Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
NQF Endorsement Status Endorsed
NQF ID 2038
Measure Type Process
Measure Content Last Updated 2021-06-30
Info As Of Not Available
Properties
Description Percentage of patients undergoing hysterectomy for the indication of pelvic organ prolapse in which a concomitant vaginal apical suspension (aka a colpopexy) is performed. This would include uterosacral ligament suspension, sacrospinous ligament or iliococcygeus suspension or sacral colpopexy.
Numerator Procedures identified by Registry entry and/or by submission of CPT codes as below: 57280 Colpopexy, abdominal approach 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex)
Denominator The number of patients undergoing hysterectomy for pelvic organ prolapse. Hysterectomy (identified by CPT codes) performed for the indication of pelvic organ prolapse (identified by supporting ICD9/ICD10 codes) The prolapse codes for ICD9 -> ICD-10 are detailed below, respectively: 618.01 -> N81.10, Cystocele, midline 618.02 -> N81.12, Cystocele, lateral 618.03 -> N81.0, Urethrocele 618.04 -> N81.6, Rectocele 618.05 -> N81.81, Perineocele 618.2 -> N81.2, Incomplete uterovaginal prolapse 618.3 -> N81.3, Complete uterovaginal prolapse
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 1
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
618.4 -> N81.4, Uterovaginal prolapse, unspecified 618.6 -> N81.5, Vaginal enterocele 618.7 -> N81.89, Old laceration of muscles of pelvic floor 618.81 -> N81.82, incompetence or weakening of pubocervical tissue 618.82 -> N81.83, incompetence or weakening of rectovaginal tissue 618.83 -> N81.84, pelvic muscle wasting CPT codes for hysterectomy are: 57530 Trachelectomy 58150 Total Abdominal Hysterectomy (Corpus and Cervix), w/ or w/out Removal of Tube(s), w/ or w/out Removal of Ovary(s) 58152 Total Abdominal Hysterectomy (Corpus and Cervix), w/ or w/out Removal of Tube(s), w/ or w/out Removal of Ovary(s), with Colpo- Urethrocystopexy (e.g. Marshall-Marchetti-Krantz, Burch) 58180 Supracervical Abdominal Hysterectomy (Subtotal Hysterectomy), w/ or w/out Removal of Tube(s), w/ or w/out Removal of Ovary(s) 58260 Vaginal Hysterectomy, for Uterus 250 G or Less 58262 Vaginal Hysterectomy, for Uterus 250 G or Less, with Removal of Tube(s), and/or Ovary(s) 58263 Vaginal Hysterectomy, for Uterus 250 G or Less, with Removal of Tube(s), and/or Ovary(s), with Repair of Enterocele 58267 Vaginal Hysterectomy, for Uterus 250 G or Less, with Colpo- Urethrocystopexy (Marshall-Marchetti-Krantz Type, Pereyra Type), w/ or w/out Endoscopic Control 58270 Vaginal Hysterectomy, for Uterus 250 G or Less, with Repair of Enterocele 58275 Vaginal Hysterectomy, with Total or Partial Vaginectomy 58280 Vaginal Hysterectomy, with Total or Partial Vaginectomy, with Repair of Enterocele 58290 Vaginal Hysterectomy, for Uterus Greater than 250 G 58291 Vaginal Hysterectomy, for Uterus Greater than 250 G, with Removal of Tube(s) and/or Ovary(s) 58292 Vaginal Hysterectomy, for Uterus Greater than 250 G, with Removal of Tube(s) and/or Ovary(s), with Repair of Enterocele 58293 Vaginal Hysterectomy, for Uterus Greater than 250 G, with Colpo- Urethrocystopexy (Marshall-Marchetti-Krantz Type, Pereyra Type) 58294 Vaginal Hysterectomy, for Uterus Greater than 250 G, with Repair of Enterocele
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 2
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
58541 Laparoscopy, Surgical, Supracervical Hysterectomy, for Uterus 250 G or Less 58542 Laparoscopy, Surgical, Supracervical Hysterectomy, for Uterus 250 G or Less, with Removal of Tube(s) and/or Ovary(s) 58543 Laparoscopy, Surgical, Supracervical Hysterectomy, for Uterus Greater than 250 G 58544 Laparoscopy, Surgical, Supracervical Hysterectomy, for Uterus Greater than 250 G, with Removal of Tube(s) and/or Ovary(s) 58550 Laparoscopy, Surgical, with Vaginal Hysterectomy, for Uterus 250 G or Less 58552 Laparoscopy, Surgical, with Vaginal Hysterectomy, for Uterus 250 G or Less, with Removal of Tube(s) and/or Ovary(s) 58553 Laparoscopy, Surgical, with Vaginal Hysterectomy, for Uterus Greater than 250 G 58554 Laparoscopy, Surgical, with Vaginal Hysterectomy, for Uterus Greater than 250 G, with Removal of Tube(s) and/or Ovary(s) 58570 Laparoscopy, Surgical, with Total Hysterectomy, for Uterus 250 G or Less 58571 Laparoscopy, Surgical, with Total Hysterectomy, for Uterus 250 G or Less, with Removal of Tube(s) and/or Ovary(s) 58572 Laparoscopy, Surgical, with Total Hysterectomy, for Uterus Greater than 250 G 58573 Laparoscopy, Surgical, with Total Hysterectomy, for Uterus Greater than 250 G, with Removal of Tube(s) and/or Ovary(s)
Denominator Exclusions Patients undergoing a concurrent obliterative procedure (colpocleisis)
Rationale Hysterectomy for prolapse and the omission of appropriate prolapse repairs are risk factors for reoperation of prolapse. Performing a hysterectomy for the diagnosis of prolapse presumes uterine prolapse. Implementing this measure would lead to more specific attention focused on suspension of the apical compartment resulting in improved durability of the repair and less recurrent prolapse. The incidence of reoperation within 10 years of surgery is 7.4 % when vaginal hysterectomy is done alone for prolapse and just 2% when concomitant pelvic floor repairs are undertaken at the time of hysterectomy. The long recognized importance of apical vaginal support has also recently been quantified in mechanistic studies. Support of the vaginal apex eliminates
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 3
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
anterior vaginal wall laxity in 63% of women with Stage 3 or 4 apical prolapse. Mechanistic analyses reveal that >70% of anterior wall prolapse is accounted for by loss of uterine or apical vaginal prolapse. A gap in care exists according to several sources. Despite a guideline recommendation from the American Congress of Obstetrics and Gynecology that a colpopexy (surgery to appropriately support the apical vagina) be performed at the time of hysterectomy for prolapse, an analysis of discharge data from 343 California hospitals between 2002 and 2006 revealed that only 35% of women have a concurrent colpopexy at the time of hysterectomy. Better rates of compliance with the recommended guideline were found among teaching institutions while those hospitals receiving primarily Medicaid reimbursement had the lowest rates of compliance with the guideline. In a recent study we found that 75.2% (480/638) of patients underwent a colpopexy and that 85% of high volume surgeons performed a colpopexy at the time of hysterectomy for pelvic organ prolapse while low volume surgeons performed this procedure only 61% of the time (p<.001).
Evidence Not Available
Developer/Steward
Steward American Urogynecologic Society
Contact Not Available
Measure Developer Not specified
Development Stage Not Available
Characteristics
Measure Type Process
Meaningful Measure Area Not Available
Healthcare Priority Promoting the most effective Prevention and Treatment Practices for the Leading Causes of Mortality
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 4
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ eCQM Spec Available Not Available
NQF Endorsement Status Endorsed
NQF ID 2038
Last NQF Update 2015-09-03
Target Population Age Not specified
Target Population Age (High) Not Available
Target Population Age (Low) Not Available
Reporting Level Not Available
Conditions Pelvic Organ Prolapse
Subconditions Not Available
Care Settings Not Available
Groups
Core Measure Set Not Available
Measure Links
Measure Program: Physician Value-Based Payment Modifier
Info As Of Not Available
Program / Model Notes
Data Sources Claims Data; Paper Medical Records; Electronic Health Record; Registries
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 5
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID S-2038
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Measure Program: Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 6
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Info As Of Not Available
Program / Model Notes
Data Sources Paper Medical Records; Claims Data; Registries; Electronic Health Record
Purposes Not Available
Quality Domain Not specified
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID S-2038
Milestone: Reference
Effective Date 1900-01-01
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 7
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Comments Not Available
Measure Program: Medicare Shared Savings Program
Info As Of Not Available
Program / Model Notes
Data Sources Electronic Health Record; Paper Medical Records; Registries; Claims Data
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/about
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID S-2038
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 8
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Measure Program: Medicare Physician Quality Reporting System
Info As Of Not Available
Program / Model Notes
Data Sources Electronic Health Record; Paper Medical Records; Registries; Claims Data
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links
Milestones
Milestone: Declined
Effective Date 2014-12-01
Comments Not Available
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 9
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Other Data Name Value
MUC ID S-2038
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Measure Program: Physician Compare
Info As Of Not Available
Program / Model Notes
Data Sources Claims Data; EHR; Registries; Paper Medical Records
Purposes Not Available
Quality Domain Not Available
Reporting Frequency Not Available
Impacts Payment Not Available
Reporting Status Inactive
Data Reporting Begin Date Not Available
Data Reporting End Date 2014-12-01
Measure Program Links https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Compare-DAC
Milestones
Milestone: Declined
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 10
Performing vaginal apical suspension at the time of hysterectomy to address pelvic organ
Effective Date 2014-12-01
Comments Not Available
Other Data Name Value
MUC ID S-2038
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Report Generated: Wed Sep 29 23:32:31 EDT 2021 | Page 11