October is Breast Cancer Awareness Month, and we would like to highlight the importance of breast cancer screening.
According to Susan G. Komen, in 2023, it’s estimated that among women in the U.S., there will be 297,790 new cases of invasive breast cancer; this includes new cases of primary breast cancer. Despite these numbers and the fact that breast cancer is the most common cancer among women in the U.S., since 2000, there has been a slight decline in screening mammography rates.
In 2021, 64% of women in the U.S. ages 45 and older had a mammogram in the past year, and only 76% of women ages 50-74 had one in the past two years.
It is proven that early detection and treatment have contributed to a 43% decline in the breast cancer death rate in the U.S. between 1989 and 2020.
Below, you will find details about the Breast Cancer Screening HEDIS performance measure:
Who should be screened?
Women, 50-74 years of age1
When should it be completed?
October 1, 2021, through December 31, 2023
More frequent screenings should occur for members at a higher risk of developing breast cancer.
The HEDIS requirement is a minimum expectation.
What are the documentation requirements?
| Member Reported Information | Mammography Report |
|---|---|
| The date of service and procedure name must be documented in the member’s medical history in the medical record | A copy of the report must be uploaded into the member’s legal health record |
Which codes can I use to document?
| Definition | Codes | Code System |
|---|---|---|
| Mammography | 77061-77063, 77065-77067 | CPT |
| Acquired absence of bilateral breasts and nipples | Z90.13 | ICD10 |
| Acquired absence of left breast and nipple | Z90.12 | ICD10 |
| Acquired absence of right breast and nipple | Z90.11 | ICD10 |
Hospice or palliative care at any point during the year excludes the member from participation.
| Definition | Codes | Code System |
|---|---|---|
| Hospice Care | 99377, 99378 | CPT |
| Hospice Care | G0182 | HCPCS |
| Palliative Care | G9054, M1017 | HCPCS |
CCA is dedicated to providing all the tools necessary for providers to meet performance measurement goals successfully. To support this, CCA maintains reference guides on our Provider Portal.
Our Quality Documentation Reference Guides provide examples of documentation standards that can be easily incorporated into any workflow process:
**UPDATE** We will update our guides this Fall to include all pertinent codes and references to bring our network providers the most up-to-date and relevant Quality guidance available!
Prevention and Screening Quality Documentation Reference Guide
Cardiovascular Conditions and Diabetes Quality Documentation Reference Guide
Care Coordination and Access Availability Quality Documentation Reference Guide
Musculoskeletal Conditions Quality Documentation Reference Guide
Behavioral Health Quality Documentation Reference Guide
MassHealth Quality Documentation Reference Guide
We look forward to your continued collaboration and engagement in our pursuit of delivering exceptional healthcare experiences. Thank you for your ongoing commitment to excellence.
Warm regards,
The Quality Department at Commonwealth Care Alliance
1NCQA is considering reducing the age to 40-74, to align with the U.S. Preventive Services Task Force and other national guideline organizations