Mount Carmel Health Partners HEDIS Tip Sheets - Page 11

HEDIS Tip Sheet Breast Cancer Screening Definition: Women 50 to 74 years old who have had a mammogram. Service Needed Mammogram between October 1 two years before the measurement year and December 31 of the measurement year. Coding: CPT 4 HCPCS Revenue 77055 - 77057 77061 - 77063 77065 - 77067 G0202 G0204 G0206 0401 0403 Exclusions: • Bilateral mastectomy. • Hospice care in the measurement year. Chart Review Tips: • Mammograms are usually in the "Radiology" section of the medical record. • Types of mammograms: screening, diagnostic, film, digital, or digital breast tomosynthesis. • Women need to have a mammogram every 2 years. • If the patient has had a unilateral mastectomy, the patient still needs a mammogram on the remaining side. • Review progress notes and correspondence for history of a mastectomy. Member Outreach Tips: • Ask the patient if she has had a bilateral mastectomy or recent mammogram before reminding her that she is due for a screening. • If the patient has had a bilateral mastectomy, please note it for future reference. • If the patient is due to have another mammogram within the next 1-2 months, call to remind her to schedule one soon. • Patients may request an appointment for their mammogram with a physician order by visiting. or calling 614-234-7400. Supplemental Data Tips • A copy of the actual mammogram must be in the chart to close the care gap. Self-reported data does not count. • Avoid biopsies, breast ultrasounds and MRIs' results due to these are not appropriate methods for primary breast cancer screening. 11