NQF 0031: Breast Cancer Screening

Measure: Record percentage of women 40-69 years of age who had a Mammogram to screen for Breast Cancer.
Numerator: Patients who meet the denominator criteria with one or more Mammograms during the measurement period or the year prior to the measurement period.
Denominator: All women 41–69 years of age with a visit during the measurement period and do not meet one or more of the exclusions.
Exclusion: Women who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies.
NQS Domain: Clinical Process / Effectiveness

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the female patient (age 41-69) at least one time during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominator*:

• Office Visit Encounter or Face-to-Face Interaction Code during the measurement period
Office Visit Encounter Codes:
CPT: 
CodeDescription
99201Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99203Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99205Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99341Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99342Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99343Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99344Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99345Home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Typically, 75 minutes are spent face-to-face with the patient and/or family.
99347Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99385Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
99386Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
99387Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
99397Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
G0438ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT
G0439ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT
Face-to-Face Interaction Codes:
SNOMED: 
CodeDescription
4525004Emergency department patient visit (procedure)
12843005Subsequent hospital visit by physician (procedure)
18170008Subsequent nursing facility visit (procedure)
19681004Nursing evaluation of patient and report (procedure)
87790002Follow-up inpatient consultation visit (procedure)
90526000Initial evaluation and management of healthy individual (procedure)
185349003Encounter for "check-up" (procedure)
185463005Visit out of hours (procedure)
185465003Weekend visit (procedure)
207195004History and physical examination with evaluation and management of nursing facility patient (procedure)
270427003Patient-initiated encounter (procedure)
270430005Provider-initiated encounter (procedure)
308335008Patient encounter procedure (procedure)
390906007Follow-up encounter (procedure)
406547006Urgent follow-up (procedure)
439708006Home visit (procedure)

Required Data Elements for the Numerator*:

• Mammogram (LOINC or CPT) Code during the measurement period or within 12 months prior to the start
CPT:  
Code Description
G0202 Screening mammography, producing direct digital image, bilateral, all views
G0206 Diagnostic mammography, producing direct digital image, unilateral, all views
G0204 Diagnostic mammography, producing direct digital image, bilateral, all views
LOINC:  
Code Description
24604-1 Breast Mammogram diagnostic limited
26175-0 Breast - bilateral Mammogram screening
26176-8 Breast - left Mammogram screening
26177-6 Breast - right Mammogram screening
26287-3 Breast - bilateral Mammogram limited
26289-9 Breast - left Mammogram limited
26291-5 Breast - right Mammogram limited
26346-7 Breast - bilateral Mammogram diagnostic
26347-5 Breast - left Mammogram diagnostic
26348-3 Breast - right Mammogram diagnostic
26349-1 Breast - bilateral Mammogram diagnostic limited
26350-9 Breast - left Mammogram diagnostic limited
26351-7 Breast - right Mammogram diagnostic limited
36319-2 Breast Mammogram 4 views
36625-2 Breast Mammogram
36626-0 Breast - bilateral Mammogram
36627-8 Breast - left Mammogram
36642-7 Breast - left Mammogram 2 views
36962-9 Breast Mammogram axillary
37005-6 Breast - left Mammogram magnification
37006-4 Breast - bilateral Mammogram MLO
37016-3 Breast - bilateral Mammogram roll
37017-1 Breast - left Mammogram roll
37028-8 Breast Mammogram tangential
37029-6 Breast - bilateral Mammogram tangential
37030-4 Breast - left Mammogram tangential
37037-9 Breast Mammogram true lateral
37038-7 Breast - bilateral Mammogram true lateral
37052-8 Breast - bilateral Mammogram XCCL
37053-6 Breast - left Mammogram XCCL
37539-4 Breast Mammogram grid
37542-8 Breast Mammogram magnification
37543-6 Breast - bilateral Mammogram magnification
37551-9 Breast Mammogram spot
37552-7 Breast - bilateral Mammogram spot
37553-5 Breast - left Mammogram spot compression
37554-3 Breast - bilateral Mammogram magnification and spot
37768-9 Breast - right Mammogram 2 views
37769-7 Breast - right Mammogram magnification and spot
37770-5 Breast - right Mammogram tangential
37771-3 Breast - right Mammogram true lateral
37772-1 Breast - right Mammogram XCCL
37773-9 Breast - right Mammogram magnification
37774-7 Breast - right Mammogram
37775-4 Breast - right Mammogram roll
38067-5 Breast - bilateral Mammogram nipple profile
38070-9 Breast implant Mammogram
38071-7 Breast implant - bilateral Mammogram
38072-5 Breast implant - left Mammogram
38090-7 Breast - bilateral Mammogram W air
38091-5 Breast - left Mammogram W air
38807-4 Breast - right Mammogram spot
38820-7 Breast implant - right Mammogram
38854-6 Breast - left Mammogram magnification and spot
38855-3 Breast - left Mammogram true lateral
39150-8 Breast FFD mammogram Post Localization
39152-4 Breast FFD mammogram diagnostic
38855-3 Breast - left Mammogram true lateral
39150-8 Breast FFD mammogram Post Localization
39152-4 Breast FFD mammogram diagnostic
39153-2 Breast FFD mammogram screening
39154-0 Breast - bilateral FFD mammogram diagnostic
42168-5 Breast - right FFD mammogram diagnostic
42169-3 Breast - left FFD mammogram diagnostic
42174-3 Breast - bilateral FFD mammogram screening
42415-0 Breast - bilateral Mammogram Post Wire Placement
42416-8 Breast - left Mammogram Post Wire Placement
46335-6 Breast - bilateral Mammogram Single view
46336-4 Breast - left Mammogram Single view
46337-2 Breast - right Mammogram Single view
46338-0 Breast - unilateral Mammogram Single view
46339-8 Breast - unilateral Mammogram
46342-2 Breast FFD mammogram
46350-5 Breast - unilateral Mammogram diagnostic
46351-3 Breast implant - bilateral Mammogram displacement
46354-7 Breast - right FFD mammogram screening
46355-4 Breast - left FFD mammogram screening
46356-2 Breast - unilateral Mammogram screening
46380-2 Breast Implant - unilateral Mammogram
48475-8 Breast implant - bilateral Mammogram diagnostic
48492-3 Breast implant - bilateral Mammogram screening
69150-1 Breast implant - left Mammogram diagnostic
69251-7 Breast Mammogram Post Wire Placement
69259-0 Breast implant - right Mammogram diagnostic

EXCLUSION DETAILS:

Exclusions include women who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomies.  In order to meet the requirements for the exclusion, the appropriate information must be documented in the chart:

One of the following:

• One Bilateral Mastectomy Code entered in Surgical History
SNOMED: 
CodeDescription
14693006Bilateral subcutaneous mammectomy (procedure)
14714006Bilateral mastectomy with excision of bilateral regional lymph nodes (procedure)
17086001Modified radical mastectomy, bilateral (procedure)
22418005Bilateral simple mastectomy (procedure)
27865001Bilateral mastectomy (procedure)
52314009Bilateral mastectomy extended simple (procedure)
60633004Bilateral subcutaneous mammectomy with synchronous implant (procedure)
76468001Bilateral radical mastectomy (procedure)
• TWO Unilateral Mastectomy (CPT) Codes OR TWO SNOMED Codes entered in Surgical History
SNOMED: 
CodeDescription
19180Mastectomy, simple, complete
19200Mastectomy, radical, including pectoral muscles, axillary lymph nodes
19220Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)
19240Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle
19303Mastectomy, simple, complete
19304Mastectomy, subcutaneous
19305Mastectomy, radical, including pectoral muscles, axillary lymph nodes
19306Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)
19307Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle
8115005Unilateral radical mastectomy (situation)
22964006Unilateral simple mastectomy (situation)
59620004Mastectomy for gynecomastia (procedure)
66398006Mastectomy with excision of regional lymph nodes (procedure)
70183006Subcutaneous mastectomy (procedure)
72269009Unilateral modified radical mastectomy (situation)
73359007Unilateral mastectomy (situation)
88764002Unilateral extended simple mastectomy (situation)
172043006Simple mastectomy (procedure)
172044000Subcutaneous mastectomy for gynecomastia (procedure)
237367009Total mastectomy and division of pectoralis minor muscle (procedure)
237368004Total mastectomy and excision of part of pectoral muscles and chest wall (procedure)
274957008Radical mastectomy including axillary lymph nodes (procedure)
287653007Subcutaneous mastectomy and prosthetic implant (procedure)
287654001Extended simple mastectomy (procedure)
317230007Unilateral subcutaneous mastectomy with synchronous implant (situation)
318190001Mastectomy with preservation of skin and nipple with synchronous implant (procedure)
359728003Radical mastectomy including pectoral muscles and axillary lymph nodes (procedure)
359731002Urban operation, extended radical mastectomy (procedure)
359734005Halsted mastectomy (procedure)
359740003Extended radical mastectomy (procedure)
384723003Radical mastectomy (procedure)
395702000Patey total mastectomy (procedure)
406505007Modified radical mastectomy (procedure)
428564008Skin sparing mastectomy (procedure)
428571003Mastectomy of left breast (procedure)
429400009Mastectomy of right breast (procedure)
446109005Simple mastectomy with excision of axillary lymph nodes (procedure)
446420001Simple mastectomy with complete axillary lymphadenectomy (procedure)
447135002Simple mastectomy with axillary lymph node sampling (procedure)
447421006Prophylactic mastectomy (procedure)

SurgicalHx_SNOMED_Mastectomy

*ADDITIONAL INFORMATION:

•  The female patient must be 41 and older or younger than 69 before the start of the measurement period.

•  It is recommend to include the code used to document the mammogram in a health maintenance/preventive care procedure checklist.

Example of a Health Maintenance Procedure Checklist

health maintenance

•   If using the LOINC code for the Mammogram preformed, it must be linked to a result and must contain the date that the Mammogram was done in the procedure order date.  If a result does not exist, a fake procedure code can be added via Practice Manager and then marked as a result and linked the the appropriate LOINC Code in Clinical.

•   The LOINC code should NOT be linked to the code used to order the Mammogram. 

Example of optional LOINC setup for Mammogram

mammogram loinc

•  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

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