name to view the group information.
RegistryThis measure can be submitted through registry.
EHRThis measure can be submitted via Electronic Health Record (EHR).
GPRO/ACOThis measure can be submitted via Group Practice Reporting Option, or GPRO Web Interface.
SurveyThis measure can be submitted/collected via a Certified Survey Vendor.

More information on these alternative reporting mechanisms is available at:
http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp.

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PQRS Measure

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ICD9 Codes

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