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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
112 2372 Process Yes Effective Clinical Care Claims

Measure Description

Percentage of women 50 – 74 years of age who had a mammogram to screen for breast cancer

Instructions

This measure is to be submitted a minimum of once per performance period for female patients seen during the performance period. There is no diagnosis associated with this measure. The patient should either be screened for breast cancer on the date of service OR there should be documentation that the patient was screened for breast cancer at least once within 27 months prior to the end of the performance period. Performance for this measure is not limited to the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on services provided and the measure-specific denominator coding.

NOTE: No notes for this Quality ID

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Women with one or more mammograms during the measurement period or the 15 months prior to the measurement period

Numerator Instructions:

Data not available

Numerator Quality-Data Coding Options

Denominator Exclusion: G9708:

Mammogram not Performed, Patient not Eligible

Women who had a bilateral mastectomy or whohave a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy

Denominator Exclusion: G9709:

Patient receiving Hospice Services, Patient Not Eligible

Hospice services used by patient any time during the measurement period

Denominator Exclusion: G9898:

Patient age 65 or older in Institutional Special Needs Plans (SNP) or residing in long-term care
facility, Patient Not Eligible

Patients age 65 or older in Institutional (Special Needs Plans) SNP or residing in long term care with POS code 32, 33, 34, 35 or 56 any time during the measurement period

Performance Met: G9899:
Mammogram Performed

Screening, diagnostic, film, digital or digital breast tomosynthesis (3D) mammography results documented and reviewed

Performance Not Met: G9900:
Mammogram not Performed, Reason not Otherwise Specified

Submit code G9900 to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Screening, diagnostic, film, digital or digital breast tomosynthesis (3D) mammography results were not documented and reviewed, reason not otherwise specified

NUMERATOR NOTE:

Data not available

Denominator

Women 51 – 74 years of age with a visit during the measurement period

DENOMINATOR NOTE:   The intent of the measure is that starting at age 50 women should have one or more mammograms every 24 months with a 3 month grace period. The intent of the exclusion for individuals age 65 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusions allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients 51 to 74 years of age on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

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