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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
225 0509 Structure Yes Communication and Care Coordination Registry

Measure Description

Percentage of patients undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram

Instructions

This measure is to be submitted each time a screening mammogram is performed during the performance period for patients seen during the performance period. This measure is intended to reflect the quality of services provided for reminding patients when follow-up mammograms are due.

NOTE: No note related

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

Patients whose information is entered into a reminder system with a target due date for the next mammogram

Definition

Numerator Instructions: The reminder system should be linked to a process for notifying patients when their next mammogram is due and should include the following elements at a minimum: patient identifier, patient contact information, dates(s) of prior screening mammogram(s) (if known), and the target due date for the next mammogram. Use of the reminder system is not required to be documented within the final report to meet performance for this measure.

Numerator Quality-Data Coding Options

Denominator Exception: 7025F with 1P:
Patient Information not Entered into a Reminder System for Medical Reasons:

Append a submission modifier (1P) to CPT Category II code 7025F to submit circumstances when the action
described in the numerator is not performed for medical reasons.

Documentation of medical reason(s) for not entering patient information into a reminder system (e.g., further screening mammograms are not indicated, such as patients with a limited life expectancy, other medical reason(s))

Performance Met: CPT II 7025F:
Patient Information Entered into a Reminder System with Target Due Date for the Next Mammogram

Patient information entered into a reminder system with a target due date for the next mammogram

Performance Not Met: 7025F with 8P:
Patient Information not Entered into a Reminder System, Reason not Otherwise Specified

Append a submission modifier (8P) to CPT Category II code 7025F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Patient Information not entered into a reminder system, reason not otherwise specified

Numerator Note: No data available

Denominator

All patients undergoing a screening mammogram

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):

All patients, regardless of age

AND

Diagnosis for mammogram screening (ICD-10-CM): Z12.31

 

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