| eCQM / NQF #: | CMS125v7 /2372 |
| Measure: | Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer |
| Numerator: | Women with one or more mammograms during the measurement period or the 15 months prior to the measurement period |
| Denominator: | Women 51-74 years of age with a visit during the measurement period |
| Denominator Exclusion: | Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy. Exclude patients who were in hospice care during the measurement year. |
| Domain: | Effective Clinical Care |
In ChartMaker Clinical:
In order to qualify for this measure, the provider must have seen the female patient (age 51-74) 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, Face-to-Face Interaction (SNOMED), Preventive Care Service, Home Healthcare Service or Annual Wellness Visit during the measurement period
Expand
Office Visit Encounter Codes:
| CPT: | |
| Code | Description |
| 99201 | Office 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. |
| 99202 | Office 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. |
| 99203 | Office 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. |
| 99204 | Office 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. |
| 99205 | Office 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. |
| 99212 | Office 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. |
| 99213 | Office 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. |
| 99214 | Office 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. |
| 99215 | Office 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. |
| 99341 | Home 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. |
| 99342 | Home 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. |
| 99343 | Home 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. |
| 99344 | Home 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. |
| 99345 | Home 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. |
| 99347 | Home 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. |
| 99348 | Home 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. |
| 99349 | Home 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. |
| 99350 | Home 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. |
| 99385 | Initial 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 |
| 99386 | Initial 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 |
| 99387 | Initial 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 |
| 99395 | Periodic 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 |
| 99396 | Periodic 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 |
| 99397 | Periodic 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 |
| G0438 | ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT |
| G0439 | ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT |
Face-to-Face Interaction Codes:
| SNOMED: | |
| Code | Description |
| 12843005 | Subsequent hospital visit by physician (procedure) |
| 18170008 | Subsequent nursing facility visit (procedure) |
| 19681004 | Nursing evaluation of patient and report (procedure) |
| 87790002 | Follow-up inpatient consultation visit (procedure) |
| 90526000 | Initial evaluation and management of healthy individual (procedure) |
| 185349003 | Encounter for "check-up" (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185465003 | Weekend visit (procedure) |
| 207195004 | History and physical examination with evaluation and management of nursing facility patient (procedure) |
| 270427003 | Patient-initiated encounter (procedure) |
| 270430005 | Provider-initiated encounter (procedure) |
| 308335008 | Patient encounter procedure (procedure) |
| 390906007 | Follow-up encounter (procedure) |
| 406547006 | Urgent follow-up (procedure) |
| 439708006 | Home visit (procedure) |
| 185463005 | Visit out of hours (procedure) |
| 185464004 | Out of hours visit - not night visit (procedure) |
| 185465003 | Weekend visit (procedure) |
| 30346009 | Evaluation and management of established outpatient in office or other outpatient facility (procedure) |
| 3391000175108 | Office visit for pediatric care and assessment (procedure) |
| 37894004 | Evaluation and management of new outpatient in office or other outpatient facility (procedure) |
| 439740005 | Postoperative follow-up visit (procedure) |
| 185460008 | Home visit request by patient (procedure) |
| 185462000 | Home visit request by relative (procedure) |
| 185466002 | Home visit for urgent condition (procedure) |
| 185467006 | Home visit for acute condition (procedure) |
| 185468001 | Home visit for chronic condition (procedure) |
| 185470005 | Home visit elderly assessment (procedure) |
| 225929007 | Joint home visit (procedure) |
| 315205008 | Bank holiday home visit (procedure) |
| 439708006 | Home visit (procedure) |
| 698704008 | Home visit for rheumatology service (procedure) |
| 704126008 | Home visit for anticoagulant drug monitoring (procedure) |
Required Data Elements for the Numerator:
• Mammogram (LOINC or CPT) Code during the measurement period or within 15 months prior to the start of the measurement period
Expand
| 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 OR were in hospice care during the measurement period. In order to meet the requirements for the exclusion, the appropriate information must be documented in the chart:
One of the following:
| 14693006 | Bilateral subcutaneous mammectomy (procedure) |
| 14714006 | Bilateral mastectomy with excision of bilateral regional lymph nodes (procedure) |
| 17086001 | Modified radical mastectomy, bilateral (procedure) |
| 22418005 | Bilateral simple mastectomy (procedure) |
| 27865001 | Bilateral mastectomy (procedure) |
| 456903003 | Bilateral extended radical mastectomy (procedure) |
| 52314009 | Bilateral mastectomy extended simple (procedure) |
| 60633004 | Bilateral subcutaneous mammectomy with synchronous implant (procedure) |
| 726636007 | Prophylactic bilateral mastectomy (procedure) |
| 76468001 | Bilateral radical mastectomy (procedure) |
| 12275171000119105 | Postmastectomy lymphedema syndrome of right upper limb (disorder) |
| 12275221000119100 | Postmastectomy lymphedema syndrome of left upper limb (disorder) |
| 172043006 | Simple mastectomy (procedure) |
| 19180 | Mastectomy, simple, complete |
| 19200 | Mastectomy, radical, including pectoral muscles, axillary lymph nodes |
| 19220 | Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) |
| 19240 | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle |
| 19303 | Mastectomy, simple, complete |
| 19304 | Mastectomy, subcutaneous |
| 19305 | Mastectomy, radical, including pectoral muscles, axillary lymph nodes |
| 19306 | Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) |
| 19307 | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle |
| 237367009 | Total mastectomy and division of pectoralis minor muscle (procedure) |
| 237368004 | Total mastectomy and excision of part of pectoral muscles and chest wall (procedure) |
| 237385002 | Excision of mastectomy scar (procedure) |
| 237388000 | Biopsy of mastectomy scar (procedure) |
| 274957008 | Radical mastectomy including axillary lymph nodes (procedure) |
| 287653007 | Subcutaneous mastectomy and prosthetic implant (procedure) |
| 287654001 | Extended simple mastectomy (procedure) |
| 303690008 | Excisional biopsy of mastectomy scar (procedure) |
| 307995002 | Excision of lesion of mastectomy scar (procedure) |
| 318190001 | Mastectomy with preservation of skin and nipple with synchronous implant (procedure) |
| 33129002 | Postmastectomy lymphedema syndrome (disorder) |
| 359728003 | Radical mastectomy including pectoral muscles and axillary lymph nodes (procedure) |
| 359731002 | Urban operation, extended radical mastectomy (procedure) |
| 359734005 | Halsted mastectomy (procedure) |
| 359740003 | Extended radical mastectomy (procedure) |
| 384723003 | Radical mastectomy (procedure) |
| 395702000 | Patey total mastectomy (procedure) |
| 406505007 | Modified radical mastectomy (procedure) |
| 428564008 | Skin sparing mastectomy (procedure) |
| 428571003 | Mastectomy of left breast (procedure) |
| 429400009 | Mastectomy of right breast (procedure) |
| 446109005 | Simple mastectomy with excision of axillary lymph nodes (procedure) |
| 446420001 | Simple mastectomy with complete axillary lymphadenectomy (procedure) |
| 447135002 | Simple mastectomy with axillary lymph node sampling (procedure) |
| 447421006 | Prophylactic mastectomy (procedure) |
| 451201000124106 | Prophylactic mastectomy of right breast (procedure) |
| 451211000124109 | Prophylactic mastectomy of left breast (procedure) |
| 66398006 | Mastectomy with excision of regional lymph nodes (procedure) |
| 70183006 | Subcutaneous mastectomy (procedure) |
| 714111001 | Post-mastectomy breast deformity (disorder) |
| 714252004 | Post-mastectomy chronic pain syndrome (disorder) |
| 726429001 | Radical mastectomy of left breast (procedure) |
| 726430006 | Radical mastectomy of right breast (procedure) |
| 726434002 | Subcutaneous mastectomy of right breast (procedure) |
| 726435001 | Subcutaneous mastectomy of left breast (procedure) |
| 726436000 | Modified radical mastectomy of right breast (procedure) |
| 726437009 | Modified radical mastectomy of left breast (procedure) |
To document this one of the following must be taken:
Option 1: Inpatient Code and Hospice Discharge Code documented together
Inpatient Encounter Code
- 183452005: Emergency hospital admission (procedure)
- 32485007: Hospital admission (procedure)
- 8715000: Hospital admission, elective (procedure)
AND
Hospice Care Discharge Status SNOMED (one of the following):
- 428371000124100: Discharged to Health Care Facility for Hospice Care
- 428361000124107: Discharged to Home for Hospice Care
Option #2 - Hospice care ambulatory code ORDERED and PERFORMED:
Intervention, Order and Performed: Hospice care ambulatory
-
385763009: Hospice care (regime/therapy)
-
385765002: Hospice care management (procedure)
ADDITIONAL INFORMATION:
• The female patient must be 51 and older or younger than 74 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.
• 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.
• 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.