Percentage of final reports for screening mammograms that are classified as “probably benign”
This measure is to be submitted each time a screening mammogram is performed during the performance period. It is anticipated that eligible clinicians who provide the professional component of diagnostic imaging studies for screening mammograms will submit this measure.
NOTE: No notes for this Quality ID
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.
Final reports classified as “probably benign”
INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.
A lower percentage, with a definitional target approaching 0%, indicates appropriate assessment of screening mammograms.
The mammogram assessment category (corresponding CPT Category II 33xxF code for assessment categories”) to be submitted is the final assessment for the screening mammographic study. If a diagnostic mammographic study follows the screening exam, the assessment category for the screening exam should be submitted with the corresponding CPT Category II code, i.e. 3340F for Mammogram assessment category of “incomplete: need additional imaging evaluation,” documented. Of note, the performance tags indicating ‘Performance Met’ and ‘Performance Not Met’ are included to highlight what is being measured and submitted and not to encourage the use and documentation of “probably benign”.
“Probably Benign” Classification – Mammography Quality Standards Act (MQSA) assessment category of “probably benign”; Breast Imaging-Reporting and Data System (BI-RADS®) category 3; or Food and Drug Administration (FDA)-approved equivalent assessment category
Numerator Quality-Data Coding Options
Performance Met: CPT II 3343F:
Mammogram Assessment Category of “Probably Benign” Documented
Mammogram assessment category of “probably benign,” documented
Mammogram Assessment Category Other than “Probably Benign” Documented
Performance Not Met: CPT II 3340F:
Mammogram assessment category of “incomplete: need additional imaging evaluation,” documented
Performance Not Met: CPT II 3341F:
Mammogram assessment category of “negative,”documented
Performance Not Met: CPT II 3342F:
Mammogram assessment category of “benign,”documented
Performance Not Met: CPT II 3344F:
Mammogram assessment category of “suspicious,”documented
Performance Not Met: CPT II 3345F:
Mammogram assessment category “highly suggestive of malignancy,” documented
Performance Not Met: CPT II 3350F:
Mammogram assessment category of “known biopsy proven malignancy,” documented
NUMERATOR NOTE: Denominator Exception(s) are determined at the time of the denominator eligible encounter during the current flu season.
All final reports for screening mammograms
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These non-covered services will not be counted in the denominator population for claims-based measures.
Eligible cases are determined and must be reported, if either of the following conditions
Option 1 – Denominator Criteria (Eligible Cases):
Diagnosis for screening mammogram (ICD-10-CM): Z12.31
Patient procedure during the performance period (CPT or HCPCS): 7706