Barrett’s Esophagus

Measure Specification

Endoscopy is the technique of choice used to identify suspected Barrett’s esophagus and to diagnose complications of GERD. Biopsy must be added to confirm the presence of Barrett’s epithelium and to evaluate for dysplasia. There is a rapidly rising incidence of adenocarcinoma of the esophagus in the United States. A diagnosis of Barrett’s esophagus increases a patient’s risk for esophageal adenocarcinoma by 30 to 125 times that of people without Barrett’s esophagus (although this risk is still small 0.

4% to 0.5% per year). Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective. A diagnosis of Barrett’s esophagus could allow for appropriate screening of at risk patients as recommended by the American College of Gastroenterology. Standard endoscopy with biopsy currently is the most reliable means of establishing a diagnosis of Barrett’s esophagus.

The definitive diagnosis of Barrett’s esophagus requires a pathologist’s review of an esophageal biopsy. Dysplasia is the first step in the neoplastic process, and information about dysplasia is crucial for clinical decision-making directing therapy. The presence and grade of dysplasia cannot be determined by routine endoscopy, and pathologist’s review of a biopsy is essential for recognition of dysplasia, especially given that there are no recommended biomarkers for Barrett’s esophagus.

Endoscopic surveillance detects curable neoplasia in patients with Barrett’s esophagus.

The diagnosis of Barrett’s esophagus requires systematic biopsy of the abnormal-appearing esophageal mucosa to document intestinal metaplasia and to detect dysplasia (ACG, 2022).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this procedure measure is submitted each time a procedure is performed during the performance period. Only one quality data code (QDC) (or equivalent) per date of procedure for each patient is required.